Lyme disease: It got me and it's coming for you next!

As of 2017, Lyme disease prevalence is on the rise. And in the summer of 2017, thanks to being bitten by a tick infected with the Lyme bacteria (Borrelia burgdorferi), the disease was prevailing in my bloodstream. And organs. And muscles. And a bunch of other places that you don’t want bacteria hanging out. This article reviews the infectious process, diagnosis, and recovery that I experienced just a few short months ago.

First, here’s a couple not-so-fun facts: According to the Centers for Disease Control, Lyme is the most common vectorborne illness in the United States. In 2016, about 300,000 people were diagnosed with Lyme disease in the US and that number is expected to rise.

If you want to be frightened, watch the rapid progression of the reported Lyme cases move westward from the east coast as you click through the annual maps on the CDC website (https://www.cdc.gov/Lyme/stats/). When I wandered the woods for hours as a child, my parents and I didn’t have to worry about Lyme. We rarely even saw ticks. In the early 2000s, there weren’t many reported cases of Lyme disease in this (western PA and northern WV) region. But by 2015, the same region of the map is heavily covered in cases. I always wanted to be a dot on a CDC map!

My clouded confusion begins

I find ticks on myself every year - after mowing, after weed trimming, after running. I’ve always made it a point to pluck them off ASAP. One must have gone under the radar. If my recollection of the earliest symptoms is accurate, there was initially a period of at least 2-3 weeks in late May to early June where my blood pressure wouldn’t regulate very well, especially if I was feeling the least bit stressed. (Perfect timing for having recently started a business!) This was always worse in the morning. Hopefully few of my patients noticed me awkwardly grabbing the furniture and equipment, but I began to feel a need to cling to nearby objects just in case I would start to crash. My blood pressure would fluctuate noticeably even while simply standing still, which means I was becoming lightheaded several times a day (though I never had true syncope (loss of consciousness)). Being a longtime endurance athlete, my heart rate and blood pressure are low anyhow, so I’m accustomed to occasional positional blood pressure fluctuations. But this seemed more annoying because it was multiple times a day and sometimes took longer to return to baseline. This symptom was sometimes intense but sometimes just a hint. It also had less to do with my hydration level like it normally would after a hotter or harder workout. Overall, it was minor compared to the other symptoms that would follow...

So tiny. So evil. 

So tiny. So evil. 

More infectious

I began to demonstrate significant symptoms of Lyme disease in the middle of June. But, of course, I didn’t know it was Lyme at the time and did not make a connection. That’s because these symptoms, like fatigue, are still not specific to the disease, just consistent with many viral or bacterial infections.

With a new baby around, I was sleeping less. He had a runny nose and recently started daycare so it would be reasonable to expect that I had just picked up an ordinary bug. Plus, I had just come off a harder run training block to prepare for an ultramarathon, so I thought initially that my body was just a tad more susceptible. This is one reason why some athletes will mistake Lyme symptoms for overtraining.

One Sunday evening, I developed a fever. This was accompanied with the worst night sweats I’ve ever experienced. The fever and sweats continued for the next three days, gradually worsening toward evening, which is common to any ongoing infection. The level of fatigue and demotivation was impressive, beyond typical flu levels in intensity and duration. With my 40-mile race looming, my wife gently (forcefully!) nudged me into an ER visit despite gradual daily improvement in the fever because I was also having a new and simultaneous lower abdominal pain (which I eventually realized was a referred pain from my thigh adductor tendons, but that’s another story). No surprise that they told me I had an infection. And elevated creatine kinase levels in my blood tests. Drink lots of water!

I thought I recovered through this initial phase by the following weekend because the fever seemed to have mostly resolved and the night sweats had slacked off. That was the weekend I ran the gorgeous Highlands Sky ultramarathon, albeit at a much slower pace than I would normally because it was obvious I wasn’t at 100% health yet. It seemed strange that I became very sore partway through the run even though I was running easier than I ever normally compete and I had rested much of the week. Then my quadriceps stayed sore at points deeper in the muscles for many more days after running than they typically would. This is unfortunately still very similar to overtraining symptoms.

running slower in the race let me take a couple of nice photos

running slower in the race let me take a couple of nice photos

Recovery?

After resting for a week, as I always do after a long race, I tried to return to my typical training with some easy running. That went well enough and the muscle soreness had resolved. Then I had a bright idea to take back a couple of Strava KOMs/course records on a local trail (because I hadn’t actually raced hard in the ultra) and I expected that it should be safe to push a little effort.

I really was finally feeling good. Good enough to push. I ran the two hill climb intervals very hard that day and took the Strava segment crowns back. Great. Whoopee. No one cares except for the guy who lost the KOM. But it became apparent after that hard effort that my heart rate was not dropping back to typical levels as rapidly as it typically would.

Cardiovascular consequences

As July began, I noticed my heart rate was still not coming back down to my normal resting levels immediately after running or when waking up in the morning. And I would sometimes feel my heart beating with ridiculous force at rest and while exercising. So I made it a point to avoid pushing the effort, thinking I just wasn’t yet recovered from the combined race, baby stress, business stress, and illness. That was partly correct. Again, I had the same fever and night sweats and fatigue. I stopped running and just started slowly hiking every couple days for only brief periods because I would feel my blood pressure swing wildly with effort.

The heart rate issues would appear to resolve with a day of rest, so I was able to resume running slowly again by the end of the week though it was still abnormally tiring. I’m sure a small part of that was related to our high July heat and humidity, but a 12-minute mile had never felt that hard before.

As each run passed, I caught onto the trend that my normal cardiac function was off drastically enough that my Garmin Fenix 3 repeatedly detected that my “performance condition” was constantly in negative figures. It’s crazy that the watch could detect such a difference with great consistency. This might normally happen for a day or two after a hard effort but not for every run over multiple weeks consecutively.

Another not-so-fun fact: there’s a little something called Lyme pericarditis, which is an inflammation of the pericardial sac that surrounds the heart. And the Lyme bacteria can invade the nerves that supply the heart, leading to issues like atrioventricular block. Suffice it to say, the nerves don’t function normally after that and can contribute to those blood pressure swings.

Respiratory weirdness

It was a strange and alarming experience when I realized that I couldn’t quite take a full deep inspiration or achieve full expiration at rest or with exercise. It felt like my stomach was constantly trying to occupy the space where my lungs must normally reside. A “belly breath” wasn’t happening, which stinks because that’s always been a reliable technique to help me relax or to flush out the sensation of going anaerobic while running. I first noticed this inability to breathe into my stomach during the ultramarathon and was glad to be going easier then because I don’t think I could have eaten and absorbed food in a normal manner otherwise.

Neurologic, muscular, and joint happenings

For weeks I had this ongoing sense of muscle tightness along my thoracic spine and it took very little effort to strain my low back one day with yard work. Much like the earlier run soreness, that strain caused a deep, sore muscle pain that lingered for a couple days longer than I would typically experience.

It was also odd that I would feel a little uncoordinated during my runs. Not-so-fun fact #1358: Along with the nerves of the heart, it’s not unusual that the bacteria invade other parts of the peripheral nervous system and can eventually make their way into the central nervous system, neither of which are going to help coordination. You can even lose your vision.

I felt weak. My attempt at returning to basic strength training in mid-July was rewarded with both wrist joints hurting and even more spine region tightness and pain. On other days my ankle joints took turns aching and at another point one of my knees became painful. It was strange that the various joint pains would come only for part of a single day and then quickly decide to move onto some other place to piss off. They were nothing like an acute pain I might traditionally feel for a day or two after overdoing any form of exercise. That makes me wonder if it wasn’t more of an infectious arthritis, which is also common to Lyme disease. Oh cool. What a not-so-fun fact.

By the middle of July sleep was not counteracting the fatigue. I was taking a nap nearly every day and I usually consider naps a giant waste of time. I don’t even nap with the flu.

Okay, I’ll get it checked out

With my wife’s encouragement, I went to an appointment with a general physician who began to do blood work like checking for low testosterone or thyroid dysfunction. Oh yeah, and they thought it would be good to check for a multitude of sexually transmitted diseases though there weren’t any questions asked on that front. Unfortunately, despite asking about the possibility of Lyme disease, no Lyme tests were performed. The physician didn’t feel it necessary because I had no recollection of a tick being attached to me for a lengthy period or having the classic bullseye rash. (So much for making a potential diagnosis based upon the patient’s subjective reports.)

Now that doesn’t mean I didn’t have a tick attach to me at any point recently, because I most certainly do recall having one attached to me at the end of a recent long run. I promptly removed it. I’m a little skeptical of the CDC reported 36-hour time frames necessary to transmit the bacteria from a tick into the host but perhaps I had an immature tick on my scalp and had no idea it was there. Or perhaps the attached tick regurgitated when I went to remove it.

It was around this time that I noticed the back of my head itching and having a rash for over a week, but maybe that was some kind of psychosomatic thing. Who knows. I don’t care because it stopped.

How many ticks can you count in this photo waiting to jump onto the passing warm blooded mammal?

How many ticks can you count in this photo waiting to jump onto the passing warm blooded mammal?

It just keeps getting better

To add to the symptom list, I developed a new problem: anxiety. Like take-your-breath away-because-your-chest-is-being-smashed-and-throat-squished anxiety. This was also worse in the morning. It lasted several days with varying intensities. Super favorite not-so-fun fact: It’s apparently not uncommon for people with Lyme disease to develop anxiety. I resisted the physician’s offer for medication because I’m too much of an arrogant “tough guy” and was hopeful we would be treating the real cause soon.

So while waiting on blood test results I began experimenting with a powerful drug. No, not the illicit kind, nothing prescribed, and not the over the counter kind either. I’m talking about the endogenously manufactured endorphin: adrenaline. You gotta try that stuff. This was really more of an experiment of exercise intensity but what I realized is that running hard into zone 5 could mimic the sensation of chest tightness and labored breathing that I might have in a competition but also what anxiety could produce. So I could actually make a run feel sorta “normal,” even though it clearly wasn’t. And the longer I would sustain a hard interval, the longer I would feel the weird blood pressure swings when the run ended. It did seem to reduce the anxiety intensity afterward though. I’m just smart enough to know I couldn’t and shouldn’t do this to myself during every run but it was an interesting observation. Perhaps one that I wouldn’t recommend if you suspect overtraining or Lyme disease. But it’s science!

My reward for seeking care

The physician calls me to let me know one of the blood tests came back with a positive finding. Apparently they think I have syphilis, because of a positive RPR test. The RPR (rapid plasma reagin) test is a non-specific test that looks for antibodies in the blood. This leads to a cascade of events. First off, now I’m a public health hazard so the medical clinic is required to report me to the Pennsylvania Health Department, without contacting me first, mind you. Kind of annoying. Then a health department nurse calls to counsel me on how avoid transmission of my STD. Fortunately, the nurse had time to chat. She understood, with some encouragement, that there’s a handful of other microscopic creatures, besides syphilis, that cause a positive RPR test, one of which is Lyme bacteria. She contacted the medical clinic and suggested that they test me for Lyme. By the way, I had no other syphilis signs or symptoms and my wife just gave birth to a perfectly healthy child less than three months ago. Congenital syphilis causes a huge number of birth defects and death in newborns. And I guess we’ll ignore our simultaneously healthy four year old because I’ve been playing the field for years now?

Increasingly irritated, I went back to the clinic that day, gave more blood and, wouldn’t you know it, the Lyme tests turned up positive a few days later. The CDC encourages testing for Lyme be done in two tiers. If the first tier tests (EIA or ELISA) are positive then a Western blot test should be confirmatory. The first tier tests could also be positive with syphilis.

Die Borrelia burgdorferi, die!

I spoke with the physician on the phone and (being a smartass) told her I’ve had more ticks on me so far this year than total sexual partners in my lifetime so statistically the Lyme disease wins. She prescribed doxycycline two times per day. As much as I hated to take an antibiotic, within a couple days the chronic fatigue began lifting and I felt noticeably better. Having been ill for so long, it was at this point that I realized how I had really been functioning almost as another person inside the same shell. Weird. Then I grew wings and flew away to Mars.

A few weeks later

I had finished up the antibiotic and fortunately none of the Lyme symptoms returned. For a couple weeks I did still have remnants of burns on my hands and fingers from taking doxycyline. For a person that tries to be outside nearly everyday of their life, increased sensitivity to sun exposure is an unfortunate side effect of this antibiotic. Did you catch that not-so-fun fact? Although, it was usually the sun exposure from mowing my yard during a two to three hour span that would lead to the burns. Is that a good reason to skip mowing? I could go run in the shade of the woods and not have issues.

An additional side effect of the medication was that part of my hands and fingers had a very frequent paresthesia (abnormal sensation). This occurred on both hands at all of the dorsal index and middle finger joints as well as the muscular part between the index finger and thumb. Those areas were extremely sensitive to hot water and were frequently reddened, almost as if I had a chemical burn. All of these side effects appeared around two weeks after starting the antibiotic and gradually worsened.

Noooooooo

Soon after I was feeling normal again, I encountered one of the smallest ticks I’ve ever seen. It had attached to my son’s back and I noticed it within an hour of him simply helping his mother in the garden for a few minutes. Even scarier when you know you have Lyme disease and you see your kid being bitten. It’s during this juvenile or nymph stage when ticks start to carry the Lyme bacteria. At about one-third adult size, they are much harder to spot and therefore more capable of infecting us. It’s amazing how quickly a tick can attach, too. In late summer I went for an hour run and by the time I made it back home there was an adult tick already attached to my lower leg.

Here’s a fun fact: Chickens and possums eat ticks. Now I just need an army of chickens and possums to trail run with me.

There's gotta be a tick in here Somewhere. 

There's gotta be a tick in here Somewhere. 

Remember kids

Lyme disease is a major disruptor of athletic performance and healthy living. It can make you quite miserable and can be mistaken for overtraining and other illnesses. You need to be aware of Lyme’s increasing occurrence and recognize that it may manifest in a number of the body’s structures and cause many different symptoms. It took much perseverance on my part to have the problem appropriately addressed medically. I’m sure the diagnostics have improved, and for that I am thankful because I had a relatively quick diagnosis compared to some people who might go for years feeling awful and ultimately have less chance of proper treatment.

Stay safe out there!

Disclaimer: Several ticks have been harmed since the original writing of this article.

Here’s a nice running-related article on protecting yourself from Lyme disease: http://trailrunnermag.com/training/injuries-and-treatment/dont-get-ticked.html

 

16 surefire ways to get and stay injured from running

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Nobody wants to be injured. Let’s review a few ways in the coming days that runners typically hurt themselves and maybe you won’t have to join that club.

  1. Chasing after specific mileages. Yes, for performance gains, you should have objective and defined goals. Certainly those can be related to mileage. But there’s more to healthy and successful running than miles per week. When a runner focuses too heavily on a certain mileage each week it doesn’t take into account many factors: the intensity of those miles, the terrain, the weather, the lack of sleep because you stayed up later than usual on a couple nights, the extra shift you picked up at work, your nutrition, and so on. You must account for all of the various types of stresses you have in order to stay healthy. Don’t be blinded by the numbers. Don’t get greedy. Improvement is a long and gradual process, and there is no equation or sum total of miles that leads to running nirvana. You can’t level up like it’s a video game after collecting mileage coins.

