Where We’ve Been

Marriage is not always pretty. It can be downright fussy. Until you realize without warning, it’s perfect. I’ve walked down the aisle four times, and ran out the front door three. Maybe it’s not the perfect record, but I’ve always said, I am where I am because of where I’ve been.

The anniversary of my last walk down the aisle was last Monday. Eighteen years ago, at 39 years old, I knew from the get-go this marriage would not go down in the Guinness book of records for the longest marriage ever – we wouldn’t live that long. What I did hope for was a ‘good’ marriage. I felt certain I could accomplish this small feat with the perfect partner.

For those first few years it was obvious you don’t pick the perfect partner – you create one. Then I realized he might be feeling the same way about me. Getting the little things right seemed incredibly urgent. I couldn’t believe he didn’t understand how important it was to turn the lights off when he left a room. He found it amazing I couldn’t be happy with the same cleaning service, gardener, or dry cleaners.

I asked him what he had learned the most after being married to me for 18 years. He said patience. After we I laughed, he told me he’s learned that I’m hard-working, thoughtful, a good listener, and that he appreciates that I have what he calls positive ambitions. The funny thing is I would have said all the same things about him.

He holds my hand when we walk together, and kisses me before he leaves to go anywhere. I think he’s the smartest person I’ve ever known. . . and the last time I wrote glowing things about him to this blog, his ego got so big I could hardly live with him for a solid year.

The first marathon I ran was 10 years ago, which means he’s spent more than half our married life enduring my long-run days, and the resulting middle-of-the-night gimps to the bathroom. It crosses my mind that we’re both getting older and you never know what these middle-of-the-night gimps may be preparing us for.

Our resolve has been tested at times, but our best decision seems to have been to approach everything as partners. We would end up being partners in businesses, investments, as parents to each other’s children, and with our families – although we both agree the most important partnership has been in life itself.

The fast-paced and adventurous early years have transitioned to simple, sometimes lazy days of retirement where it seems more important than ever to be at peace with yourself and each other. We are here, after all, because of where we’ve been.

 

The Anatomy of a Runner: Pain

The sixth in a series of posts about what makes runners uniquely equipped to run. This post explores why it hurts. . . and how to make it stop.

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Photo: Jonathan Moore/Getty Images

Being a distance runner is about handling pain. If you can’t manage pain, you probably won’t end up as a distance runner.”

KARA GOUCHER, American long-distance runner

There are many ways to categorize pain, but a broad definition would be acute vs chronic. Acute pain comes on suddenly, has a limited duration, and is often caused by damage to tissue (bone, muscle, organs). Chronic pain lasts longer and is more resistant to medical treatment, such as with long-term illnesses like osteoarthritis.

IMG_33971 of 3 graphics from totalinjury.com: How the Brain Responds to Pain

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WHY IT HURTS

IMG_3374Recurring pain is normally caused by:

  • mechanical injury, such as a fall or twisted joint;
  • repetitive micro trauma, as with overuse injuries that cause stress to the tendons or bones, or micro tears to the skin, as with calluses or blisters; or
  • muscle imbalances – weak glutes, overdeveloped quads, or not having a strong core, for example.

The medical community says “pain is what you say it is” because pain is subjective. A person’s general health, previous experiences, stress, anxiety, depression, and motivation can influence how we perceive pain.

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Totalinjury.com

Soreness vs Pain

Muscle Soreness

Everyone gets sore with intense exercise. Pain from sore muscles is usually felt the next day and comes from microscopic tears in the muscle fiber. Rebuilding of the muscle damage creates larger, stronger muscles.

If soreness seems especially severe and lasts for several days, it’s probably delayed onset muscle soreness (DOMS), and may be a result of performing new exercises at a relatively high intensity. Studies suggest theories to explain the mechanisms of DOMS, including lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and enzyme efflux.

Muscles build up resistance to DOMS with multiple sessions, but new runners who can’t shake the burn after a day or two can try massage or light exercise. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms.

Reference: Cheung K, Hume PA, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003;33:145–164

Sharp Pain

A sharp pain during exercise – in contrast to muscle soreness – can be indicative of an injury. This type of pain can be located in the muscles or joints, and may linger without fully going away even after a period of rest. Runners should not push through a sharp pain since it can exacerbate the injury.

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Source: American Physical Therapy Association (APTA)

ATTACK AND HEAL

IMG_3449The body’s response to injury is inflammation, which is designed to attack and heal. The early stages of inflammation enlist the immune system to protect the body and control infection. Like pain, inflammation is categorized as acute or chronic.

John Hunter (1728–1793, London surgeon and anatomist) was the first to realize that acute inflammation was a response to injury that was generally beneficial: “But if inflammation develops, regardless of the cause, still it is an effort whose purpose is to restore the parts to their natural functions.”

Increased blood flow to the area causes redness and heat; the accumulation of fluid causes swelling, pain is due to the release of chemicals that stimulate nerve endings, and loss of function is a combination of factors.

Inflammation is part of the natural healing process; without it wounds and tissue damage would never heal. Reducing inflammation may be necessary in some cases where inflammation has caused further inflammation – becoming self-perpetuating, which may lead to chronic inflammation.