  2. Being unwilling to diverge from your cookie-cutter workout plan. How many times have you heard “listen to your body?” If you are sick or noticing the start of a slight niggle of an injury, don’t try to stubborn your way through while hoping the luck gods take pity on you. Weigh your options. Do you have more to gain or lose by completing three more of the Runner’s World website-prescribed 400 meter repeats on an aching calf? How much fitness would you really gain from that day of junk miles? When you are thrown a curveball it doesn’t mean you can’t get in a workout. It doesn’t mean your race in two weeks is now an impossibility. If you remain willing and ready to modify your plan at any time, it isn’t so traumatic to do so. You can become an exercise ninja, ready and able to adapt at any instant. That might mean cross training. It might mean rescheduling a hard day for a couple days later. It might mean taking a full rest day. It might mean completely ditching the plan you found doing a Google search.

  3. Doing the same thing over and over. Doing the same thing over and over. Doing the same thing over and over. Doing the same thing over and over. Isn’t that annoying? Guess what? Your body thinks it’s pretty annoying when you run the same pace and distances all the time on the same roads and same sidewalks. Is it that uncomfortable to do something different? Unlikely. But that protective part of your brain will tell you it is a problem to deviate. I don’t personally understand this - I hate running the exact same routes and intensities all the time - but I’m a weird trail runner and road runners don’t associate with us weirdos. The pavement pounders seem more reluctant to purposely and drastically switch things up. Yes, there is some good that comes from a consistent training stimulus because the frequent loads actually helps prevent injury. But that’s better off being an AEROBIC effort in most amateur runners, which means you have to run slowly. No, slower than that. (Thank you not-so-accurate online pace calculator for messing this up.) EVEN slower. More like trotting at times. Especially since we have these things called hills. What most runners do is train a bit too hard, too often, so it becomes a different stimulus. They sit just on the edge of discomfort, drifting past a high aerobic effort and into tempo pace, which is ANAEROBIC metabolism. That’s not something you should do for several runs in a week. You’ll get faster doing that, for a little while, but it’s not sustainable and eventually leads to every runner’s fear: a performance plateau. I’m giving you permission to not make every run hurt.

  4. Ignoring overall athleticism and strengthening. I’m going to keep harping on this one until at least the year 2025. If you have no variability in your movement, you are asking for trouble to occur at some point. If you aren’t strength training and doing something to improve and explore the way your body moves as an overall athlete, running itself will not keep you healthy for very long. It might take a few years, but the problems will come. The muscles and nervous system demand frequent challenge, or they gradually begin to lose optimal function. You won’t detect it at first, but it’s no great mystery of physiology that we start to lose strength beyond the age of 30. Running doesn’t keep anyone strong or powerful. (Though it’s certainly better than doing nothing.) Performing strength work even once per week is a potent stimulus if you work hard.

  5. Discounting the role of your routine posture and activities. I bet you thought about sitting up taller when you read the word POSTURE. Our daily lifestyle has more to do with getting injured than most people realize. One of the most common and detrimental issues I see in the clinic is that frequent sitting tightens the hip flexors on the front of the body. This keeps you from using the big gluteus maximus muscles that should produce a ton of force to propel a runner forward. So people begin to use the quads and hip flexors even more, the pendulum of the running stride shifts forward from its ideal location, and the cycle continues. It’s not as simple of a fix as just doing a couple hip strengthening items twice a week. The low back, neck, and thoracic regions are also areas that adapt negatively, thus shifting your body into an overall poor alignment. Mobility is lost. Strength is lost. Overall movement changes and there are eventual consequences.

  6. Using the workout plan of a runner who is of a higher ability level. You know, because if they got better with this plan then surely you will get better and run just like them in a couple months. Nevermind that they have different genetics, better running technique, and 13 more years of running experience. Plus, they have full hip and ankle joint movement and muscle control that you lost 8 years ago thanks to your desk job. Yes, clearly all of the details are all the same. I always wonder how many people try to mimic the workouts of elite endurance athletes when they end up on a website somewhere. Just because the pro marathoner does back-to-back long runs doesn’t mean you should for your first marathon.

  7. Listening to people who have no actual expertise but are ready to use you as their own personal guinea pig and offer plenty of untested advice for your training or injury recovery. I know this is often done in innocence, but that doesn’t make it any less concerning. Perhaps a more advanced athlete invites you to run with them and you decide to follow their workout or are too embarrassed to put forth any effort less than they are performing. The other athlete can mean no harm but may not really analyze the many possible scenarios that will impact your individual health. Them: “This is what my coach had me do.” You: “Oh my god, you have a coach, you must know what you are talking about.” People often do the same thing when they are injured. Them: “When I had plantar fasciitis the personal trainer told me to just do this stretch to my foot every day and not run and then it seemed like it got better in a couple months.” You: “I guess I should do that stretch everyday and not run.” Wait, you are taking secondhand advice about treating an injury from a personal trainer? I hope they have additional credentials!

  8. Not having fun. If it’s not fun, you’ll eventually burn out, which is the ultimate injury. Training variation can keep things fresh and interesting. Strength and plyometric training will help your running, so don’t shy away from it if you enjoy that type of exercise. If you are the competitive road racing type, maybe you need to train for an adventure race, triathlon, mountain bike race, or trail running race. Try Crossfit (but don’t get hurt) or play rec league soccer. Or even leave running altogether for a few months, not that I ever would encourage someone to do such a thing. Sometimes people do appreciate their running more and can actually improve performance and decrease injuries when they have been away from running for awhile. If you aren’t having fun, what is the point? To make yourself routinely miserable? Find something you actually enjoy and keeps you healthy. 

  9. Thinking an injury is gone just because an initial pain has subsided. Your nervous system is super smart. It can decrease the amount certain muscles work when moving and use an alternative strategy if doing so leads to less pain. It can shift the demand to other muscles to still get the movement done with the same total force output. Most people won’t have any awareness of this change in muscle activity. The initial area of injury may never flare up again, but many times when another pain arrives, the real problem isn’t where the newest pain is occurring. For example, low back or gluteus maximus pain leading to an Achilles tendon pain months to years later. This inhibition of muscle activity is clearly not ideal if those muscles were working just fine prior to the initial injury. Traditionally people (clinicians included) mistakenly try to rehab the area of current pain when they ought to be emphasizing something else. Prior injury matters.

  10. Not taking any easy days. Running is supposed to be hard! Running is supposed to hurt! I’m going to do high intensity intervals every time I run! And that’s four days every week right now but I’m going to work my way up to five days! What...the...heck? Why? Can we talk about how much I’m not impressed by Instagram photos of people “crushing it” multiple times each week? I get that there’s a satisfaction in showing off your hard work. But no one with any real longevity in endurance sport trains this way (because it’s unsustainable). Anaerobic efforts, like intervals and tempo work, are super helpful to improve fitness, technique, and speed - but are not necessary for every workout. Easy, slow distance miles just don’t give the sexy social impression that interval work creates. If you want to run for only five, maybe ten years, then go ahead, do crazy intervals for every run. To summarize a phrase from fellow PT Christopher Johnson: runners run at 80% effort 80% of the time which leads to an injury occurrence of up to 80%. Strive to stay in the 20%! Use a heart rate monitor, power meter, or monitor your breathing to truly keep tabs on your intensity. Pace is a poor measure of intensity for many runners but that’s what people rely on because it’s simple.

  11. Not recognizing the importance of recovery time and being proactive in your recovery techniques. Yes, I know you are busy. But do you want to run a handful of years or do you want to run for decades? Each day you should have a goal, and that goal doesn’t always have to be increasing speed, fitness, or strength. Recovery time can be broken into active and passive methods. Easy running days should be active recovery days, meaning they aren’t intended to gain you fitness but they are intended to make you feel loosened up and healthy. It’s still exercise. You should be able to finish an easy aerobic run and say “I could easily do that again.” On the passive side, learn a couple techniques to directly work on your muscle, tendon, and fascial tissues. Get yourself a lacrosse ball and a massage stick and use them at least three times a week on your major leg muscle groups to break up those funky tender and hard spots you have inevitably created in your legs. If you aren’t familiar with any muscle self-treatment techniques, check out “The Roll Model” by Jill Miller or “Becoming a Supple Leopard” by Kelly Starrett for ideas. Recovery time requires planning, just like the workouts. We create the muscle fiber adaptations to training gradually, while you aren’t training, so if you don’t allow enough time for that, when are the adaptations supposed to happen?

  12. Not being proactive about your recovery from an injury. Instead of actually completing what’s required to recover from an injury, some athletes prefer to do nothing. It’s the wait-and-see approach. Our bodies want to heal, so rest typically decreases pain in the short-term. But it doesn’t address the root of the problem for recurring and long-lasting overuse injuries. Unfortunately, this is a common practice among injured athletes, who routinely take a couple days of rest before trying to resume their typical training without any modification. If the pain just started a couple days prior and is getting better quickly because you did your due diligence, that’s one thing. But it’s an entirely different scenario when you’ve had persistent pain for a couple weeks, a month, maybe longer. Clearly rest isn’t the solution at that point. Some people avoid proper treatment because they are afraid of getting worse or delaying what little progress they’ve made if they attempt something new (like seeing a PT, massage therapist, or chiro). Or maybe a negative experience treating a prior injury leads to reluctance in discovering the best ways to treat a current injury. Some are fearful that nothing can be done to help their injury and they would be wasting their time to try other tactics. More often than not, doing nothing doesn’t get you very far. While adequate rest is oftentimes an integral part of the recovery process, it should never be considered the sole means to addressing an injury.

  13. Relying on medications to control symptoms. Medications, whether it be pills or injections, are not a viable long-term solution to a mechanical overuse injury problem. As athletes, when we get injured, we naturally look for the quickest solution that would allow us to return to training without pain. And because you are working hard in training, there’s little energy or time left to devote to active injury recovery techniques. While NSAIDs and corticosteroid injections have their place in orthopedic medicine, they rarely, if ever, provide a long-term relief of symptoms or resolution of an overuse injury. And let’s not forget the well documented side effects that these medications have when used with frequency.

  14. Trying to conform too rigidly to a supposedly ideal running technique. We all move differently. There are certainly some good components to things like Chi Running and the Pose Method but on some level you gotta do you to accomplish the task at hand. We were built for movement variation, so why not take advantage of that? You improve and become efficient at the things you work on most, meaning you will get faster if you work on speed specifically. Or you will gain endurance from emphasizing more long aerobic efforts. But there are also running form changes that come with mixing up your speed. Mindless running at the same pace, in a straight line, and on flat terrain doesn’t exactly encourage you to learn what is efficient for a given demand. Good runners are efficient at a variety of running paces. They know exactly how much effort to put into their movement to achieve a specific result. You don’t want the same muscles producing the same force in the same range of mobility with every practice run. Your nervous system, which is ultimately responsible for how your muscles work, will become efficient at running that one pace only. And if your most efficient form can only be performed at one pace, don’t expect that you will have the movement skills to stay uninjured and efficient if there is as need to run at other speeds (faster or slower). This problem becomes obvious in those who say, “I can run 10:00/mile pace but as soon as I go faster I start having pain at my _________.” Performing 5-10 second long strides/striders during or after a run can be helpful in teaching you how to propel your body forward quickly and efficiently but without the fatigue or technique breakdown that occurs with long intervals. They are especially helpful if you have little to no speedwork experience. And it’s okay to sustain a slower, trotting pace at times too. Also, don’t obsess over how your foot is contacting the ground (heel vs. midfoot vs. forefoot). Current research indicates that the location of where your foot contacts the ground relative to your center of mass matters more. We should be able to use any of those types of foot contacts depending on the situation (uphill, downhill, flat, loose rocks, etc.) The more varied your overall training, the more capable you will be of tolerating technique changes and running with your own best stride.

15. Believing you can rely solely on rest once you have signs of injury. Yes, there are times for rest, but they should be kept brief for tendon and muscle overuse injuries.

Runner: I’ll just rest for a week and that will take care of it.

Me: No, it won’t.

Runner: But rest took care of it when I had this injury a couple years ago.

Me: Did it? Apparently it didn’t or it wouldn’t have happened AGAIN. The real problem was never addressed. This thing has just been biding its time, always remaining a weak link, probably in conjunction with other problems of strength and mobility outside the area where you actually have the pain. The moment you have a training error, like running faster or further, it’s the first thing to break.

Runner: Oh. Well, I’ll just rest until the end of the week and then do my long run on Saturday.

Me: Did you hear anything I just said? *Pounds head on table.*

Our bodies adapt most favorably post-injury with controlled, specific stresses on the injured tissue. The best stress to place on a healing tissue isn’t more running either. If running was the cure then it wouldn’t continue to provoke long-term pain. Running places very high loads, thousands of times on the legs, hips, and torso. This requires a certain amount of muscle strength be in place to perform running safely. Strength that many runners don’t actually have when they start a running program. People too often try to gain fitness running but they don’t have the basic strength-based fitness necessary to run safely in the first place. So while you are resting the pain away, the strength isn’t increasing, is it?

 

16. Not trusting in the process of proper training by becoming impatient. We want it now, at broadband speeds, not dial up! So many runners do all their runs at a high intensity, assuming that strategy is the fastest way to improve. And many newer runners of all ages do find quick success as they make rapid cardiorespiratory gains. But three years into their careers, they start breaking down because the muscles, tendons, joints, and bones just can’t adapt with the rate of improvement the way cardiorespiratory fitness can. People that are hurt frequently aren’t able to train consistently so they stay injured and don’t reach a very high performance level, at least not for very long.

Instead, you should trust the training process and limit high intensity workouts to once or twice a week. You should work hard enough on the hard days to promote gains and then let recovery do its job. The performance gains you should expect from a single hard workout will be very small, if not imperceptible. In reality, much of succeeding is slowly and methodically putting in your time and simply remaining consistent at lower intensities. You have to think long-term. Like at least six months. There are no shortcuts to success.

If you like to run fast, you can do it frequently if you keep the durations VERY short with striders, which are great to perfect and maintain your form as often as every run. Most amateurs could improve their running technique anyway, so this will be time well spent. Then transition that better technique into your longer but less frequent (1-2x/week) intervals and tempo runs.

Some questions to think about:

  • Are your intensities and volumes during hard days and longest runs sustainable across a several month span of time?

  • Can you feel just  about fully recovered from any workout in two days or less?

  • Can you add an extra easy run or cross training day during the week and not feel destroyed after it?

  • Could you have done one more hard interval at that same pace?

  • Could you repeat that entire easy run all over again as soon as you completed it and still feel good?

If you are answering no, you might want to back off your need for crushing it a smidge. You can only go to the well so often in a short period of time. If you want to improve while staying uninjured, over the long haul your goals should be consistently good technique, sustainable and repeatable hard efforts, frequent but brief exposure to fast running, and frequently being active at lower aerobic levels.

 

Brain Training For Capturing Your Next PR

Do you ever wonder why some athletes are so consistent in their performance while others are all over the map? If factors like nutrition, training, and physiological capacity are similar between two people, especially at elite levels, there must be a hidden difference or two in why one person consistently outperforms another.

A huge piece of that difference is psychological. One athlete might catastrophize when things don’t go as planned. Prior experience may lead that athlete to experience negative emotions, increased stress, and increased self-doubt. Once a moment of negativity is allowed to creep in, it leads to a steady performance decline. But somehow, another athlete faced with the same issues might continue to excel despite encountering a hiccup. Just how can they do that? Are we born with these skills or is it the result of dedicated practice?

Brain-Body Connection

There is no denying a connection between your psychological state and physiological outcomes. All you need is to feel a little stressed and you can watch your heart rate and blood pressure rise. What if you could reverse engineer this brain-body connection and use it to work for you instead of against you?