When joint tissues have not been given adequate time to fully regenerate between workouts, they may become chronically inflamed and/or degenerate to the point of serious injury. Overuse injuries, such as runner’s knee, develop in this manner. It’s the harder than normal workouts that cause significant tissue damage and post-workout inflammation. For this reason, most training programs increase duration and/or intensity more slowly to allow the body the necessary time to recover and adapt.

Note: Scientists at Emory University School of Medicine in Atlanta, Georgia, found in a study that poor sleep quality, and short sleep durations are associated with higher levels of inflammation.”which in turn increases the risk of developing heart disease and stroke.” What drives the inflammation in the first place is still a mystery.

Pain Management

Physiologists at the University of Wisconsin used spinal injections of a powerful painkiller to block lower-body pain in a group of cyclists; the cyclists actually got slower. They initially felt great and started out faster than normal, but then faded. Without the feedback of pain, they couldn’t pace themselves properly. Training to live with pain: What we can learn from Olympic athletes 

Everyone reacts differently to pain, which means how each person manages their pain will also be unique. Complicating each approach is the fact that injuries themselves react differently to treatment therapies. Following is at least a partial list of pain management therapies, in no particular order.

Ice or Heat? If the injury is sudden and acute, ice is preferred for the initial two or three days post injury – 20 minutes each two to three hours until the ‘heat’ comes out of the injury. Ice will also reduce inflammation and provides pain relief by reducing the blood flow to that area.

Heat should be avoided in the first 48 hours as it encourages bleeding. Once the ‘heat’ is out of the injury, heat packs can be used to stimulate blood flow, which will aid healing, help muscles relax and ease the pain – 20 minutes a few times a day using a heat pack, or alternatively take a warm bath or hot shower. Heat stimulates sensory receptors to block the transmission of pain signals to the brain.

Post Exercise: Ice, Heat, or Both? Although light exercises or gentle stretching may be equally effective in reducing pain after a hard bout of exercise or race, ice baths, or cold water immersion, has long been a popular interventional strategy (the ideal temperature range seems to be between 50 and 59° F for 10-15 minutes).

There is some reasoning that the benefit has less to do with the temperature of the water than the immersion itself, however, and the deeper underwater the body is, the better (in other words, jumping in a lake or swimming pool is even better than soaking in a tub).

Read more:  Ice, heat or a little of both? How do you recover from a hard workout?

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1 of 5 graphics from RunnersWorld “Where it Hurts”

Meditation: studies show that meditation increases immune function, decreases pain, decreases inflammation at the Cellular Level, decreases anxiety, depression and stress, increases grey matter of the brain and cortical thickness in areas related to paying attention, improves focus and memory (see all the studies at psychology today.com.) Lebron James, Kobe Bryant, Misty May-Treanor and Kerri Walsh are a few of the athletes that meditate to improve their game.

Strapping tape vs supportive tape: taping can stabilize and support the injury, provide pain-relief via de-loading of the vulnerable or painful structures, and facilitate normal movement, muscles or postural patterns.

  • Rigid strapping tape is commonly referred to as ‘sports tape’ or ‘athletic tape’.
  • Elastic strapping tape can be used when less rigidity or support is required.
  • Kinesiology tape is an improved version of elastic sports tape that acts to dynamically assist muscle function.
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RunnersWorld
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RunnersWorld

Massage: Massage has been utilized in the treatment of illness and injury for thousands of years by health care practitioners as a treatment for reducing stress, pain and muscle tension. Nonetheless, research has generally failed to demonstrate massage significantly contributes to the reduction of pain associated with delayed onset muscle soreness, enhances sports performance and recovery, or plays a significant role in the rehabilitation of sports injuries. The most successful treatments combined a massage therapy program that also included stretching, walking, swimming, aerobics, strengthening exercises, and education on posture and body mechanics. (Reference: The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction – Jason Brummitt, MSPT, SCS, ATC  North American Journal of Sports Physical Therapy)

Three forms of massage are frequently reported in sports medicine literature: effleurage, petrissage, and deep transverse friction massage (DTFM).

Massage therapy modalities can include Swedish, Deep Tissue, Sports Massage, Trigger Point Therapy, Thai Massage, Thai Herbal Compresses, Hot Stone, Lymphatic Draining Therapy, Shiatsu, Cupping, and Reflexology, among others.

Acupuncture: Dating back more than 2,500 years, acupuncture is based on the premise that there are more than 2,000 points in the human body connected by bioenergetic pathways, known as meridians where Qi, or energy, flows. When a pathway is blocked the disruptions can lead to imbalances and chronic disease.

In various studies, acupuncture has proven beneficial in the treatment of chronic health conditions, and has been found safe for children. It works, in part, by stimulating the central nervous system to release natural chemicals that alter bodily systems, pain and other biological processes.

Proprioception / Balance Exercises: These exercises teach your body to control the position of a deficient or injured joint. A common example is the use of a balance or wobble board after an ankle sprain. Unpredictable movements provoked by the balance board re-educates the body to react without thinking, restoring natural balance and proprioceptive reactions.