Through dedicated practice, focusing consistently on a single task and being aware of that present moment, you encourage control of your emotions and enhance your self-awareness. Perhaps you can decrease the more intense physiological responses that accompany stress. Even though endurance sports, like running, are fatiguing and sometimes uncomfortable, the brain can be diverted to a single focus of operation: to get the primary task done.

I have a theory that the most successful athletes (e.g. happy, consistent) use their sport as a form of meditation. Some have suggested that we naturally seek out altered states of consciousness and exercise is just another gateway to this state. Perhaps this ability to refine and control thought is a key to enjoying exercise instead of dreading it. Sure, there are people that still look at meditation as being a 1970s hippie phenomenon, so they automatically won’t like the idea. But consider it just another skill within a toolbox of physical and mental skills. No psychedelic drugs necessary. By exercising in this semi-meditative state, the brain learns to function and focus in a precise way during that activity.

What is Mindfulness Meditation?

Practitioners of mindfulness meditation emphasize remaining observational and non-reactive to what you might sense during meditation (see footnote below). One result of remaining mindful is improved decision making simply because you have greater knowledge. You then respond to your findings without excess reaction, without judgment. It’s similar to someone telling you, “don’t overthink it.” Who doesn’t want or benefit from improved decision making?

A search of the NCBI database reveals that using mindfulness techniques during exercise is a relatively new research area. Mindfulness concepts are commonly utilized in research on yoga and martial arts. It is also more common to see meditative techniques used in addition to exercise for treatment purposes (e.g., chronic pain, depression, etc.). Mindfulness and meditation are becoming more popular topics, so you can expect more research will begin to pop up.

Using a Body Scan to Control Pain

Endurance sports involve cyclical movements (e.g., steps while running, pedal strokes while cycling, etc.)  that provide ongoing feedback from the body. That feedback is useful, if you are listening. You might refer to this listening as a “body scan.” It’s a technique used in mindfulness-based meditation and has been studied for treatment of depression, anxiety, stress, obsessive-compulsive disorder, insomnia, various cancers, chronic diseases, and chronic pain.

Athlete or not, one of the biggest goals of a body scan is to increase your awareness of your body’s signals, top to bottom. During constant activity, the best athletes are able to continuously monitor and adjust their status at any given moment, much as a person would in mindfulness meditation. The athlete is monitoring the important factors as they encounter them, responding with only the absolute necessary changes so that, over time, physical and mental energy are conserved.

While scanning, I frequently discover that I will shrug my shoulders when running harder or becoming fatigued, so I immediately know to drop my shoulders. Or I notice my breathing becomes too rapid and shallow, which reminds me to take a cleansing breath. No surprise, there’s always an immediate improvement in mood, performance, and comfort.

Within an event or training day, one key is to continuously perform the body scan to the point that any small problem is detected and corrected before it becomes a big problem. Maybe some people would consider this a waste of mental energy, and maybe it would be for the unacquainted. Instead, with practice, I would expect it to decrease mental fatigue because it’s far easier to address a small problem intermittently than to become stuck obsessing over a more catastrophic and constant state of stress that causes a flood of negativity.

Other Mindfulness Techniques

Bringing your attention to the present, with something like basic step counting, can push out negative thoughts. You might initially just count four steps before your focus diminishes but with practice it could be 50 steps or 100 steps. Count steps until the next maple tree comes along or the next aid station.

Some athletes are better able to apply meditative techniques if they have a mantra to rely on. Much like step counting, the job of the mantra is to hold your attention. It is a word or phrase that you return to when you find your attention has drifted. It can be something like “long and strong” or “I can, I will.” And still others are able to focus on their breathing count and pattern with great success.

The cyclical nature of an endurance sport also lends itself well to this internal or mindfulness approach because you can become completely lost in the total movement, the breathing pattern, or even the individual footsteps. I’m so stuck in this mode from running that I struggle with counting repetitions while strength training. I become so internally focused on the technique and how the movement feels with each rep (the way I would with running) that I don’t care about the number.

Regardless of your choice, focusing on any of these patterns requires attention to factors other than your fatigue-induced discomfort. They all provide a rhythmic pattern, a consistent place to focus after a distraction, a point of fixation.

Being Stubborn Isn’t Enough

This isn’t simply about being stubborn. Stubborn can get most people only so far. When you finally break at your point of maximal stubbornness, there must be some other tactic to fall back on to hold yourself together mentally.

An experienced ultramarathoner isn’t going to rely on being stubborn through an entire race, though it may appear that way on the surface. They are likely getting to the point that simply feeling their breathing or arm and leg movements can provide a point of focus as the distance gradually ticks away. It’s more about executing at that very moment while turning off emotional and judgmental tendencies.

Application to Training and Competition

In training, try to maintain a body scan or an intrinsic technique focus during short, hard intervals of 30-60 seconds. The goal can be to move quickly and feel discomfort while focusing only on one or two technique trouble areas. You can make the intervals increasingly longer (eg. 5-10 minutes) as you have more success sustaining a focus during the shorter lengths.

Use your miserable days as a primer. Gross weather? Feeling generally crappy? Don’t bail. I hate to spoil this for you but 99.9% of competition days are not going to go as planned. To truly be prepared, you need to experience less than ideal conditions in advance. The rough days are an opportunity to see if you can bring yourself together mentally and maybe even surprise yourself.

Started out a race too hard? Don’t panic. Accept the situation and move on, responding only to your requirements at that very moment. You can’t change the past so stop getting caught up in it. Feeling inefficient? Focus on a component of movement, like arm swing, that you can control. Continuously thinking “this hurts” or “I’m getting slower” is harmful to performance and enjoyment. Once those initial thoughts begin, you will almost certainly begin to slow down and have even more negative thoughts.

You aren’t going to wish an opponent into slowing down and you aren’t going to wish yourself into going faster. Focus on factors that you can control and you just might go faster. But that’s not going to happen without maintaining an internal locus of control - meaning you become solely responsible for and controlling of the outcome.

In longer events, like a marathon, it is wise to not only avoid deep analysis and judgment of your overall condition but to address the basics of what you can at that very moment and reassess after a mile or a few minutes later. Just because you are beginning to feel miserable one minute does not mean you are destined to feel that way 10 minutes later.

According to the book “Running With the Mind of Meditation: Lessons for Training Body and Mind” by Sakyong Mipham Rinpoche: “Ignoring the pain takes enormous mental effort. The first step is to acknowledge the pain. The pain is one thing, and the mind reacting to the pain is another, so the second step is not to overreact. Becoming startled by the pain only exacerbates the pain, like throwing gasoline on a fire: our reaction to the pain makes it even worse. Therefore we acknowledge the pain, but we avoid having the immediate reactionary response.”

Your preferred method of mindfulness may also change with the intensity or duration of exercise. Through most of an endurance competition I’m doing a body scan. Late in a competition I might begin to use a mantra, often rhythmically with the movement. I also like to create a mental picture of how I am moving as a whole, as if I’m watching myself in a mirror.

Find What Works For You

If you have never tried any of these mindfulness techniques before, don’t expect it to be easy and automatic the first time. There is no wrong way to do it; try a few methods and see what sticks.

Some people have the perception that meditating while exercising would require you to completely shut off the outside world. But you have the choice to turn off and to turn on those inputs. If you have to be on high alert for a moment to make sure you don’t miss a turn of the trail in the woods, then stay on high alert. Go back to whatever technique you like once you make the turn. You don’t become a zombie while doing a body scan.

The bonus of these techniques is that you can transfer this behavioral control to other sports and aspects of life like school or work. After developing the mental skills necessary to get through a tough training or competition day, taking that college exam or giving that presentation to your boss might not seem so tough.

It’s worth looking at the various mental skills you can develop while exercising so it isn’t all just a frustrating slog. Certainly, exercise can provide a fantastic time to step away from our stress and problems. And not every moment of exercise needs to be a test of will or focus. Just don’t be afraid to consider the importance of mental skills training if you are seeking performance gains.

Main points:

  • A body scan, mantras, step counting, and breath counting can all be useful methods to improve performance.
  • A body scan can be used to continually monitor movement and discomfort levels. It allows you to attend to small running technique flaws or areas of excess muscle tension before they become large and painful problems that will undoubtedly be mentally fatiguing and detract from performance and enjoyment.
  • Practice the mental focus in training with hard and short efforts initially and then progress to longer and harder efforts.
  • Bringing your attention to the present, with step counting, breath counting, or a mantra can push out negative thoughts.
  • Realize no competition is going to proceed 100% as planned. Use your most unpleasant training days as an opportunity for preparing your mental state.

Please share this article with your running friends! To receive updates as each blog comes out, complete the form below. And if you have any questions, please email me at derek@mountainridgept.com.

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Sources:

1 According to a 2010 article from Birrer and Morgan: “Mindfulness techniques emphasize the non-judging awareness and acceptance of present cognitive, affective and sensory experiences, including external stimuli and internal processes. Stimuli that enter awareness are observed but not judged, and internal experiences (thoughts, feelings and sensations occurring through internal or external stimulation) are instead accepted as natural, transient facets of human existence.”

http://www.atrailrunnersblog.com/2017/06/stealing-fire-ultrarunning-and-pursuit.html

https://www.ncbi.nlm.nih.gov/pubmed/26406766

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2010.01188.x/full

http://onlinelibrary.wiley.com/doi/10.1111/aphw.12063/full

http://www.huffingtonpost.com/2013/07/22/meditation-in-action-running-mindfulness_n_3625110.html

http://www.runnersworld.com/meditation/why-you-should-try-meditating-while-running-and-how-to-do-it

 

20 Cold weather running tips and tricks

The warm weather of spring will be here before you know it...or not. I don’t love the cold, but I’ve learned to appreciate the unique challenges of snow, wind, rain, ice, and that abominable snowman from Rudolph the Red Nosed Reindeer (hot cocoa!). Here are some thoughts on surviving this less pleasant time of year.

First off, it’s about mindset. If you keep telling yourself it’s going to suck to be in the cold, no surprise, it will suck. Have the attitude that you are adaptable and that the conditions are fun or unique in order to shift your perspective. If you have the guts to commit to consistent exercise, you have the guts to tolerate the cold for a bit.

If you struggle with the initial shock of cold when heading outside, try getting your core temperature up indoors first with 2-10 minutes of indoor biking, treadmill running, push-ups, air squats, running in place, butt kicks, or high knees.

It’s never as cold as you think it’s going to be - as long as you are consistently moving. Pretend you are dressing for a temperature that is 10-15 degrees warmer than the actual thermometer reading.

However, if you would happen to become injured by the aforementioned abominable snowman and had to stop moving, how long do you think you would stay warm? Probably not as long as you think. This is where it is smart to carry an emergency item or two, especially if you plan to be far from civilization, home, and other people. We’ve all heard about dressing in layers, but I like to dress with the intention to pack away the outer layer. A tightly packable, waterproof jacket is a great addition, especially on those damp 40-degree days. It’s there if you need it but not a hindrance if you never use it. In a pinch, a simple kitchen trash bag with a hole ripped in the bottom for your head can be used as a rain, cold, and wind barrier. Cheap, simple, and effective, but don’t expect it to be breathable. Space blankets are a great compact option. On long, adventurous trail runs, my ultimate choice would be a bivy sack, especially for going out into a more risky environment that would be less accessible in an emergency. Of course, this is overkill for running roads in a city. Consider that even if you had to stop moving for 60 minutes while waiting for help, a bivy sack or space blanket would be a welcome and potentially lifesaving item that weighs very little. Though it’s a little larger and heavier, the bivy is more ideal than a space blanket because you can actually get inside of it.

It’s not just the temperature that you have to consider. Wind and water will make the temperature feel at least an extra 5-10 degrees cooler. But if the sun is out, it can easily feel an extra 5-10 degrees warmer. The hardest conditions to dress for are when it is raining at 35 to 48 degrees. That’s perfect hypothermia weather. There’s a definite need for a breathable, waterproof jacket in that instance if you plan to stay out for 30 minutes or more.

Wool is an awesome material to layer, especially for socks. Many people love wool for the heat retention it maintains while wet, which can easily happen if you sink a foot in a puddle of slush. The Smartwool socks I’ve had have been amazingly durable and are my favorites so far. Anything but cotton, please!

In full-on cold muck, around 34-48 degrees, consider a waterproof/windproof sock, like this one from Sugoi. I’ve used these intermittently over the past five years. They definitely weren’t manufactured as a hiking and running product as they do slip around in the shoes a little. And they have external seams that might annoy some people. But they are flexible and my feet would only get a bit damp from sweat. (Keep in mind the dampness from sweat can cause chilling though.) They are useless if you dunk your foot deeper than ankle depth.

Check out some running gaiters if the snow is getting deep or if it’s slushy and muddy. Even a thin gaiter can keep debris from accumulating in your shoe. And if the weather is really poor, you might have a hard time untying the shoe to get that debris out in the middle of a run. Prevent it in the first place.

A single, thin layer can go a long way toward improving comfort. You don’t always have to use heavy, thick layers to get the job done. And the nice thing about a single layer is that it is still very breathable. This is why I hang onto a 15 year-old, super worn pair of tights that my wife would like to throw away. They are perfect for the 30-40 degree days. I’ve found that some areas are more sensitive to cold than others. My shins don’t need much coverage so one layer there is often plenty. My hands are super sensitive though and I’ll need to layer up a liner gloves and possibly mittens.

Carry a Buff or other similar multi-purpose garment. Options are nice. This can cover and protect your neck, face, ears, and head in one fell swoop, in any combination.

Cover your hands in a thick moisturizing and protective barrier like Bag Balm, beeswax, Aquaphor, or petroleum jelly. I have pretty poor blood flow in my hands and this, at the very least, buys me some additional time before my hands start to ache and lose blood supply. And it seems like the act of massaging these products onto the skin is helpful to increase blood flow even before going outside. If it was super cold out, I would put this same protective barrier on my face as well. I’ll carry a little tube of this stuff on a long run for reapplication and chaffing problems.

Sheet metal screws tightened into the bottom of your shoes make for cheap, light, and effective studs on slick surfaces. Just three to five of them can go a long way towards enhancing your stability if they are thoughtfully placed.

Cross train on snowshoes, cross country skis, or just go for a hike. Nobody feels their most fit when exercising in the cold. The clothing is restrictive, breathing is difficult, everything feels stiff, and the footing is horrible. These other activities are more than acceptable to provide an aerobic workout. As a bonus, they break up monotony and train your body in ways you might not normally. Were you going to PR today anyway?

Keep in mind any food you take will become more firm, perhaps more… chewy as it gets colder. Which means you will probably have a desire to drink more while eating. If you tuck the food close to your body prior to eating, it won’t be so darn hard to chew.

Similarly, if you use a hydration pack, tuck the tubing into your jacket so that it doesn’t freeze up. Depending on the size of pack, you may be able to place it under an outer layer of clothing. Drink small amounts from the pack often to keep the water moving. The real hard-assess of winter running mix a little vodka or whiskey into their water to help prevent freezing. It doesn’t take much to lower the freezing point.

Warm liquids are amazing in the middle of a long, cold bout. My dad always brought a small thermos of hot cocoa for me when I was a little kid hunting in the cold. I promise you, in the middle of a cold long run there is nothing better than hot tea or chicken broth. I haven’t found a thermos that works better than a Zojirushi

Carry back up charcoal hand warmers. Just don’t expect them to heat up quickly. For that, there are more instant hand warmers. Or make your own out of these inexpensive flexible heating pads.