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RunnersWorld

Stretching: In its most basic form, stretching is a natural and instinctive activity. Considered a form of exercise, stretching improves the muscle’s felt elasticity and achieves comfortable muscle tone. The result is a feeling of increased muscle control, flexibility, and range of motion.

There are five different types of stretching: ballistic, dynamic, SMF stretching, PNF stretching, and static stretching. (Read about each one here.)

Athletes stretch before and after exercise in an attempt to reduce risk of injury and increase performance, although these practices are not always based on scientific evidence of effectiveness, and depending on which muscle group is being stretched, some techniques may be ineffective or even detrimental. A study in 2013 indicates static stretching (vs dynamic stretching) weakens muscles, or “stretch-induced strength loss,” which you would want to avoid too close to exercise or competition. (Note: other studies have found that reducing the amount of time a static stretch is held (say 15 seconds instead of 30) is beneficial to some individuals pre-exercise.)

Muscle “tightness” results from an increase in tension from active or passive mechanisms. Passively, muscles can become shortened through postural adaptation or scarring; actively, muscles can become shorter due to spasm or contraction. Regardless of the cause, tightness limits range of motion and may create a muscle imbalance – which we have learned will eventually lead to acute or chronic pain. (Source: International Journal of Sports Physical Therapy)

Static stretching is more effective than dynamic stretching for those recovering from hamstring strains, and they seem to recover faster by performing more intensive stretching than less intensive stretching, and a gentle, static stretch relieves the pain associated with a sore Achilles’ tendon. Patients with knee osteoarthritis can also benefit from static stretching to increase knee range of motion. Researchers have shown that 12 months of stretching is as effective as strengthening exercises or manual therapy in patients with chronic neck pain.

The effectiveness of stretching is very individual, but most research concludes a routine of regular stretching, especially as you age, is beneficial in overall conditioning, can alleviate pain, and will improve muscle strength over time.

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Yoga & Pilates: Pilates is a form of exercise that focuses on the activation of the deep core muscles, while yoga is a mind-body workout that combines strengthening and stretching poses with deep breathing and meditation or relaxation. Both exercises will improve flexibility, core stability, overall body strength, postural alignment, balance, reduce the chance of re-injury, and help correct muscle imbalances that created the pain initially.

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RunnersWorld

Bergamot: Bergamot essential oil reduces the feeling of pain in the body by stimulating the secretion of certain hormones which lessen the sensitivity of nerves to pain. Massage a few drops into the affected area for temporary relief. (Read more.)

Arnica: dating back to the 1500s, Arnica is used topically for bruises, sprains, muscle aches, wound healing, joint pain, inflammation and swelling from broken bones. Arnica is available in gels and creams, but should never be applied to an open wound or taken orally, except in an extremely diluted form.

Aspirin: A standard (325 mg) or extra strength (500 mg) dose is an effective pain killer and also works as an anti-inflammatory, making it a possible treatment for rheumatoid arthritis, osteoarthritis, lupus, and mixed connective tissue disease. (People at increased risk of bleeding should avoid aspirin. Contact your health professional to discuss possible contraindications before beginning any pain management therapy.)

Over-the-Counter Pain Relievers include:

  • Acetaminophen (Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn)

Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs also reduce inflammation. (Inflammation is a necessary part of the healing process, and reducing injury-related inflammation may not always be an effective treatment therapy.)

Acetaminophen (Tylenol) works on the parts of the brain that receive the “pain messages.” NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain.

Using NSAIDs increase the risk of heart attack or stroke and have also been known to cause stomach problems. (Source: webmd.com)

One study on the effects of Ibuprofen on skeletal muscle showed that taking ibuprofen during endurance training canceled running-distance-dependent adaptations in skeletal muscle.

Another study confirmed in the laboratory that the use of NSAIDs after exercise slowed the healing of muscles, tissues, ligaments and bones.

During the first 2 to 3-days of an acute injury, taking a NSAID is advised, but once you exceed this window, general advice is let the body do the work. No evidence shows that a NSAID will provide benefits during a run or race, and may hinder.

A list of possible side effects of NSAIDs can be found at nhs.uk.

A Montane athlete, Marcus Scotney, had a potentially life threatening experience following the 2014 Iznik Ultra in Turkey. Read an interview following that event with UK’s key specialist on kidney function, Dr Richard Fluck, regarding the impact of NSAIDs and Sport.

Note: People given a placebo for pain control often report that the pain ceases or diminishes.

 

This post is meant for informational purposes only. It is not intended to provide medical advice. Please consult a physician to discuss your specific pain/injury, the treatment options most appropriate for you, and to ensure there are no contraindications in the treatment options you may adopt.

Read more:

Before You Take Ibuprofen, Try This (Time.com)

Ibuprofen and Running: Anti-Inflammatory Drugs Hurt Your Training

What Are the Best Anti-Inflammatory Spices? Outside Online

How Exercise Works (HowStuffWorks)

RUNNERSWORLD: articles related to stretching for runners

Stretching: The Truth (New York Times)

Main Types of Chronic Pain (verywell.com)

Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise

Best Essential Oils for Pain: EssentialOilExperts.com

 

 

Isn’t this fun? Isn’t fun the best thing to have?