Make loops that include public buildings where you could warm up for a few minutes if necessary.

Don’t tie your car or house key to your shoe in wintery conditions. Your hands might be too cold to untie the knot or the knot might just be completely frozen. There is no worse feeling than standing outside a locked warm car or house when you are super cold.

That's disappointing

That's disappointing

Find someone to hold you accountable to getting your run done. A consistent training partner can be a great motivator who won’t let you slack off and make excuses. Training groups can provide that same motivation. Plus it’s safer for everybody involved.

Bonus: Make a game out of it. A Hash House Harrier run is the best example of this game atmosphere. You will be so busy wondering where you are on the random course and where you are supposed to be going that you just might forget about the cold.

Bonus: Cellphone batteries die very quickly when exposed to the cold. Keep your phone closer to your body to keep it warm. If it does die, getting it warm next to your body may breathe some life back into it again.

Let me know if you have questions: derek@mountainridgept.com

Tips for assessing last season and planning next season, Part one

Whatcha’ gonna do with all that data? Use it to plan next season, of course.

We log workout data, and some of it never sees the light of day again. Whether you like the old school pencil and paper method or the website technology of Strava, Garmin Connect, Mapmyrun, or others, it’s worth reviewing from time to time. I favor the digital side. Mostly because it makes the math easier and I can make some pretty sweet maps and graphs afterward. There are few things I appreciate more than maps and graphs.

My 2016 running heat map

My 2016 running heat map

So why are you really tracking all of this information? Most would say to allow the ability to see when they are improving. Bingo. But there are a few more reasons to keep track of and analyze the information regularly.

  • Increase the chances of short term and long term success
  • Compare real objective measures to what you *think* is going on
  • Improve your time management
  • Determine where injury or overtraining may have occurred (a breaking point)
  • Determine whether you met your full true physiological potential (or if you were just slacking off)
  • Make it easier for a coach to analyze (currently or on down the road)
  • Remind yourself of events and workouts you never want to do again
  • Remind yourself of events and workouts you would love to do again
  • Determine overall strengths and weaknesses
  • Prevent burnout
  • Define reasonable future goals
  • Recognize any past goals met
  • Discover what aspects of training and competing are really important to you

I started keeping a training log when I was around 15 years old.. Too bad they didn’t have these new-fangled wrist-worn GPS devices back then. There was more guesswork at distances and paces, especially because I was just making courses up. And sometime in college I tried logging everything into a Microsoft Excel spreadsheet, but that felt too cumbersome. Somehow, there are people still doing this! I salute your ability to tolerate the pain delivered from the software equivalent of a Ford Model T.

A spreadsheet isn’t specialized in its design, but it has the potential to be more informative than a paper logbook. Now the GPS watch companies produce some pretty decent metrics and there is additional software like Golden Cheetah and websites like Training Peaks that gobble up and produce more information than anyone can ever want or use. I love it.

At the least, take a look back at these basic measures:

  • Total yearly time
  • Total yearly distance
  • Average daily, weekly, monthly, yearly mileage
  • Average daily, weekly, monthly, yearly pace/speed
  • Competitive performance times, distances, paces

If there is one thing I can emphasize, it is that you should pay attention to trends, not single workouts, weeks, or even single months. Success is not built upon these brief intervals of time, nor is failure. Most injuries are not the result of what happens in a short period of time either.

Monitor the trends of speed, mileage, and duration for each week, month, and year. Following these trends, you can determine if there is consistent improvement or recognize unexpected losses before it is obvious in your performance.

Average speed across 2016. Trend line peak coincides with June event where I wanted a best performance. 

Average speed across 2016. Trend line peak coincides with June event where I wanted a best performance. 

Solely considering mileage, sure, you can progress each week greater than the generally recommended 10%, but should you do it for several weeks in a row? Most people are not going to withstand those increases. If you don’t look at the long-term trends, then you may just very well forget that you progressed 30% in volume for two weeks in a row just a month ago.

The same would apply to the quantity of high intensity work. Progressing too rapidly in the volume of intense exercise can be a problem, even if total amount of time or distance stayed the same from one week to another. Progressing too rapidly will eventually cause a problem one way or another.

Were you injured this year? Compare the time frame where you were injured to the time frame just prior to injury. Was there a fluctuation in intensity or in mileage volume? Maybe it’s something you can’t quite put your finger on.

That’s when you realize that miles, pace, and distance do not tell a full story. This is where more advanced measures become helpful. These advanced measures are likely to be most beneficial to an athlete that is trying to make a large amount of progress or achieve their peak fitness:

Fatigue points

  • In terms of time, where did you begin to bonk or have a drop of pacing? Where did you think “this stinks” or begin to mentally struggle with the work being done?
  • These points are commonly where technique breaks down. It’s good to have a specific goal for when these moments arrive. For instance, if you know your cadence starts to slow, let’s say to 165, then focus entirely on keeping it higher, like 175.
  • Mimic these moments in training in order to determine the resolution that allows you to avoid injury and performance decline. You will probably never fully avoid these points but with training you can keep shifting them further away to prolong the time before trouble strikes. Of course, this is dependent on other factors that would need to be duplicated, like speed and distance. With that in mind, this clearly isn’t something you would try to work on everyday.

Acute:Chronic Workload Ratio

  • Calculated as the most recent weekly mileage or duration divided by weekly mileage or duration total during the last 4-8 weeks. This is a newer consideration, yet so simple. It was introduced in the 2015 research with a study on rugby players. They found that having a high ratio of 1.5 or greater was a associated with onset of injury. Interestingly enough, a ratio of 0.85 to 1.35 was found to be protective to injury acquisition. Even though the research was done on rugby players, it’s easy to calculate, so I would suggest applying it to your training if you can measure volume. The result is similar to a 10% weekly progression.
Pressing my luck with an acute:chronic workload ratio of 1.7 for a little while there. 

Pressing my luck with an acute:chronic workload ratio of 1.7 for a little while there. 

Average daily, weekly, monthly, yearly heart rate

  • Yes, I know heart rate isn’t the most fabulous measure. But if you are using only the basic metrics, this is a good place to start because devices are now measuring heart rate at the wrist and the chest straps are way more comfortable now than 5 years ago. Trends in heart rate can demonstrate overtraining habits or improvements in performance. For instance, if I am ramping up my base miles I can compare performance on a certain loop at the same pace/time and might see a lower average heart rate for the same speed.
Average heart rate was at its lowest while heading into June as well. 

Average heart rate was at its lowest while heading into June as well. 

Elevation gain/loss

  • Someone unfamiliar with the impact of elevation might mistakenly call an average pace of 10 minutes/mile “slow.” They aren’t accounting for the fact that the average mile climbed was 200 feet. This is the main reason I do not believe in online running pace calculators for training or competing on hilly terrain. This is why power will be a much better measure of effort and stress. So...

Power

  • A newcomer to the running world. Just give it a couple years and many of you will have power data on your fancy GPS watches.
  • Although the current power meters for running don’t directly measure the force produced by your body, it’s still more accurate than guessing based upon how you feel.

With software like Golden Cheetah or Training Peaks, you could dive even deeper with these calculated measures:

Critical velocity

  • Critical velocity is the pace that you could theoretically sustain for an indefinite amount of time. Training at or above critical velocity is one way to focus on becoming faster.

Training stress scores

  • Training stress is a measure calculated by considering heart rate (as a measure of intensity) and time.
  • Acute or short-term training stress (stress over the last 7 days) vs.
  • Chronic or long-term training stress (stress over the past 42 days)
  • Training stress balance is about managing the balance between the two in order to provoke higher competitive performances
Training stress graph for 2016

Training stress graph for 2016

Next post I'll go over more planning tips. Please let me know if you have any questions at derek@mountainridgept.com. 

A new method to predict marathon race times with wanderings and wonderings about base versus interval training

Prediction of running performance is nothing short of an intriguing concept. Everybody wants to know what they are capable of achieving, according to internet math, even if they don’t actually pull it off in real life. Predictive measures have been used to obtain expected race times for multiple decades, and I would like to think they are more accurate now than in the 1970s. There is nothing like a true performance at a specific distance to guide your training and racing. But for a beginner or someone that has done just a handful of events, a race predictor can be really helpful to determine appropriate pacing.

I recently came across an article on a new marathon time prediction method that can be found here. The calculator is found here. It is based on research by the same author, available at this page. The researchers used my favorite statistical method, regression analysis, to create a prediction model for amateur runners, based on amateur data. This differs from previous predictors which were largely created from the performances of elite runners.

Runner’s World recently updated their predictor to this same format because it tends to generate a slower time than other predictions would develop. Why is that important? To keep you from blowing up badly, particularly if you are mid-pack or slower runner.

The nice thing about this specific calculator is the fact that it considers your average weekly mileage in the equation. This lets you see where training can play a role. You can really ask yourself if that extra 10 miles per week is worth it when the gain is just one minute over the course of an entire marathon.

For some, of course, the answer is “yes.” But for others that extra 10 miles each week can result in frustrating injuries that could keep them from training and racing altogether. And maybe during that 10 miles you would rather be playing with one of your kids. There is also research to indicate a lessening health benefit of higher mileages (http://www.mayoclinicproceedings.org/article/S0025-6196(16)00068-9/fulltext). The predictor provides a nice method to weigh the diminishing levels of improved performance with the benefits of health and sanity.

This had me thinking, it would be interesting to see how training type plays a role in the goal performance for a given individual. In other words, do you gain more improvement from a focus on long, base runs, or on high-intensity interval work? The average marathon training program is going to include both, because they work different metabolic systems, but I would be curious to know which is more critical for a given person. Sometimes it is obvious, sometimes not.

Let’s say you want to run a 3:30 marathon on 25 miles per week but the predictor expects you to do a 3:35. Is there a certain type, frequency, or amount of anaerobic training that could make up the difference while keeping the mileage that low? Maybe that’s not reasonable and it really comes down to making sure you get in increased mileage to gain that five minutes.

It will undoubtedly vary depending on training history and genetics. The Crossfit nation would try to make us believe that it’s all about the interval training. I would argue that lack of familiarity with longer distances weighs more heavily in a new runner than any amount of anaerobic ability gained with high-intensity intervals. Once you have some base training and long racing experience, then feel free to focus on both or just on harder intervals. I venture a guess that intervals and tempo efforts gain fitness for many people simply because they haven’t stressed themselves in that specific manner. That fitness won’t help much if you mentally crack at mile 23 because it’s all new territory.

To think you can do a marathon well and only do long runs of six or eight miles seems like a recipe for disaster in the uninitiated, though. For a 5K or 10K race, I suspect that many amateurs could rely heavily on interval training two to three times each week for multiple weeks in a row and never once do continual easy or moderate paced runs. Yes, it would still be useful to at least occasionally cycle through weeks of longer, slower base training to stress the aerobic physiology. It is not common to fluctuate training this dramatically, though. Yeah, the mileages would be all over the place. I may have to use myself as a test subject. Maybe it’s a little different way to consider “polarized training.” If nothing else, it is a definite change of pace.

The variation of training stimulus could keep injury rates lower yet continue to change fitness. I recall reading a research article many years ago indicating performance gains in elite level endurance athletes because they essentially doubled their base aerobic training time. These are athletes that are already at the top of their game but they swung the training pendulum one direction and changed their program so dramatically that it helped get them through a plateau. This can clearly work both directions.

My only concern is to be cautious of injuries. Hyper-volume training is surely a recipe for overuse injuries. Too much interval work could be a problem too, especially if you were trying to keep overall weekly mileage high, if your interval running technique was drastically different than your normal slow technique, or if your muscles and tendons were just not up to either task because of strength deficits (a.k.a. start strength training in any case).

Send questions and comments to derek@mountainridgept.com. 

Canary in the Cave 25K Race Report

I’ve wanted to travel down to Fayetteville, WV for the Canary in the Cave 25k for the last couple years, but I just hadn’t made it a priority. Being a WV Mountain Trail Runners event, it automatically had potential to be a quality event. Little did I realize what I had been missing. It is now in my top three all-time races.

The weekend weather lately has been superb for running. This time around it was sunny with a cloudless sky and about 30*. Entry to this event was small at 108 pre-registrants and just 79 finishers. I imagine that would increase if people knew exactly what fun these trails are and the stellar views they could find along the way.

The majority of the trails are wooded singletrack. This time of year it can be hard to tell exactly where a path is under all of those leaves, so you have to be vigilant to stay on the course at times. That’s where it is nice to be near someone from the area and just let them lead. I did inadvertently go off course briefly twice, even though it was generally very well marked.

The terrain was rolling, up until mile 9. Early on, the Fayetteville Trail leads into the Boy Scout Camp Arrowhead trails. Those trails are actually designed for mountain biking but are really awesome to run. Off-camber surfaces are minimized because the trails have been cut into the sides of the hills. Even with all of the leaves, I realized that the trails were primarily packed dirt with minimal roots and rocks.

It’s very twisty, which I love. It brings the pace down a little but is so much more distracting than a straight line. Any short descent is quickly matched with a little rolling uphill. They have produced a rollercoaster-like feel with the quick ups and downs. Even more like a coaster would be the brief sense of weightlessness while launching off the small dirt mounds.

During the early Arrowhead trails, perhaps around mile 4, another runner started nipping at my heels. I would throw various surges to get a feel for where he might drop off. It seemed like the descents and more technical sections weren’t his forte. He wasn’t going anywhere on the climbs though.

Coming off the Camp Arrowhead trails we descended on a fantastic old dirt and gravel access road that has been carved into the steep pitch of the New River Gorge. I will not forget this part, from miles 10 to 13.  You could seriously fly on the upper part. The sun hadn’t hit in here yet so it was very chilly. I took in a couple glimpses of the gorge at this time but couldn’t stare too long as there were definitely loose, washed-out areas. It’s the kind of old forest road that most people would be really nervous to drive on. To your left is a very steep drop off, older growth trees, and otherwise nothing to stop you from rolling hundreds of yards down into the ravine. To your right are absolutely humongous gray sandstone boulders, bigger than semi-trucks.

I used the early steepest part of the gorge descent to put a gap between me and my chaser. But, despite my efforts, he caught back on when the decline below became more shallow.

Having never done the event, I didn’t realize the intensity of the final climb and just out of bad timing I started to eat a gel as we rounded the turn to the Kaymoor mine where I knew we would begin to ascend. Crap.

I was disappointed to see the end of the descent, not only because my mouth was full of gel, but because I wanted to get even closer to the railroad tracks and the New River that I had just viewed from 500 feet higher up the mountainside. The river is still another 500 feet lower than the turn. The race director informed me the original race course did descend further but mud slides haven’t been kind to the lower portion of the Kaymoor Trail.

One-third of the way up what is known as the Kaymoor Miners Trail, the person who had been pushing me for the last 9 miles began to absolutely crush the quick and steep upward scramble. I quickly realized this was a high schooler. Not again! A repeat of last weekend. We climbed multiple flights of wooden and rock stairs while trying to get up this 0.4 mile-long beast. It was hands on knees hiking for much of it and occasionally hands on rocks and trees for stability. Thank goodness it wasn’t any longer.

I had red-lined so hard that I struggled to recover and regain the previous pace at the top. The final portion was a revisit of the first three miles of the course, now in the opposite direction. It hurt much more now though. Boy was I happy to see the “1 mile to the finish” sign. I couldn’t even see the high schooler anymore as he maintained pace very well.