Four laps around the track and I was already negotiating with my training schedule. Maybe I’d make tomorrow a rest day. Maybe I’d cut this run short and add the miles to Sunday’s run.

Six laps around, I had earned the upper hand in the negotiation and settled the dispute – I’d take two weeks off. A few steps later I said out loud, “What am I waiting for?” I stopped running and began a two-week holiday.

It’s a double-edged sword – learning to push the envelope of training without getting injured – although I’ve decided being downright pooped may be a form of injury in and of itself, and knowing when to hit the pause button is the next lesson to be learned in my journey as a runner.

Last year, when I got thoroughly pooped, I threatened to go to the doctor for a full set of blood work. Or was that the year before? A few weeks ago I finally went. The nurse called, “Everything is within normal ranges.” It wasn’t my thyroid, and I wasn’t deficient in this or that (although I could still blame it on menopause).

As usual, my husband was right. It’s training error. Fine.

Cross-Training 2017

On the first day of holiday, I went for a long walk around Lake Junaluska where the landscaping is positively inspirational. My husband went with me. This little slice of paradise is less than a mile from home. I did not even contemplate wearing running gear for this lovely walk.

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Lake Junaluska is a conference and retreat center (part of the Southeastern Jurisdiction of The United Methodist Church) that first opened in 1913.
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There’s a 3.8-mile walking trail around the lake via sidewalks, paved trails, and a wooden bridge.

There were several days of all-day gardening while my bike enjoyed a full tune-up at the local bike shop. Then I rode my bike.

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After a brief 1-mile torturous trek along Hwy 19 into Maggie Valley, my bike route turns right onto Jonathan Creek Road, which is amazingly flat.
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The fog hangs just below the top of the mountains in early morning. That’s a lumber yard and log cabin builder across the street. There’s also farms, old barns, cows, a produce co-op, oodles of churches, RV ‘parks’, a creek, and a few weeks ago, a fox that ran just off the road alongside my bike for several minutes.
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Much to my delight, this route can extend for more than 30-relatively-flat-miles by turning left onto Cove Creek Road. I used the parking lot of this adorable church as my turnaround on yesterday’s ride.

My husband and I decided paddling would be fun and spent several afternoons searching for canoes on Craigslist – until I went for another long walk around Lake Junaluska and realized we could rent a kayak or canoe on the shores of their sandy beach for just $5/hour. A whole new world was opening up all around.

Then my friend, Maria, and I went for a hike – 1-1/2 hours up the mountain to Waterrock Knob and 1-1/2 hours back down again. It was delightful. We’ve already planned another even longer hike for next week.

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The view from my Jeep on the ride up the Blue Ridge Parkway to the trailhead.

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We stopped along the trail to take a picture.
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Maria and I at Waterrock Knob – the highest peak in the Plott Balsams and the 16th-highest mountain in the Eastern United States.

My two-week hiatus from running ended about six weeks ago, but I haven’t forgotten the lessons learned from being too narrowly focused on running: there’s lots of fun things to do, and isn’t fun the best thing to have?

The Anatomy of a Runner: the Wall

Hitting the Wall: In endurance sports such as cycling and running, hitting the wall or the bonk is a condition of sudden fatigue and loss of energy which is caused by the depletion of glycogen stores in the liver and muscles. (Wikipedia)

Alternative Definition: a collapse of the entire system: body and form, brains and soul.

Etymology, usage, and synonyms: The term bonk for fatigue is presumably derived from the original meaning “to hit”, and dates back at least half a century. Its earliest citation in the Oxford English Dictionary is a 1952 article in the Daily Mail.

The term is used colloquially both as a noun (“hitting the bonk”) and a verb (“to bonk halfway through the race”). The condition is also known to long-distance (marathon) runners, who usually refer to it as “hitting the wall”. The British may refer to it as “hunger knock,” while “hunger bonk” was used by South African cyclists in the 1960s.

It can also be referred to as “blowing up”.

Possible Symptoms: a fast or pounding heartbeat, cranky/irritable, headache, dizziness, light headedness, nausea, hunger, extreme and debilitating fatigue, shaking or trembling, unclear thinking, poor coordination, possibly hallucinations and/or mental confusion, a complete absence of energy.

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Endurance athletes experience indescribable ‘pain’ as a result of glycogen depletion: a complete or a near-total depletion of glycogen, the storage form of glucose which is the source of human energy derived from carbohydrates consumed through food.

Glycogen is a molecule derived from the carbohydrates in our diet, which is stored in the body and used as a source of energy. The amount of glycogen stored in the body mostly depends on physical training, basal metabolic rate and eating habits, but the average body stores approximately 2,000 kilocalories of glycogen at any given time – just about enough glycogen to support the average adult for 12-14 hours, or up to about 2 hours of exercise.

Why do marathon runners ‘Hit the Wall’? (Yahoo Answers)

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Athletes engaged in endurance exercises produce energy via fat metabolism and the breakdown of glycogen into glucose – both facilitated by oxygen. How much energy comes from each source depends on the intensity of the exercise.