Despite being a youngin’ in the trail running world, Jacob Birurakis ran this course like a seasoned veteran. He was the runner-up at the WV XC State Championship for AAA this year, which might explain his ability to go pretty darn hard up a climb. Nathan Bonham led from the start and destroyed the previous course record, completing the course in under two hours.

I ended up with 15.6 miles on my Garmin with 2014 feet of climbing. Others had as much as 17 miles on their devices. The director reported the course is around 16.5 miles. It’s a strange sensation but I felt like I descended much more than I climbed. Nobody is going to complain about that. My only complaint is that this isn’t a 50K where we could have done two laps of that beautiful course!

Participants received a multifunctional headwear/neckwear/wristwear item and some unforgettable views. Proceeds benefitted the local 4-H group and the WVMTR.

 

Results: http://www.wvmtr.org/events/canary-in-the-cave-25k-2/canary-in-the-cave-2016-results/

 

The latest research on compression garment effectiveness

The main reasons to wear compression garments, like compression socks, would be to: 1) improve athletic performance or 2) improve recovery. Is compression wear worth the hype in either of these cases?

Performance:

A 2016 review on the effects of multiple types of compression garments (Engel et al.) examined 32 studies performed between 1987 and 2015. In eight of the studies they found no significant improvement in race completion time with compression for any distance from 400 meters to marathon. In seven studies, they did find a small improvement in time to exhaustion while wearing compression. Four studies reported improved running economy values. Sixteen of the studies were associated with improvements in psychological variables.

Despite being financially supported by a garment manufacturer, a 2015 study by Areces et al. found no benefit of compression socks in post-marathon exercise performance or race times.

In a 2015 literature review of four studies by Stanek, compression socks were reported to have no effect on several physiological measures like heart rate, perceived exertion, and lactate levels. Although one of the four studies noted an improvement in maximal running speed.

Recovery:

Performance improvements are often based on perception of effectiveness. In a 2016 study by Brophy-Williams et al. the participants were asked about their perceptions on the usefulness of compression socks in enhancing exercise recovery. This article is ahead of print, but according to the abstract (yes, I know that’s bad science) the participants performed better if they believed the compression was going to be helpful in recovery. Thank you placebo effect.

The 2016 Engel review of 32 studies found nine articles reporting large positive changes in exercise or post-exercise muscle soreness.  

A 2013 meta-analysis by Hill et al. revealed some benefit in reducing the pain of delayed onset muscle soreness. They also found that muscle strength and muscle power measures recovered more quickly with compression usage.

A 2016 meta-analysis by Marqués-Jiménez et al. identified several studies indicating multiple biochemical markers were improved following exercise if compression garments were worn. In five studies, muscle swelling was also improved. Another eight studies indicated improvements in exercise recovery in muscle strength and five studies in muscle power.

Anecdotally, I don’t find compression to change anything about my personal running performance. Maybe I would notice a change if I used it more often. But I definitely do like the way compression feels for a day or so after a hard workout or race. I really love the way compression feels at super high levels with a compressive device - above 80 mm Hg, which isn’t what these studies and reviews analyzed. Even if compression garments aren’t changing recovery on a physiological level, they are all capable of decreasing the sensation of soreness.

It appears that the most recent research evidence supports the use of compression in decreasing the intensity of delayed onset muscle soreness. The helpfulness of these garments may be event greater in an individual that must spend more time on their legs during the post-exercise period of soreness. Let’s say in a multi-day event or going back to work on Monday.

Could you make arguments for using compression using the latest literature? Sure. Would I use it in every race or workout? Nope. The reality is that if you think it helps you, then keep using it.

Sources:

http://journals.humankinetics.com/doi/pdf/10.1123/jsr.2015-0048

http://journals.humankinetics.com/doi/abs/10.1123/ijspp.2016-0162

https://www.researchgate.net/publication/301581402_Is_There_Evidence_that_Runners_can_Benefit_from_Wearing_Compression_Clothing

http://www.jospt.org/doi/full/10.2519/jospt.2015.5863

http://starkandwatson.com/wp-content/uploads/2014/10/Compression-and-Excercised-Induced-Muscle-Damage.pdf

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0031938415301566?returnurl=http:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0031938415301566%3Fshowall%3Dtrue&referrer=http:%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0031938415301566

How to keep muscle cramps from ruining your workouts and competitions

A CASE STUDY

The scene: It’s a hot, 75 degree Saturday in June, humidity 85%, birds singing. Maybe the most hot and humid day so far this month.

The athlete: Is 6 miles into what is expected to be a 15-mile long run. Last night they enjoyed a couple beers with dinner after completing a 4-mile easy run. Work was pretty hectic, so they drank coffee all day to keep focused. They didn’t consume much water or other fluids.

The cramp: Comes quickly into one calf during the long run, rendering the leg nearly useless and painful, despite the individual believing they weren’t putting out much effort. This has happened before. The runner stretches the muscle for 10 seconds, decreasing the pain and begins to run again. Four minutes later it happens again so they repeat the process until 8 miles, when they finally quit the run out of frustration.

Talk about a wasted training day. Did this runner do something wrong in their preparation for this run? Yes. No. Maybe. Perhaps I’m trying to trick you a little because the truth is we don’t have enough information about the entire situation. What is their maintenance routine like outside of running? Do they strength train? Have they eaten during the initial part of the run?

SO MUCH TO THINK ABOUT

You should see that there are a variety of factors to consider regarding the onset of muscle cramps. Here are some you’ve heard of and maybe some you haven’t:

  • Prior training experience regarding intensities and durations
  • History of muscle cramping
  • Current hydration status, particularly related to level of sweat loss
  • Electrolyte levels of magnesium, calcium, sodium, and potassium in the blood and muscles
  • Muscle tone, which is controlled by the nervous system and reinforced by day-to-day use patterns (and also changed with routine soft-tissue maintenance)
  • Central nervous system status, as in higher anxiety and stress levels
  • Peripheral nervous system status
  • Stimulant intake, such as caffeine, which impacts nervous system function
  • Recent physical activity and fatigue levels
  • Environmental conditions regarding temperature, humidity, and terrain
  • Muscular demands at that moment, as in the force of muscle contraction required
  • Direct muscle trauma

There is likely an interplay of these factors and you therefore need to consider them all in muscle cramp prevention. How are you going to do that? Partly with good regular maintenance and training habits. Partly with a little trial-and-error testing.

Muscle cramps have been a thorn in the side of many athletes for decades, and what fixes them in one athlete may not work for another. Some athletes just seem more prone to cramping while others have minimal issues. I would be surprised if the crowd that is prone to cramping didn’t have at least one or two of these areas to address though.

Available research indicates three main theories exist in the cause of exercise-induced muscle cramping:

  1. “Skeletal muscle overload and fatigue from overuse or insufficient conditioning can prompt muscle cramping locally in the overworked muscle fibers.” (Bergeron, 2008)
  2. “Extensive sweating and a consequent significant whole-body exchangeable sodium deficit can lead to more widespread muscle cramping, even when there is minimal or no muscle overload and fatigue.” (Bergeron, 2008)
  3. “Either neural activity in the spinal cord or in the peripheral could be the cause of the cramps.” (Nakagawa, 2013)

WHAT WE'VE GOT HERE IS A FAILURE TO COMMUNICATE

Lately, the neurological cause has been winning research arguments, so it would make sense to try the solutions that have the most bearing in that area. I frequently tell athletes that the muscles only know what they are told by the nervous system. Without a motor nerve supply, muscles are useless masses of floppy meat. Which means that if the communication between the motor nerves and the muscles goes wrong, you will have a failure of the muscle’s normal function.

This nerve-muscle communication is as much about sending signals to a muscle as much as it is about stopping those signals. It is possible that, with repetitive use and fatigue, the signal from the motor nerve to the muscle isn’t stopped as efficiently as it should be and then the muscle insists on maintaining a contracted state, otherwise known as a cramp.

If cramps occur intermittently for you during exercise, the most likely scenario is one or a combination of these factors:

  1. Poor self-maintenance habits of the muscles
  2. Poor nutritional choices
  3. Subpar preparation of the muscles and nervous system for the task at hand
  4. Neglecting to account for environmental demands

YOUR HOMEWORK

Prevent the cramp with proper preparation and regular maintenance:

  • First and foremost, if you always cramp in the same muscles, I would not be surprised to find that the resting tension in that muscle was elevated compared to muscles where you don’t ever cramp. Cramping muscles are likely to be more tender to firm pressure. Plus, you may be able to tell that those muscles are physically more taut than your other muscles. Your focus needs to be on getting that resting activity to decrease at all times. For that, you are going to routinely and specifically massage that muscle 1-2 minutes every other day with a massage stick, lacrosse ball, or your hands. It should be uncomfortable to work on the irritable tissue. And it’s going to take a month or two of consistent work to keep that muscle more relaxed. If you want it quicker, then my suggestion is to have dry needling to “reset” the nerve-muscle communication.
  • Strength train the muscles that routinely cramp to increase their fatigue resistance while simultaneously strengthening any other muscles that can assist with the same motion. For example, the calf muscles are effective pushing muscles so be sure to address any strength loss in the other rearward pushing muscles like the gluteus maximus and hamstrings.
  • Consider the psychological aspect. Cramping has a lot to do with nervous system function. You aren’t going to make the situation any better by increasing anxiety and stress levels. Athletes that struggle with this need to practice techniques that can lower their stress through deep breathing, meditation, yoga, or sports psychology. It’s no surprise that you could train for weeks without cramps but on race day the anxiety increases at your main event, contributing to the mystery cramps.
  • Expose yourself consistently to any triggering environmental stimuli, like higher heat and increased humidity.
  • If you are expecting to be in a competition that requires minimal or significant terrain changes then try to duplicate those changes or lack of changes in your training.
  • Progress gradually and consistently in durations and intensities of prolonged exercise.
  • It’s easy to suggest staying hydrated. Typical advice. Just keep your urine on the clearer side consistently. Not just the day of or day before longer exercise bouts. Don’t overhydrate because that can carry health consequences as well.
  • Consistently eat a well-rounded diet. If you start restricting specific foods that carry important nutrients, then you need to ensure you are obtaining a suitable replacement. For instance, by restricting meat you may cut out a large magnesium source. Do your research on what micronutrient requirements frequent exercisers have and adjust accordingly.

Prevent the cramp during activity:

  • Vary the range of motion and demand on the muscle as much as you can before you have any sense of cramping. For instance, to change the motion and demands of the calf while running switch from your usual forefoot strike to a heel strike for 20-30 seconds every 1-2 miles. Research indicates that the muscle fibers must achieve a shortened state in order to cramp (Bertolasi, 1993). For instance, if you are constantly running on your forefoot, the calf muscle fibers don’t get a chance to elongate, keeping them in a shorter, and riskier, position at all times.
  • Eat something containing carbohydrates during the exercise. It stands to reason that if muscle fatigue is delayed by eating to supplement energy stores, then you may not cramp as soon or maybe even at all if a few calories are always coming in (Jung, 2005). Nerves must have a supply of energy to function, too. They like glucose. It never ceases to amaze me how many people think they can go harder and faster in an event than they do in training with fewer or worse yet, no calories. Multiple systems change function without normal blood sugar levels.
  • Stick to a reasonable plan. Just because you feel good physically and mentally from resting a couple extra days prior to competition doesn’t mean you should suddenly decide to pursue higher intensities than you have trained for. Even if you don’t cramp, you will probably bonk in a long event, or blow up in a short event.

If the cramp happens:

  • Attempt to stretch the muscle. Do not stretch it rapidly and do not stretch it as hard as you can. A gentle but prolonged stretch is the best option at this point. Hold the stretch for at least 30 seconds. Now is not the time to bounce to the end point of the stretch because you have special structures in place to cause muscle contraction when that bounce hits its end point.
  • Massage the muscle with firm pressure. Even a single, prolonged pressure of 30-60 seconds to the muscle may break its cycle of cramping.   
  • Eat. Didn’t I just go over this?
  • Try my personal favorite solution, dill pickle juice, as the muscle threatens to cramp. It’s not the salt that is effective but the noxious stimuli from the vinegar. A new sports drink named Hot Shot relies on a similar mechanism but it has more of a spicy flavor. Either way, the potent oral stimulation effects nervous system input.
  • Try a couple electrolyte tablets or maybe a sports drink containing electrolytes. This isn’t supported by research, but a placebo effect is still a possible effect. But will you still have the placebo effect now that I’ve told you it shouldn’t work? Please let me know how that goes. I personally stopped using them.
  • Overall, you must adjust according to the variety of factors at hand. If you know you are under-hydrated, aren’t eating enough, haven’t maintained your frequently cramping muscles, undertrained, stressed out, and it’s really humid outside, then your best option is to slow down a little, learn a lesson, and work on the flaws before your next event.

There are instances where cramping with great frequency can be a sign of diseases and serious neurological issues so do not hesitate to contact a medical professional if muscle cramping is occurring outside the realm of exercise. Even a history of sciatic nerve problems can predispose a person to cramping during exercise.

Take care of the muscles and the nervous system with planning and preparation and they will take care of you.

Please let me know if you have any questions at derek@mountainridgept.com. And definitely let me know if you find some of these ideas helpful in muscle cramp management by liking the Mountain Ridge Physical Therapy Facebook page. Or buy me some dill pickles. 

For those who would like to geek out on some related material:

  1. http://journals.lww.com/acsm-csmr/Abstract/2008/07001/Muscle_Cramps_during_Exercise_Is_It_Fatigue_or.9.aspx
  2. http://link.springer.com/article/10.2165/00007256-199621060-00003#page-1
  3. https://www.researchgate.net/publication/299960193_Neural_Mechanisms_of_Muscle_Cramp
  4. http://home.trainingpeaks.com/blog/article/controlling-neuromuscular-performance-to-prevent-muscle-cramps?utm_source=tpr&utm_medium=email&utm_campaign=07-16-anl

Tips for achieving a perfect shoe fit, Part 2

Here are a few more tips to consider when looking for your next pair of athletic or running shoes.

  1. Always take a potential new shoe for a several-minute test run. You wouldn’t marry someone without dating, would you? Walking mechanics are not running mechanics. Jogging in place doesn’t count. Use the shoe like you plan to use it.
  2. Try to fit your new shoes at the end of the day to account for swelling. It’s even better if you have already gone for a run. Just find some clean socks first.
  3. Feel around the inside of the shoe for areas of prominent stitching or materials that could become blister-producing sites.
  4. Check for manufacturing flaws. The shoes should be symmetric in construction of their uppers and soles.
  5. A wide and appropriately tall toe box can be a lifesaver. Everyone thinks of the foot as having a single arch but we actually have three arches. One of those arches runs through the forefoot at the ends of the metatarsal bones. Scrunch those metatarsals together in a narrow shoe and that arch doesn’t function appropriately for stability, shock absorption, or propulsion. You also run the risk of compressing the nerves that are between the metatarsals.
  6. There hasn’t been any convincing research to indicate that the various types of shoes (cushioning, stability, motion control) can decrease injury risk. Which is why you need to emphasize finding a shoe that feels good more than any other goal.
  7. Realize that shoes are not an appropriate fix for lost motion of the ankle and big toe. If you keep acquiring the same injuries regardless of shoe choice, the problem isn’t the shoes. You need to have a trained expert in movement analyze your strength and motion. Let’s say your lower leg muscle group has shortened over a series of years and you switched to a zero drop shoe because it was trendy. That might be a little dangerous if you don’t allow for a several-month-long adaptation period. It would be safer to transition from a shoe with a thicker heel height to less heel height and then to zero drop.
  8. The heel cup should not allow the heel to slide side to side or up and down once the shoe is laced snugly.
  9. Don’t forget about the footwear you use during the rest of the day. Your body will adapt to the positions it stays in the most. Which means using a thick heeled shoe during the day only to switch to a zero drop shoe for a 45-minute workout is a sudden and severe change.
  10. Use multiple types of shoes in training. This helps vary the demands placed on your body and may even help prevent overuse injuries that come from repeatedly working in the same range of motion.
  11. More cushioning is not always better. Shoe manufacturers love creating trends because trends equal money. Now that we have passed the minimalism trend, it’s onward to maximalism. Here’s the thing with those super cushiony shoes: more cushioning means you will hit the ground harder. Our bodies are always trying to seek a sense of stability and in order to obtain it, your foot will try to plow right through a thicker layer of foam. And the more foam, the lazier your gait can become. Muscles, tendons, and proper technique should provide most of the impact absorption.

Sunday Q and A: Marathon Leg Pain

Question of the week:

Last year during marathon training, when I ran more than 15 miles, my legs would begin to have a lot of pain. Is there anything I can try to help lessen my leg pain when running high miles?

As far as the leg pain goes, I’m going to answer this question specifically about training and the muscles themselves. Hopefully it’s not the joints causing pain and I especially hope it’s not generated from nerve structures. Without seeing an individual’s running technique or knowing anything about their training history, some things I expect to help would include:

1. Strength training the quads, hamstrings, calves, and gluteals. A period of higher reps with light to moderate resistance and a period of lower reps against a high resistance are both useful. Performing higher reps against a moderate resistance to the point of failure can be very helpful in improving the resilience of a beginner or intermediate marathoner’s muscles. Hammer the quads with lunges, the hamstrings with dead lifts, and the calves with bent and straight knee calf raises. Performing enough reps to cause failure can promote great changes.

2. Self-massage the quads, hamstrings, calves and gluteals. A supple muscle is better at absorbing loads. This also helps relax the more irritable areas in the muscle that some people call “knots” or trigger points. In my personal experience, it prevents cramping that is associated with fatigue. Rolling with a foam roller, tennis ball, lacrosse ball and a massage stick are all common and useful depending on the location.

3. Address any running technique issues. Over-striding, for instance, can kill your quads early. It is also common for newer runners to lack the understanding of how their bodies should absorb impact. A few (4-8) strides of 25-50 yards in your bare feet one to two times weekly can help most runners gain a little insight into proper force absorption. Grass and turf are nice for this. You shouldn’t sound like a herd of cattle when your foot hits the ground. Speedwork can improve running technique as well, so….

4. Increase your speedwork. For a beginning marathoner, one speed workout per week is sufficient. Part of the leg discomfort may simply be from the byproducts of rapid glycogen breakdown in the muscle. The best way to become used to cleaning up those byproducts is to train at a higher speed on a frequent basis. That means you should purposely make the muscles hurt in short, hard runs so they find the pace of a longer run easier to sustain.

5. Continue to emphasize longer runs every one to two weeks. If you have a three-month training block before the marathon, that’s at least six critical long runs, maybe even up to twelve. There is a huge and important adaptation time that must be considered when you are planning to run longer distances.

6. Don’t go out too hard. Better to start slow and prevent your body from quickly depleting the stored glycogen sugars. If you feel well at mile 12 and you are going 15 miles, then by all means pick it up a bit at that point. Make note of what you felt like throughout and adjust the pace accordingly in the next run. Long runs are all about aerobic base training, not speed or pace records, so there’s no shame in going super slow and even walking frequently to keep the stress lower.

7. Eat during the long runs. If you only have a few years of running experience, it is unlikely that you are burning your energy stores at the most efficient rate no matter your pace. So your best option is to eat during the longer training runs to insure a constant supply of energy. Even consuming 50 calories an hour can help tremendously, though you should experiment with taking in more, as long as your stomach tolerates it. Most people can consume at least 100 calories in an hour without distress if they are moving at a pace that is hard but sustainable for at least 90 minutes. Some do better with liquid calories, some with solids. Some people can only eat unprocessed foods while others can eat sugary gels until the cows come home. Experiment in training, not on race day. And start eating early in the run, by 30 minutes.

Let me know if you have any training and injury questions at derek@mountainridgept.com. 

Are you bonking?

Anyone who exercises for an extended period is at the mercy of their stored energy and blood sugar levels. Glucose is the basic sugar circulating in the bloodstream and it is well controlled within a specific range for a healthy person. Stored sugar, glycogen, from your liver and muscles, can be used to keep the blood glucose regulated.

If your blood sugar decreases to lower levels during prolonged activity and can’t be stabilized, your brain will prioritize itself over anything else because glucose is its primary fuel source. This means working muscles are not exactly high on the list. You are in the process of bonking, otherwise known as non-diabetic hypoglycemia or exercise-induced hypoglycemia.

Risk of bonking increases with the following:

  1. Longer duration of exercise
  2. Higher exercise intensity
  3. Exercise in a hot environment
  4. Insufficient calorie intake during the day of exercise
  5. Chronically insufficient calorie intake over a period of days
  6. Insufficient recovery time from a prior bout of exercise or multiple days of exercise as it takes nearly a day to restore glycogen after it has been used (in ideal conditions)
  7. Another recent episode of bonking
  8. Dehydration
  9. Limited prior exposure to depleting exercise
  10. Athlete inexperience

Athletes are not always aware of the signs and symptoms of bonking until they become more dramatic. Some symptoms of the blood sugar drop are mental and others are physical. The initial cues can be subtle but the symptoms can progress to more severe levels rapidly. Many marathoners know this as the feeling of “hitting a wall” around mile 18 to 20.

When bonking, pace per mile might initially change by something small, like 15 or 20 seconds. But if the effort continues and no calories are consumed, you could easily slow by 1-5 minutes per mile or even more.

I’ve known many hard-working, well-trained marathoners that train months for an “A” race, doing tons of distance and maybe even trained up to 23-26 miles. They feel strong but depleted at the end of those long training runs but they train more slowly than they race. So by running faster in the actual race they burn through their energy stores sooner and completely crash despite decreasing mileage for several days in advance of the marathon. That’s tons of training wasted because they refused to learn to eat a little something in the marathon.

Bonking happens around the same point for most people because we all store similar amounts of glycogen that are used up at similar rates. It’s possible that years of training could allow someone to burn a greater percentage of fat for energy, but harder efforts always require higher glycogen dependence. And having run for just a couple years isn’t long enough to perfect a fat burning metabolism.

The signs and symptoms of declining blood sugar, in a general classification order of increasing severity:

Your job is to detect symptoms as soon as possible in order to keep your state from declining further. Ignoring the symptoms and hoping for the best is never going to end well. If you have signs and symptoms consistent with the green items, there’s a good chance you can pull things back together if you take appropriate action, though it won’t be a day of personal best performances.

A few experienced and lucky athletes might be able to come back quickly from the yellow zone but nobody is bouncing back from the red zone. Only the more stubborn people will even push themselves far into the yellow zone. It’s a super dangerous, slippery slope. Don’t do it. You can’t win against physiology.

Many people don’t have the motivation to put themselves deep into the pain cave, so they just automatically slow down in order to feel better when they feel uncomfortable and have persistent negative thoughts. Kudos to you for not being a ridiculously stubborn fool like some of us!

Simply slowing down may be sufficient to finish out the workout or competition. If you don’t want to slow down, then you need to eat something containing carbohydrates as soon as possible. Ideally this would be something with simple and complex carbohydrates. There are receptors in your mouth that detect sugars and just the act of eating can immediately reduce the brain’s stronghold on protecting you… from you.

But there’s a good chance that you need to slow down AND eat something, depending on how long you are planning to exercise. If you are bonking after 90 minutes and planned to be active for 3-4 hours then it’s going to be unreasonable to sustain the same effort without eating many more calories.  

Three truths about bonking:

  1. You have to learn to eat during prolonged activity, even though you often won’t feel like eating, or the bonk will occur.
  2. If you don’t eat and your intention is to maintain both a high intensity and a prolonged duration of greater than 2 hours, the bonk will occur.
  3. Bonking is completely preventable.

Thanks for reading! Please let me know if you have any questions at derek@mountainridgept.com.


 

Coopers Rock Stump Jump 10K Trail Race Report and 6 Trail Running Tips

This Labor Day weekend I was looking forward to a little trail time at Coopers Rock State Forest. Last year I didn’t have a great performance at this race, ultimately blowing up in the last mile. For such a small event (61 racers this year), the fellow competition can be pretty stiff. I just remember it hurt more than the average 10K. In 2015, my speedy high school cross country running neighbor exclaimed “that’s the hardest thing I’ve ever done” afterward.

No doubt, the course is difficult, primarily because of the elevation changes. At nearly 800 feet of gain, no one is going to set a new 10K PR. Additionally, the easiest section, Roadside Trail, is along the first mile and then it becomes more technical from that point.

Tough elevation profile

Tough elevation profile

I expected that the switch to an early morning race time (9:00 a.m.) from last year’s afternoon time would be beneficial for performance. And it was. Sweat volumes were down 43% (exact figure gathered in a very scientific manner). The weather for running is fantastic in the forest now that September has rolled around and the humidity is dropping a bit. Fall can be the best time to run. Go outside!

Through my typical warm-up running I couldn’t seem to make my legs feel very powerful. This is entirely my fault for pushing them a little too hard earlier this week with weight training. They were not recovered and the soreness made that obvious. Not an “A” race but a slight bummer, nonetheless.

After the start, it didn’t take long for one racer to go hard off the front. Since he looked young, I opted to let him go alone at that quick pace, hoping he would explode on the brutal climb at mile 4 known as “The Wall” or “Vomit.”

I lost sight of him by mile 1 and promptly rolled my left ankle off the side of a small rock. It popped and hurt a little but wasn’t the worst roll ever, so I kept running. Maintaining a higher turnover cadence minimized the damage, thank goodness. Yes, I hurt myself on the easiest section of the course.

Tip #1: Look at the exact spot where you want your feet to land. Don’t look at anything you don’t want to touch. If you look directly at that slippery root or rock, you are probably going to step on it. That can be both good or bad. Set your gaze just beyond the bigger obstacles.

My splits were more consistent this year than last because I conserved in the first mile, so I tried to focus on an even effort now that I was alone in no man’s land. The legs were just not getting it done and never did come to life.

The descent that begins after mile 2 is lengthy, as it lasts until mile 4. It’s not super technical but it is long enough that it will take a toll on the leg muscles. But it is fun and there are a couple of logs and streams to hop. Think I jumped a stump in there too.

Tip #2: A course like this does not lend itself to obtaining even mile splits. You have to be good at reading your effort level or learn how to use a heart rate monitor to control your effort. With technical trails, you are likely to run at least 1-1.5 minutes slower per mile than a road 10K. And that’s just on the flatter or rolling sections. Hill climb miles will take an extra 2-3 minutes per mile, if not more.

At mile 4 the real climbing begins. Now that the descent has deadened your quads and so many miles have passed, we head up The Wall, where I always remember being unable to ride on a mountain bike as a teenager. That’s because it’s between 15 and 20% grade for the first tenth of a mile. But the whole climb is nearly a quarter of a mile long.

Tip #3: Nearly everyone walks on the steepest climbs of trail running. Anytime you choose to walk, walk with a dedicated, driven purpose. The walking is still going to allow a little recovery from running, even if you push your pace. So many folks hunch over, give up, and can’t even take a deep breath when they decide to walk.

There’s a moment of rest to be had while descending Rhododendron Trail, but it’s short-lived as the final 1.5 miles of the course account for at least 400 feet of the course’s elevation gain. This is where I was really suffering last year. I had conserved better this year and could actually push the effort a little bit.

Tip #4: Save a little something extra for a course that is known to have a large climb near the finish. You will always be more tired at that point than you think you should be.

Tip #5: Wait, you didn’t know there was a climb at the finish? Doing a little research can go a long way. Just ask around the group. Someone will be familiar with the area and course. I knew there was a long climb last year but I didn’t realize it would be so persistent and unforgiving.

About a half-mile from the finish the course drops into an awesome area known as Rock City where sandstone boulders are a gigantic 20-30 feet tall and large enough to contain a trail network. It’s a favorite for runners and hikers, as well as the average passerby.

A couple greenbriar snags later, at the finish, I was thrilled to cut a big chunk of time off of my attempt from last year. I would have been more happy to run this as a 20K since my old man legs haven’t done any speedwork lately.

Standing at the finish line, I saw many racers completing the event with blood on their legs, on their arms, and even on their faces. These trails are no joke.

Tip #6: You can catch a toe on anything that sticks up in the trail, at any time. Many accidents happen when you tire a little, let your guard down, and aren’t picking up your feet as high. But even with excellent vigilance and balance, falls are common to trail running.

Big thank you to Mark and Eleanore Jones who always do such a great job of directing these endurance events at Coopers Rock. As runners themselves, they get it done right. What a great way to support the Coopers Rock Foundation.

The 2016 results are over on iplayoutside.com at http://iplayoutside.com/Events/2016/09/16190r.html

The 2015 results are at http://www.webscorer.com/race?raceid=50270

Sunday Q and A

I recently had the pleasure of meeting with a few parents and students on the Mountaineer Middle School cross country team as they were getting ready to start their season. I wanted to touch upon a couple questions that were asked because I imagine multiple people, of any age, can gain value from the answers.

Question #1

One runner asked if there was anything he can do to change the fact that his legs become tired far before his breathing or heart feel fatigued during a race. This typically occurs for him halfway through, but then about 75% of the way in, he is able to overcome the leg fatigue to finish strong. This was especially problematic for him on flat courses.

First off, I expect this to occur to some extent, especially in a younger, less-trained, or less-experienced group of runners. It’s common to feel good and be excited, so you barrel off the line. It happens to everyone from ultra-marathoners all the way down to 400-meter runners. Let’s say we apply an old coaching philosophy: run the first one-third with your head (smarts), the second one-third with the legs (fitness), and the final one-third with your heart (desire).

Sounds like this young man has the final portion down but there’s a good chance his first one-third is faster than ideal. Young runners are notorious for going out too hard, which makes the later stages of the race more uncomfortable. One problem is that in a cross country race these kids almost always have to do this because the area available to run shrinks down to a narrow path where real estate is at a premium.

So let’s just leave the “going out too hard” concept alone for now, because it’s not a road race where you can easily pass people. This student has to go a little harder than ideal in order to be competitive in a 3K race. In order to get through that middle one-third, there will be discomfort, but it’s the point where the person with the most fitness will excel because he can recover on the move from the slightly too quick first third. Plus, there is research at the 5K distance to show that starting out 3-6% faster than average total race pace results in faster overall times. (http://www.ncbi.nlm.nih.gov/pubmed/17149992)

I suggested that this young man focus on his cadence just prior to the point where he feels the leg fatigue. As we fatigue, our cadence tends to slow down. There’s a good chance he ran the first one-quarter to one-half mile with a quicker cadence but then settles into a longer, more loping stride. At the same time, the pace drops a bit. To take some of the stress off of the painful quadriceps and calf muscles you can decrease your stride length and increase your turnover.