Activating the fat-burning process takes longer (and more oxygen) than burning sugar, which is why the body generally uses glucose unless it has a compelling reason not to. (In extreme cases, such as severe hunger, the body can also use protein for energy.)

Note: Carbohydrates – foods such as rice, potatoes, bread, tortillas, cereal, fruit, vegetables, and milk – are the body’s main source of glucose. If you eat more glucose than you need, your body will store it in your liver and muscles or change it into fat so it can be used for energy when it’s needed later.

IMG_3386With intense exercise that pushes the limits of VO2 max, most energy comes from glycogen and is burned off quickly. Lowering the intensity will also lower the amount of energy burned per unit of time, which is why runners learn not to start a race too fast. Elite runners practice maintaining their ideal race pace with an even effort to extend their glycogen stores for as long as possible – hopefully to the end of the race.

The brain uses glucose exclusively – in fact, it is said that seventy-five percent of the glucose available to the body is used to service the energy requirements of the brain and the central nervous system. Stored glycogen is also used to regulate blood sugar levels in the body between meals.

Once the glycogen is stored in the muscle for fuel, however, it is not flexible in terms of its deployment in the body since muscle-stored glycogen isn’t capable of being shared with or transported to other areas that might require fuel. It must be used at the point of storage.

If the body were to rely solely on glycogen for energy, 31 kg (67.5 lbs) of stored glycogen would be required as compared to 4.6 kg (10 lbs) of fat.

As people become more fit, it has been thought the muscles shift from burning carbohydrates (glucose) to burning fat; in fact, this shift in substrate utilization from glucose toward fat has been a traditional hallmark of trained muscle. In other words, it has been long believed that training improves endurance because it allows the muscles to more effectively burn fat as an energy source.

There are several issues with using fat as the predominant source of energy, however:

  • Fat is slow to digest and be converted into a usable form of energy (it can take up to 6 hours).
  • Converting stored body fat into energy takes time. The body needs to break down fat and transport it to the working muscles before it can be used as energy.
  • Converting stored body fat into energy takes a great deal of oxygen, so exercise intensity must decrease for this process to occur.

Hitting the Wall

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Hyvon Ngetich, 29, was leading the pack of top female runners at the 23-mile mark of the 2015 Austin Marathon when the Kenyan’s body began shutting down. Race volunteers brought a wheelchair for her, but she refused it and began crawling toward the finish line.
(1 of 3 photos courtesy of: DailyMail)
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Even as she crawled she had to pause to summon more strength, ultimately finishing the race in 3rd place in 2:34:42.
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After the race, Ngetich said she does not remember how she crossed the finish line, but hearing from a race volunteer that she was almost there gave her the strength to stay the course.

Top-level athletes get closer and closer to their real physiological maximum,” says Dr. Samuele Marcora, a fatigue researcher at the University of Kent in Britain, “but they never quite reach it: the brain applies the brakes before the heart, lungs or muscles fail.”

Findings in a study released in May 2017 (PPARδ Promotes Running Endurance by Preserving Glucose) shows that rather than training the body to use fat more efficiently as previously believed, training actually teaches the body to burn less glucose (remember, the body simultaneously burns a combination of glucose and fat depending on the level of intensity).

In other words, the body prioritized energy derived from fat (FA catabolism) thereby lowering the conversion of glucose to energy (glycolysis) with the net effect of preserving systemic glucose reserves in the body. This new thinking is that training progressively re-programs muscle to burn less glucose, preserving it as an energy source for the brain.

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In the top part of this image, muscle consumes glucose and fatty acids during exercise. In the bottom part, muscle that’s been stimulated by PPARδ consumes mostly fatty acids, leaving more glucose for the brain. (Courtesy: inverse.com)

A focus of the study was to better understand ‘hitting the wall’ – their results show that when the brain runs out of glucose, the body shuts down. . . the wall is made of sugar.

In endurance sports, ‘hitting the wall’ is a dramatic demonstration of sudden and complete exhaustion. You become disoriented, maybe dizzy, overtaken by sudden and overwhelming fatigue – the symptoms of hypoglycemia, or low blood sugar.

The surprise of the science here is that the longer the brain stays active, the longer you will be able to run. And so it’s more about the brain and sugar than we previously thought.”

Ronald Evans, co-author of the study, American professor and biologist at the Salk Institute for Biological Studies in La Jolla, California and a Howard Hughes Medical Institute Investigator.

Note: The next logical question for the scientist of this latest study was whether a drug could trigger the body’s exercise gene to instruct the muscles to burn fat and preserve glucose. The chemicals (mimetics) given to the mice in their study improved performance by 70%. Their goal now is to quickly transition this into a drug for people (currently known as the ‘exercise pill’), which has been taken on by a Boston-based company, Mitobridge. The study’s abstract concludes by saying, “Collectively, these results . . . highlight the potential of PPARδ-targeted exercise mimetics in the treatment of metabolic disease, dystrophies, and, unavoidably, the enhancement of athletic performance.”

Moving the Wall

It may not be that you have simply hit the wall, maybe there’s a blister on your foot, you’re dehydrated, or worse, your stomach is having its own moment of distress, and no matter how hard your mind wills your legs to move, they refuse. How endurance athletes convince themselves to keep putting one foot in front of the other despite the pain requires that we understand ourselves, and how committed we are to what motivated us to be here in the first place.

There was a good article about pushing through the wall in RunnersWorld a few years ago where one expert was quoted as saying the biggest challenge in pushing through the pain is to understand that this kind of pain won’t kill us. “After a lifetime of avoiding pain or being protected from it, the reason a runner won’t push through a wall of exhaustion could be good old-fashioned self-preservation.” Instead of pushing through the pain, our natural instinct is to stop.

Dealing with pain can be learned; it’s one of the objectives of our marathon training programs. There’s a few different approaches to consider – marathon pace runs help prepare our minds for race day, as will speeding up for the last third of a long run, for example. Another option is to eliminate carbs the day before a long run, or go all the way with a ketogenic diet. If you typically run with music, try turning it off completely for your next long run, or, as some coaches recommend, go for a run when you’re hungry, or tired – something that may not require a lot of planning for some of us. (Thoroughly research the strategies you deploy to understand risks and recovery.)

Whatever the approach, the intent is to prepare our minds for the inevitable end-of-race push we’ll need to reach the finish line.

Association/Disassociation

Elite runners tend to use the attentional strategy of ‘association’ to deal with pain, which involves focusing their attention internally on the body’s sensations, such as muscular strain, breathing, etc. They literally embrace the pain and see it as a necessary part of their eventual success.

Non-elite runners, on the other hand, are more likely to direct their attention away from the body’s physiological signs of distress by distracting themselves and concentrating on other things, or ‘disassociation’.

Although research findings seem to be mixed, association is generally related to faster running times than dissociation, although runners of all levels are more likely to associate during competition and disassociate during training runs.

It is the state of association that holds a greater risk of injury by continuing the effort despite the body’s warning signals. When used properly, however, association can allow runners to successfully ride the thin line between pushing hard and overdoing it.

The Carbo Load

Carbohydrate loading is the technique of gradually increasing carbohydrate and fluid intake each day, beginning anywhere from a week to 24 hours before competition, while exercise is tapered downward, to maximize glycogen storage.  Some strategies also called for depleting carbs by exercising intensely and lowering carb intake. This approach has proven dangerous and did not necessarily optimize glycogen stores (Reference: Advanced Sports Nutrition by Dan Benardot).

Each subsequent study seems to tweak the original carbo-loading approach ever so slightly, which is why I’m going to stick with my favorite advice on this one: do what works best for you. However, there’s some interesting information out there in regards to pre-race nutrition and refueling options during the race:

  • Maybe it’s the taper, not the carbo-loading: a 1992 study at McMaster University reported that a seven-day taper increased glycogen stores in middle-distance runners significantly and also resulted in a 22 percent increase in running time to exhaustion. Diet was not manipulated in this study.

By sharply reducing mileage, as with the pre-marathon taper, the amount of carbohydrate the muscles burn daily also sharply decreases, causing glycogen stores to increase without any change in the diet.

  • A study of 257 male and female runners in the 2009 London Marathon revealed that carbohydrates eaten at breakfast on race day, during the race itself, or on days earlier in the week were relatively unimportant. It was primarily what people ate on the day before the race that mattered. The runners who consumed more carbohydrates the day before the race maintained their pace past the 18-mile mark where the others did not.
  • It’s worth repeating that glycogen stores are used up faster if your pace fluctuates above and below a certain average than if your pace holds steady at that average.
  • On the other hand, if you feel your glycogen stores won’t last, a walking break will help preserve glycogen. You might also try Jeff Galloway’s run-walk-run approach.
  • Instead of increasing food volume or calories the day before a race, replace some fats or proteins with carbohydrates.
  • A 2016 study found that carbo-loading may be harmful to the heart by reducing the production of atrial natriuretic peptide (ANP), a hormone that helps the body get rid of excess salt and reduces blood pressure. The principal driver for this acute reduction in ANP appears to be the increase in glucose. A word of caution for Clydesdale runners or runners with pre-existing health issues.
  • Immediately following an intense workout is an ideal time to consume simple carbohydrates (some say this window of time is within the first hour while others say within 2 hours). There’s a great post by Rob Sulaver on Arnold Schwarzenegger’s website explaining the science behind this (Exercise & Carbs: A Game-Changer). This science shows that consuming carbs during this window of time feeds the muscles without getting stored as fat.

The Carbo RE-Load

Refueling during the race is a science of its own, and the options seem limitless when you consider energy drinks, energy gels, caffeinated options, and homemade varieties. Studies continue to find carbohydrate refueling an important component of maintaining exercise durations longer than 90 minutes.

A Human Kinetics post, Carbohydrate Intake During Exercise, included an excerpt from a study (as documented in the book, Sport Nutrition) that showed glucose concentrations dropping during exercise (at 70% of V.02max) after 1 hour, and reaching extremely low concentrations at exhaustion after 3 hours. With carbohydrate feeding, glucose concentrations were maintained and the test subjects continued to exercise for 4 hours at the same intensity.