One good thing is that cross country around this region generally means terrain changes. Hill climbs are the perfect time to increase cadence. This is easily achieved by pumping the arms more quickly. The legs and arms will always be in sync. If you think about increasing speed of arm movement, the legs must follow. The steeper the incline, the shorter your stride should become. A single leg turnover of 96 per minute going up super steep hills wouldn’t be crazy. A gradual incline might demand something in the range of 88-94 foot strikes per minute.

Even on a flat course you can make the conscious choice to fluctuate your cadence. It’s a nice distraction, if nothing else. Hopefully it is done in a preventative manner prior to the leg muscles feeling highly fatigued, but better late than never. A flat cadence could be more like 84-90 per minute. On downhills it could easily drop into the upper 70s.

One key to all of this is to experiment and train with the cadence fluctuations. It’s not going to come naturally in a race if you’ve never done it before. Instead, it’s just another burden to add stress and you might just forget to do it. Plus you are more likely to waste energy if it’s extremely new. Your nervous system has to practice the quicker turnover in order to make it efficient.

The more recent GPS training watches, like the Garmin Forerunner series, have a cadence measure. It’s worth paying attention to this number while running. And if you upload the data onto the Garmin Connect website or other training sites, you can see where the cadence tended to slow down or speed up during training or racing. It wouldn’t be surprising to see the turnover slow just as the point of heavy leg muscle fatigue approached.

Here’s a fun little experiment. Go find your favorite hill for repeats. Something at least 100 yards long and hopefully more gradual. Run it hard once with your normal turnover rate. Run it again while trying to maintain the same pace but while really trying to stretch your stride out extra long with a slow turnover. Do it a third time while focusing on a super quick turnover, again maintaining the same pace. Now there’s going to be some fatigue by that point, no doubt, but can you feel the difference in the demands that it places on your body?

 

Question #2

One parent wanted to know if their child needed to drink a sports drink before their cross country meets. Not that I have a perfect diet, but I’m not a big fan of mainstream sports drinks in the first place because they are often loaded with tons of processed simple sugars.

In shorter races like the 3K or 5K, the runner is primarily relying on stored energy, glycogen, within the muscle fibers. For a short event there should be plenty of that stored glycogen available unless you haven’t eaten for several hours or maybe you exercised really hard in the 1-2 days prior.

Some sports drink sugars, like fructose, are known to cause stomach upset if consumed before, during, or after exercise. That’s not very conducive to performance (or a pleasant child, for that matter.)

A snack or lunch two to three hours prior to the event should be sufficient for topping off the calories needed to get through these shorter events. Drinking water after that point is plenty sufficient.

I’ve seen parents “grasping at straws” when their child has succeeded in the main season and is headed to a big event, like a state meet. Instead of sticking to the same nutritional plan that the runner had used all season, the well-meaning parent has their child drink some new mysterious sports drink 15 minutes before their race. Maybe the runner tolerates it. Maybe they don’t and fail miserably. That’s the equivalent of playing with fire in my mind. Go with what has worked in the past.

The one instance where I can think a sports drink might be appropriate is if the runner had missed their lunch or breakfast for some reason. And that should not be happening. Plus, the runner has hopefully tried the same sports drink on an earlier occasion. It might be smarter to have the individual carry an emergency “real food” snack. That’s a good idea anyway because you should avoid becoming hungry on race day.


Do you have any questions about training, racing, recovery, or injuries? If you do, shoot me an email at derek@mountainridgept.com and you might get to see the answer in a future blog post.

Three common overuse injury mistakes you are making and how to avoid them

Using the “wait and see” method:

There are two ways to go wrong with the “wait and see” method. In the first, an athlete, believing “rest” is the critical factor in injury recovery, takes a large amount of time off after the initial onset of pain. When they do finally return to activity, having had no pain for a day or two, they often start out with way too much intensity or time. If you haven’t run in 2 weeks, then the first run back should not be a 5-mile excursion. In fact, it should be quite brief. And of course, instead of running an easy 10-minute mile pace, your legs are fresh, so 7- or 8-minute miles seem suddenly more comfortable than ever.

Few people ever follow this advice because there is a misconception that rest fixes all. (Same assumption goes for surgery fixing everything, but that’s another story.) And then the athlete can’t figure out why the injury came back a couple weeks later. Of course that recurrence is followed by yet another solid block of rest and the cycle of inconsistency continues. The body WANTS to heal. I find that to be pretty amazing. The key is providing consistent exercise loading to not only maintain fitness but to improve tissue integrity.

Don’t get me wrong. Rest is extremely important in recovery from training and from injury. But it should all be administered in appropriate doses. If you know, deep down, that rest is powerful then you should be doing a better job of resting prior to any symptom onset, not waiting until something hurts. Rest should never be considered as the primary method to address injury.

In the second scenario, the athlete ignores their initial injury symptoms and continues to exercise, waiting for the injury to spontaneously resolve. This can stack too much stress onto an already injured area. It’s often easy to do with running, because so many muscle and tendon injuries actually feel better once the tissues have warmed up a bit. That’s why overuse injuries are so deceiving. If the pain is gone while exercising, you must be doing okay, right? Well, no, it’s not that easy.

If we were to classify the onset of pain from overuse injury, there’s typically a progression:

  1. Pain only after exercise.
  2. Pain during exercise, though not at a high enough level to stop.
  3. Pain during exercise that does limit time or performance.
  4. Pain so severe you absolutely cannot exercise.

Athletes often become stuck at the second phase. Sometimes for months at a time. When they approach the third phase, they suddenly become desperate and finally begin addressing the things they knew were problems in the first place. Don’t be “that guy.”

Consider yourself only as good as your last successful, pain free run. Best not to worry about progressing when injured if you want a long career. Best to worry about preventing regression and working on your known problem areas, like hip strength or ankle range of motion. If you don’t know where your problem areas are, seek guidance from a movement expert.

Relying on pills and injections:

Everybody loves a “quick fix.” Some like it because it requires no real effort or time to take a pill. Others like it because it might reliably take pain away and they are unaware of any other treatment option. For some people, they feel they don’t have time for proper injury treatment. In any case, once the pain decreases you expect to go on about your training as soon as possible without any other care.

But think about this for a moment. If a mechanical stress led to your painful tissue damage, then there’s good reason to focus on a mechanical solution when there is one available. Medicines aren’t typically designed to alter mechanical stress. Let’s say the medication did stop the pain. Just because the pain stopped doesn’t mean the underlying problem went away.

Unfortunately, rarely is the proper solution a quick one. Pills and injections are not a reasonable long-term solution. Just like appropriate doses of rest, NSAIDs and corticosteroid injections certainly have a place in treatment. But they are not a valid long-term option for relief of overuse damage.  

Blaming the shoes:

I am guessing the shoe industry is at fault for this perception. It’s not about the shoes. Overuse injuries are likely to be caused by a variety of factors but most frequently by training errors. This means your intensity was too high, distance too long, or the rest was insufficient. (This is the third time I have mentioned rest!)

Even the biomechanical flaws that I might address in the clinic take a back seat to poor program design. We are highly adaptable. Each running technique is known to stress specific tissues.

What might be considered horrible running technique can be safely performed if you progressed slowly enough and were strong in all the right muscles, tendons, and ligaments.

Summary:

Like the cause of the injury, resolution should be a multifactorial approach. The trick is going to be exercising within the tolerances that the injured area allows while also working on any related deficits. Back the distance and pace down.

It’s unreasonable to believe that you don’t have mechanical deficits somewhere that contribute to the injury. Training errors in speed and time just make those flaws more prominent. You must look outside the area of injury. The body relies on an integration of systems for movement so if just one system fails at its job then you have a problem. And that problem probably isn’t where your pain is occurring. Is your balance perfect? Movement awareness stellar? Posture perfect? Strength out of this world? Have the joint motion of a 10 year old? Unlikely. Bring home those new shoes and get to work on the right things.

 

Strength Training for Runners, Part 5: Exercises

To finish up this series of posts on strength training, let’s cover a few examples of exercises that you can incorporate into your routine. Most of the videos focus on the lower body and trunk, though you should certainly work the upper body. With several of the lower body exercises, you can integrate in an upper body component to add an additional challenge. The Mountain Ridge Physical Therapy YouTube page contains several variations of these exercises, from basic to advanced versions. 

Quadriceps

Lunges, Bulgarian split squats, Squats, Step ups, Step downs, Plyometrics

Hamstrings

Squats, Hamstring curl with swiss ball, Hamstrings heel slide, Deadlift, Single leg deadlift, Plyometrics

Lateral gluteals

Side lying leg lift, Single leg pelvic drops, Airplane, Clamshell

Gluteus maximus

Lunges, Squats, Step ups, Single leg bridges, Double leg bridges, Glute thrusts, Plyometrics

Gastrocnemius/soleus

Calf raises, Plyometrics

Hip rotators

Single leg hip rotation

Abdominals

Front plank, Side plank, Anti-rotation walkout

Low and mid back extensors

Prone trunk extensions (Superman), Thoracic rotations, Front planks, Side planks

 

Please let me know if you have any questions at derek@mountainridgept.com. If you enjoy reading these articles and applying the information to your training, please “like” the Mountain Ridge Physical Therapy Facebook page.

 

The art and science of exercising in the summer heat

Your body is finicky about its temperature, which means it will carry out whatever processes are necessary to stay within the best working range. And that includes slowing you down when you go outside to exercise.

In a hot environment, at rest and with activity, blood is diverted to the skin for cooling purposes via increased sweat production. The sweat on the surface of the skin leads to a loss of heat via convection and evaporation (hooray for science). It’s a pretty awesome and effective system - as long as you aren’t working at really high effort levels or in a really hot and humid environment.

Sustained exercise causes a shift of a portion of our blood volume to the working muscles. And the bigger the muscle used, the bigger the blood supply required to keep it going. Harder efforts will inevitably use more energy at a quicker rate and therefore increase your core temperature to even higher levels than easy efforts. That’s where the sweating mechanism gets a little more inefficient as you are generating more heat than you can get rid of. High humidity also affects the cooling mechanism because the evaporative efficiency of sweating is reduced.

And then we add a third concern: dehydration. Dehydration decreases overall blood volume which magnifies the blood distribution problem further. This means there’s less blood volume for cooling and less blood volume for working muscles. This does not mean you need to go overboard with drinking water, as you could end up in a dangerous state of hyponatremia where you have actually diluted your body’s electrolytes. This ultimately wreaks havoc on your brain function and can lead to death. Some level of dehydration is expected during hard exercise in hot conditions, you just don’t want it to get out of control. Drink to quench your thirst and do not try to drink excess amounts to “stay ahead” of water losses.

Unfortunately, when it’s hot, the body uses more of its stored carbohydrate, glycogen, for energy. This may not be much of a factor for a 30-minute run, but if you intend on racing a marathon you must consider it a factor because you are hoping for your glycogen stores to last as long as possible.

You might think you can compensate for that increased glycogen loss by eating more during longer runs, but there are still a couple problems. One problem is that when the core blood volume is reduced to maintain cooling and supply working muscle, there isn’t much blood left for the internal organs, particularly the intestines and stomach. The other problem is that any carbohydrate you take in while exercising in the heat is used at a slower rate.

With the loss of blood volume to the digestive organs, your stomach might feel like it has a brick in it after deciding (too late) to eat that first gel at mile 10 when you realize you are suddenly feeling woozy. Is it the heat? Are you dehydrated? Was it the pre-race pasta dinner? It’s just poor planning and underestimating Mother Nature.

Those gels are meant to be consumed with large amounts of water: 6-10 ounces. Guess how much water is in one of those little aid station Dixie cups? Probably 1-2 ounces. Gels are a very concentrated source of calories, so the proper amount of water needs to be included to dilute them or it will often upset your stomach.

Once the woozy bonking has started, it’s usually too late to get those calories in quickly and maintain your pace, at least for a few minutes. So back off the pace, eat, and then reassess. You can keep the workout from being a complete disaster by making that choice to slow down for a mile and getting in some extra calories and fluids when you first notice a decline in performance and mental state. A slower than expected race finish is better than a DNF, and slowing down on a training day is better than needing your significant other to come pick you up in the car. Nobody needs to see your Road ID bracelet today.

Prevention is the optimal solution for feeling well and having a decent race or training day when the heat is brutal.

Most of us are capable of absorbing around a liter of water per hour but for prevention all you would need to do is drink 16-20 ounces of fluid per hour. I’m saying “fluid” because you may like energy drinks, but realize those don’t always work well in the heat for the same reason the gels can be a problem; too many calories and not enough pure water can slow the rate that fluids are absorbed in an already stressed digestive system.

You should also consume a small amount of calories early and often. Maybe you normally take in 100 calories per hour starting at 45 minutes in a 2- or 3-hour event. Well, you might start at 25-30 minutes instead and try to do it in smaller quantities and at more regular intervals. You might see if you can get in 110-130 calories in an hour instead. And preferably use something you have eaten in hot weather and at a high effort before. There’s nothing worse than experimenting on the day of a competition. Don’t blame me if you haven’t tried these things out before race day.

If you can pull it off, it is wise to use ice and cold water to help regulate your body temperature before and during exercise. During my most recent long run, which lasted 2.5 hours in the middle of a humid 90-degree day, I sat or stood in four creeks for 1-2 minutes each. I’m sure some purist runners would have a problem with mid-run stops, but I consider it a way to ensure success and consistency in pacing for the remainder of the run. You can also chew on ice, use wet sponges or clothing, and place ice within your hat and clothing. If nothing else, the cold is a nice distraction.

Proper pacing or effort dosing is critical in prevention. Expect the worst if you plan to start out at your PR pace on a humid 85-degree day. The calculator at this link can help guide pace adjustments. It’s probably not going to be a PR kind of day but finishing strong would be nice wouldn’t it? It’s also not the kind of day to do speedwork or long, hard pushes in a competition.

A huge part of prevention is regularly having heat exposure during exercise leading up to a particular event. This is the reason why you will experience a disaster day if you always train early in the cool mornings or only exercise indoors at a 65-degree gym. Your body is exceptionally good at adapting to the stressors consistently placed upon it. Try to have the heat exposure for at least two weeks prior to a hot competition or big training day.

Some other thoughts:

  • Plan ahead by checking the weather forecast before you head outside.
  • Try to exercise in shaded areas to avoid direct sun exposure that will heat you more.
  • Figure out ahead of time if you are going to develop blisters from wet socks and shoes by going for multiple brief runs with the shoes and socks wet. Shoes that are well broken-in are less likely to be a problem.
  • Wear light-colored clothing.

Clearly, exercising in a hot environment requires your body adjust to not one but many stressors: your working muscles, increased need for temperature regulation, and increased demand on glycogen energy stores. Training or competing in the heat doesn’t have to be dangerous if you are otherwise healthy, well prepared, and plan appropriately.

Seek medical attention if you have any of the signs and symptoms of heat illness:

  • Headache
  • Nausea
  • Vomiting
  • Pale, ashen, or flushed skin
  • Loss of sweating
  • Confusion
  • Loss of or changes in consciousness
  • Excessive fatigue
  • Sudden onset of weakness
  • Visual disturbances
  • Chills
  • Severe muscle cramping
  • Severe stomach cramping

Stay safe out there. Share this article with all of your exercise buddies. If you have any training questions contact me at derek@mountainridgept.com.

 

Strength Training for Runners, Part 3: How?