The very best article I’ve found on the subject of refueling is at fellrnr.com. This article, “A comparison of the best energy gels”, explains which gels work best, for what reason, a definition of gel’s ingredients, as well as a comparison of the ingredients between major brands of gels, and when to use them. There’s also dozens of links to additional resources from the original article. What follows is an excerpt of this article copied directly from the fellrnr.com site.

 

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View a larger version of this chart that’s easier to read here: fellrnr.com

1. Energy gels are easy to digest, but they can spike your blood sugar, so ideally take one within 5 minutes or so of starting the run. I think the Peanut Butter Gu is a good option as it has a little bit of fat and isn’t too sweet, but other gels will work well. If you need something more substantial, consider a meal replacement drink like Ensure.

2. An Accel Gel is a good option as far as gels go, but you’re better off with something more substantial like a meal replacement drink (Ensure, etc.) or a chocolate milk. I’d only use Accel Gel if I needed something post run that I had to carry on the run itself.
The time and distances here are broad guidelines. Generally you shouldn’t need carbohydrate support for shorter runs, but if you’re Glycogen depleted from a long run, then a Gel might be useful. On ultra-distances, carbs and gels become less important and you start needing more “real food”.

3. Caffeine can improve performance at all distances, but for shorter distances, it’s probably best to take it before the run. Consider a Red Bull or other caffeinated beverage, or even caffeine tablets. I’d avoid coffee as there is evidence that you don’t get the same benefit from caffeine when it’s in coffee.

4. A little protein can help offset muscle damage, and so swapping your carbohydrate based gel for an Accel Gel might be good on ultras. However, you should be looking at other fuel sources in an ultra for most of your calories.

5. Caffeine can improve performance at all distances, and a gel can be a convenient way of taking it. Note that Caffeine can trigger some digestive problems in some people, and other forms of Caffeine might be easier pre-run. Consider a Red Bull or other caffeinated beverage, or even caffeine tablets.

6. You can sweat out a lot of sodium when sweating heavily, with estimates as high as 5,000mg/hour in some cases. In those situations, even the 200mg of PowerBar gel is not much, but it may help. The sodium in a PowerBar gel could help augment the limited sodium you would get in most sports drinks. (See The Science Of Hydration for details.)

7. There is some evidence that pickle juice can help with Cramps, and that it is the taste rather than the absorption of the pickle juice that helps. Therefore it is possible that the sour, tart flavor of eGels might help deal with cramps.

8. Reactive hypoglycemia is where consuming carbohydrate causes your blood sugar to rise, and then the resulting insulin release causes a blood sugar crash. This is believed to be quite rare and even rarer during exercise. If you think you suffer from this problem, I would advise you to verify this by checking your Blood Glucose. The meters are cheap and easy to use.

9. As well as Hammer gel, consider Carb BOOM or SIS Isotonic gels.

10. See How to eat a Gel for details.

 

 

Featured Image: Statue of the “Tired Man” (Megfáradt ember in Hungarian), referring to the poem of Attila József. The statue is the work of József Somogyi.

Read more:

Exercise-in-a-pill’ boosts athletic endurance by 70 percent (Science Daily)

“Exercise-in-a-pill” boosts athletic endurance by 70 percent (Salk.edu)

The physchology of sports injury: is ‘no-pain no-gain’ the path to sports injury? Sports Injury Bulletin

A Winner Runs Through It  RunnersWorld

The Evolving Art of Carbo-Loading, Active.com

How and when to carbohydrate load (AKA carbo loading), Fellrnr.com

When to eat Energy Gels in the Marathon, Fellrnr.com

 

This post is meant for informational purposes only. It is not intended to provide medical advice. Please consult a physician to discuss your specific pain/injury, the treatment options most appropriate for you, and to ensure there are no contraindications in the treatment options you may adopt.

 

 

My Garden Path

This summer’s project can be summed up in one word: landscaping. I was determined to reveal my progress last week until I saw the pictures. Another week of work, I thought, and it will be ready for prime time. It’s been another week and then some. . . let’s just agree to view my efforts through the lens of potential.

Ivy has been the predominant landscaping material house after house – not by choice. I have seriously wondered if there is some life lesson I should be learning that only ivy can teach. It eludes me still.

Ivy was everywhere.

Eradication consumes the larger part of year one. Mine is not a sophisticated approach. Grab it by the roots and pull. One pull always leads to another, and another – and you never know where it will take you. Roots become entangled – a pull here is thwarted by a root crossing over, which can change the direction of your effort 180 degrees, and send you on a wild chase under the fence, across the yard, or straight up the mountain.

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Mounds of ‘pulled’ ivy, and Mr. Boggs

A garden from long ago taught me there is only so much wilderness you can expect to tame, and I’ve attempted to be more realistic in my approach. The best results seem to come about naturally, as if this little spot of ground or that shady area in the corner is ready to become something different.

The dogs always play a role in my landscaping plan as well, and it has served me well to wait a bit and let them chart the path.

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The dogs created a path through the garden before I started pulling the ivy.