So hopefully I’m persuading a few runners to try adding strength training to their regimen. Let’s go over some general strength training tips and the primary objectives to consider for the various muscle groups.

Strength training tips and objectives

1. Your primary goal is to place a stress on the body that it isn’t accustomed to and that, in some ways, exceeds the stress that running places on the body. This demand is what leads to positive adaptations.

  • Efficient running is stressful for the muscles, tendons, bones, joints, and other tissues in the body.
  • Inefficient running is even more stressful on many of these structures, which means you want to either get rid of the inefficiency (ideal) or make your body more tolerant of it (not ideal).

2. The progression should go as follows: mobility → skill → stability → endurance → strength → power

  • This means you need to master the basic movement pattern with a full range of motion far before you attempt to move heavy amounts of weight or move explosively.
  • Running requires tons of repetitions of a powerful movement yet many people don’t have the basic mobility and strength down to safely use that power.

3. Circuit train, especially if you aren’t accustomed to strength training yet.

  • Runners love to stay moving, so your earliest forays into strengthening can emphasize circuit training of the entire body. Circuit training allows you to move right from one exercise into another, bringing the heart rate up and providing a similar feel to the constant work of running that we crave.
  • Circuit training is more reasonable from a time-management perspective.
  • If you are new to strength work, alternate upper body, lower body, and core exercises to let each muscle region recover effectively in between exercises.
  • More experienced athletes can stack a single set of two or three similar exercises together to increase the muscle demand. For example, lunges followed by single leg squats and then on to step-ups.
  • You can add plyometric and agility drills throughout the strength session to keep the heart rate up and integrate running with speed, which is discussed next.

4. Integrate strengthening into your run workouts to improve your awareness of how to use those muscles while running.

  • Going back to circuit training, here’s one of my favorite winter activities when the weather is horrible and I must run inside:
    • Treadmill run 5 minutes
    • Hip strengthening and stability 1-2 minutes
    • Core strengthening and stability 1-2 minutes
    • Leg strengthening 1-2 minutes
    • Wash, rinse, and repeat for 45 to 90 minutes total
  • Perform a couple of bodyweight resisted exercises like leg raises or planks during your warm up to emphasize core and hip stability, strengthening, posture correction, and muscle awareness.

5. The abdominals (and actually some hip muscles) are primarily stabilizers when you run so learn to use them in that way.

  • Instead of crunches or sit-ups, use variations of planks and bridges.
  • Emphasize single leg activities with the pelvis held in a level position. I reviewed the pelvic position last week with the Trendelenburg's sign.

6. Work one side of the body at a time.

  • Symmetry in muscle strength is a key point. Working both sides of the body at the same time is less challenging and less productive because you will inevitably use a more dominant side without even realizing it.

7. Work multiple muscle groups simultaneously by emphasizing “closed chain” movements.

  • Closed chain implies the end of the leg or arm will be in contact with the ground or fixed object. Examples include squats, lunges, push-ups, step-ups, power cleans, planks, pull-ups, and most plyometrics like jumping and hopping.
  • Closed chain movements mimic running and normal daily activity. Open chain exercises, like leg extensions, do not often duplicate our day-to-day movement.

8. Think about performing exercises by the plane of movement that you move each joint through and then do a little work for each plane.

  • Squats and lunges emphasize a forward/backward plane at the knees and hips.
  • Single leg hip rotations emphasize a horizontal plane at the hips.
  • Pelvic drops emphasize a side-to-side plane at the hips and trunk.

9. When an exercise has become too easy, add an element to decrease stability and see if that doesn’t increase the difficulty.

  • For example, a standard front plank is easily advanced by lifting one leg, one arm, or both at the same time. The idea is to increase the wobble factor.
  • Some equipment options to increase instability include swiss balls, BOSU balls, and wobble boards.
  • Many standing exercises can be performed on a single leg to challenge the stability but you need to be proficient with their double-legged versions first.

10. Avoid using machines, emphasize free weights.

  • The limited range of motion keeps you from working in the positions that you actually need to gain usable strength.
  • Machines do not challenge the stabilizing muscles and nervous system components that can be beneficial for injury prevention and optimal performance.
  • Free weights are more likely to mimic the tasks that we perform in daily life because we commonly lift and move heavy objects.

11. Reduce strength training loads primarily in the week before your “A” races but not before “B” or “C” races.

  • Strengthening is part of the constant stimulus that you are trying to adapt to, so you don’t want to recover excessively before your low priority events. Train on through.
  • While training just before a low priority event you can decrease the number of repetitions in a set by 3-5 but keep the weight the same.
  • Before an “A” race, decrease both the sets, resistance, and repetitions if you have been working with resistances that cause failure at higher repetitions (i.e., do only 1-2 sets of 15-30 repetitions instead of 2-3 sets of 15-40 repetitions). If you have been gearing up with really high loads and performing more powerful, explosive moves, then back the sets down and the resistance only slightly (ie. do 2-5 sets of 3-8 repetitions instead of 5-6 sets of 3-8 repetitions).

12. Once your priority event has passed, back off of the rapid power and agility movements and encourage basic strength and strength endurance again for 2-4 weeks.

13. Perform strength training on shorter or less intense running days, especially if you have never strength trained before.

  • We don’t need too much of a good thing. Too much exercise stimuli in a day or series of days is a recipe for injury.
  • I often still use running as a brief warm-up before strengthening and, as mentioned, incorporate running drills throughout the strength workout.
  • Strength days are a great time to do other cross training on a bike, elliptical, rower, rock wall, or anything that allows you to experiment and break up the monotony of running.

14. A general initial strengthening structure could consider spending:

  • 50% of the time on the large primary movement muscle groups that undergo heavy use in running to improve overall movement strength and strength endurance.
    • These muscles, like the quadriceps, gluteus maximus, and hamstrings, can be pushed harder with higher resistances.
  • 25% of your time focusing on the muscle groups that are not dominant and become neglected in the running motion to prevent injury.
    • These muscles, like the deep gluteals, usually require very little resistance because they are not large or power producing.
  • 25% of the time integrating plyometric drills to increase power output, speed, and agility.

15. Allow at least 6-8 weeks of working at least 1x/week for noticeable performance changes.

In next week's blog I'll go over more application specifics and exercises. 

Please let me know if you have any questions at derek@mountainridgept.com. If you enjoy reading these articles and applying them to your training, please “like” the Mountain Ridge Physical Therapy Facebook page.

Strength Training for Runners, Part 2: Why?

Why strength and plyometric train?

Why not strength and plyometric train? That’s a better question. My personal excuse is that it’s not as fun as running, partly because it’s not done outside and nowhere near the woods. I’d rather move me, not a dumbbell. Although I’m sure some would say by moving myself I am indeed moving a dumbbell. *Sigh*

For myself and many other runners, strengthening is a necessity if you want to run long, hard, or into old age. I will gladly give up 3-6 junk miles every week to take the time for this type of cross training. Strength training gets me to a point that makes the other runs more enjoyable. How does it improve my running enjoyment? Largely because I stay less injured overall, my back doesn’t hurt during long runs anymore, I recover quicker, and my legs never get that completely destroyed feeling in long races that they once did.

I would argue that running itself is a series of plyometrics. (The Merriam-Webster definition of a plyometric activity is “exercise involving repeated rapid stretching and contracting of muscles”). Plyometrics are just high speed strengthening.

Here are a few reasons runners should consider strength training:

1. Strength training improves performance. Every runner can benefit from strength training. Competitive trail runners, marathoners, and speed demons who compete at any distance could reap very significant gains. At the same time, the less competitive folks running just for fun could benefit too.

The mechanisms of improved performance can be attributed to any one or a combination of the following factors:

  • Increased hip and core stability
  • Increased force production of the muscle fibers (aka strength)
  • Increased fatigue resistance of the larger leg muscle groups (aka endurance)
  • Increased endurance of the core, hip, and leg muscle groups while producing greater force (aka strength endurance)

Increased hip and core stability

Having a strong core and hips takes unnecessary trunk motions out of the equation. You can then move the arms and legs more quickly and with greater force without disrupting the stable base. I noticed this in the 2016 women’s 10,000 meter U.S. Olympic trials. Molly Huddle maintains a very stable trunk posture. As a result, there is less energy wasted during the early and middle part of the run and that energy can be put to use in the closing laps. And at that point many of the competitors are flailing anyway.

 

Increased force production

As far as the prime movers of the legs go, if you want to move faster while running, your options are to:

  • increase turnover while maintaining the same muscle force output,
  • increase force from the muscles while maintaining the same turnover, or
  • increase both muscle force and rate of turnover.

Strength (and plyometric) training is a great way to teach your larger leg muscles to generate that force in an efficient manner. Many of the changes that we would refer to as increased strength are actually the result of the nervous system’s ability to refine how the muscle fibers fire. It’s definitely not all about making the muscles bigger. By increasing the ease and efficiency of force production, you can become faster.

Increased fatigue resistance of the larger leg muscle groups and increased endurance of the core, hip, and leg muscle groups while producing greater force

Greater total muscle strength can lead to greater strength endurance capacity. Strength endurance is concerned with the ability to generate a certain force for a prolonged period. In other words, after strength training for a few weeks I can make a muscle produce the same or greater force for a longer period of time before it begins to fail. This is a huge benefit if you have reached the limits of what your fast-twitch muscle fibers are willing to perform with standard running interval training techniques.

Racing and hard efforts can rely heavily on the fast-twitch muscle fibers, and slow endurance training does very little to train these muscle fibers because slow training is primarily using slow-twitch muscle fibers. You can only perform so much high intensity interval work while running so strength training is another way to stimulate these muscle fibers. By regularly training the fast-twitch muscle fibers, you can improve movement economy and improve fatigue tolerance. Better fast-twitch muscle fiber use will help you when bridging a gap in a race, moving at faster speeds, and climbing hills.

2. Strength training can help you prevent injury. There is research citing decreased injury incidence in athletes with consistent strength training routines (http://bjsm.bmj.com/content/early/2013/10/07/bjsports-2013-092538.abstract). Stretching, on the other hand, has no consistent research support in injury prevention. For one, as mentioned, proper strength training helps to increase hip and core stability so that the legs and arms are moving on a stable base. My theory would be that it’s mostly the strength, stability, and muscular endurance of the hips and core that help to keep a runner away from injury though it's certainly important to train the rest of the leg as well. This is where many runners have the wrong idea of what strengthening should really be about. The primary objective is to take the unnecessary motion out of the system in order to reduce the injury causing “slop.”

3. Strength training can help you recover from injury. Often, strengthening of specific muscles is a vital component of any patient’s injury recovery in my clinic. In the case of both injured and uninjured tissues, the intention is to rely on these primary concepts:

  • Improved structural integrity of muscle, tendon, ligament, and bone, and
  • Improved strength and neurological activity in weak muscles

4. Strength training changes your perspective on higher training intensities. If you can perform enough repetitions with a high resistance that you reach a point of true muscle failure, you begin to understand what it’s like to really push that extra bit of effort from yourself. That can make a finish line sprint or track workout feel a little easier, for the muscles at least.

5. Strength training helps decrease age-related strength loss. Aging causes a loss of the fast-twitch types of muscles fibers and their associated nerves. Frequently demanding work from those muscle fibers slows the rate of loss. Nobody wants to lose the strength necessary to do daily tasks but I assure you that it will happen if you let it. I didn’t think about this until I started approaching 40 years of age (and the girls stopped whistling at me.)

6. Increasing strength makes you a generally healthier individual and a well-rounded athlete. There’s nothing better than being able to confidently lift a 50-pound bag of potting soil from the ground without fear of hurting your back. And being able to randomly and confidently play a pickup game of {insert any sport here} is pretty awesome too.

7. Variety and changes in your training program prevent burnout and staleness. The same old, same old becomes dull and demotivating for most people. There is so much variety possible with strength and plyometric training that it can really freshen up your outlook.

8. Strength training can boost you through a performance plateau. The repetition associated with some endurance training programs will inevitably lead to a plateau in many athletes. In order to bust through the plateau you need a new type of training stimulus. Resistance training can be that stimulus if delivered correctly over a 4-8 week period of time, especially if you add the plyometrics and change up your running interval program.

Please let me know if you have any questions by emailing me at derek@mountainridgept.com.

 

Should you exercise while taking antibiotics?

Did you know that there are some prescription drugs that can have a negative impact on exercise capacity, recovery, and injury?

As if most of us didn’t already dislike taking antibiotics, now you might want to think about the documented exercise-related side effects from a specific family of antibiotics known as fluoroquinolones. These drugs have been associated with a risk of tendon rupture and tendon overuse injury.

Image courtesy allmedtech.com

Image courtesy allmedtech.com

Fluoroquinolones are frequently used to treat sinus infections, bronchial infections, and urinary tract infections, and work well against a large variety of bacteria. Which means many of us have taken these drugs.

Examples of these drugs include:

  • Levaquin (levofloxacin)
  • Cipro (ciprofloxacin)
  • Avelox (moxifloxacin)
  • Floxin (ofloxacin)
  • Factive (gemifloxacin)

Despite the consistently positive effects, in May 2016 the FDA made this statement available: “An FDA safety review has shown that fluoroquinolones are associated with disabling and potentially permanent, serious side effects that can occur together.  These side effects can involve the tendons, muscles, joints, nerves and central nervous system. As a result, the FDA is also requiring label changes for all systemic fluoroquinolone antibacterial drugs to reflect this new safety information.”

The FDA is not suggesting that doctors should stop prescribing these drugs. They are suggesting that they should not always be the first line treatment.

These side effects have been researched since 1996 (and one source documented tendon damage from the use of one of these drugs in 1983). Often the individuals begin to have tendinitis-like symptoms that quickly progresses to partial or full tearing of the involved tendons. Achilles tendon damage has been particularly well documented with tendinitis and ruptures.

image courtesy abc2news.com

image courtesy abc2news.com

Does this mean you will definitely have a torn tendon after taking these antibiotics? No. But as an individual with a more active lifestyle that heavily stresses your connective tissues, you should be aware and concerned if you begin to have tendon pain while taking or shortly after taking a course of these drugs.

Before taking these drugs, you may want to discuss the need for that particular prescription with your doctor, as you might qualify for another option. Should you begin taking these antibiotics while having an already existing tendon injury, be extra cautious with your activity for at least a month (negative effects have reported up to three months later). If you begin to have tendon pain while taking them, get in touch with your prescribing physician.

Having seen many patients who underwent surgical tendon repair procedures, a tendon rupture is not an injury that you want to deal with if it can be avoided. The likelihood of rupture is rare with 15-20 cases per 100,000 drug uses. If you must use that specific family of drugs be sure to monitor yourself, cut back on your exercise routine and talk to your physician if you should start to develop tendon region symptoms.

The information provided here is for informational purposes only. If you are concerned with your antibiotic use, seek further guidance from your primary care medical professional. 

Geek out:

  • http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm500325.htm
  • http://www.runnersworld.com/injury-treatment/fda-warns-of-tendon-damage-linked-to-antibiotics
  • http://www.medscape.com/viewarticle/410546_3
  • http://www.ncbi.nlm.nih.gov/pubmed/15777120
  • http://www.ncbi.nlm.nih.gov/pubmed/12587511
  • http://www.ncbi.nlm.nih.gov/pubmed/8863030
  • http://www.ncbi.nlm.nih.gov/pubmed/8832995
  • http://www.ncbi.nlm.nih.gov/pubmed/11409663
  • http://www.ncbi.nlm.nih.gov/pubmed/21686678