This was the year my husband also got involved. His first order of business was to organize a thorough clean-up.

Ardy and his crew spent three days taking out dead foliage, pruning overgrown limbs, and clearing the fallen trees. They sorted out the hardwoods for firewood, and burned the rest in four self-made fire pits around the house. The fires burned for two days after they left.

After suffering through a constant string of poison ivy outbreaks, we realized Bentley must be bringing it back down the mountain and transferring it directly to me. Abel stopped by and weed whacked the whole mountainside, and I’ve been free of a new outbreak of poison for over two weeks.

Dudley, Mr. Boggs and Bentley (right to left)

A Garden of Potential

With a clean slate (or, at least almost clean) we visited the Lowe’s Garden Center discount cart weekly (or more) and it was shocking what could be found there – $5 hydrangea, $2 canna lilies, $1 coral bells.

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The ferns are placed in such an even line around the rock that I wonder if this was a flower bed long ago – before the ivy took over. 
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There were day lilies underneath mounds of ivy on the other side of the path.

The $2 lilies found a home in one of the fire pits on the far side of the front yard. Fifty years of dead trees were removed from behind the house and now we can see all the way through the forest.

The patio being cleaned last August before we moved in, and at its most barren state this February.

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By May, the ferns have taken over with just one lone day lily peeking through.

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The sun hits this side of the house late in the day, and it seems to shine a light on a path that leads through the garden and up the mountain. . . some day.

The excess spring rain has nearly destroyed the potted plants, Dudley chased a critter underground and tore up the herb garden, and Mr. Boggs plows right through the ferns smooshing them flat to the ground.

As with life, each season brings new challenges, unexpected catastrophes. . . and sheer delight. There’s lots of work to be done before this project looks like my inspiration photo at the top of the post, and I wonder what sweet journeys lie ahead on our humble garden path.

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The Anatomy of a Runner: Wooly Chaps and the Big Joint (the knee)

The fourth in a series of posts about what makes runners uniquely equipped to run. This post is a comprehensive review of the knee, including function, injuries, recovery and strengthening specific to runners.

THE KNEE

FUNCTIONAL OVERVIEW

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Courtesy: Hospital for Special Surgery

The knee is a complex synovial joint that flexes, extends and twists slightly from side to side. It joins the thigh bone (femur) to the shin bone (tibia). When we’re sitting, the femur and tibia barely touch; standing they lock together to form a stable unit.

Two groups of muscles support the knees, including the hamstrings, which are the muscles on the back of the thigh. They run from the hip to just below the knee and work to bend the knee. The other are the quadriceps, which are the four muscles on front of the thigh that run from the hip to the knee and straighten the knee from a bent position.

Webmd.com defines knee conditions not covered in this post, such as ACL strains or tears which leads to the knee “giving out,” damage to a meniscus – the cartilage that cushions the knee, which often occurs with twisting the knee, rheumatoid and knee osteoarthritis, bursitis, and gout (also a form of arthritis).

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A common sporting injury is pulling or straining the hamstring tendons, two groups of string-like connective tissues at the back of the knee and thigh that connect some of the major muscles of the knee.

Knee injury symptoms include pain, tenderness, swelling, locking, “giving way,” snaps, crackles, or pops.

For this discussion we’ll focus on the most common runner’s knee injuries, which fit into two categories – they rarely occur together:

1. pain on the side: iliotibial band syndrome (ITBS)

2. pain on the front: patellofemoral syndrome (PFPS)

PFPS affects the kneecap and surrounding area, where ITBS definitely affects the side of the knee (the side facing outwards).

Iliotibial Band Syndrome (ITBS)

IMG_3244The iliotibial band (IT band) is a band of fibrous tissue that runs along the outside of the thigh, from just above the hip to just below the knee, (like a cowboy’s chaps).

The IT band is made up of fascia, an elastic connective tissue found throughout the body.

Fascia is a sheath that encloses muscles, connects muscles to bone and compartmentalizes muscles that serve a similar function. The IT band is the largest piece of fascia in the human body.

It has traditionally been understood that the IT band provides stability to the knee and hip, and helps prevent dislocation of those joints. Hold that thought.

Understanding the IT Band

Opinions regarding the IT band, its definition, function, injuries and recovery, have evolved. In fact, precise descriptions of the IT band – which muscles attach to it and where – have been all but non-existent leaving this part of the anatomy perhaps one of the most controversial of all.

An injury of the iliotibial band, Iliotibial Band Syndrome (ITBS), was first identified in the 1970s and was thought to be the result of the IT band becoming tight or shortened, thus the recommended treatment of stretching.

Researchers at the University of Kentucky compared runners with IT band syndrome to healthy runners, however, and found that the injured runners actually had longer IT bands on average, but weaker hip muscles, indicating that strengthening the hip muscles may be more effective – not only for rehab, but for preventing the injury in the first place.

New studies have set out to prove that the iliotibial band moves, which also gave way to a new name for its injury: Iliotibial Band Friction Syndrome, or ITBFS –  except that this entire study contradicts other studies that have concluded motion of the IT Band is simply an illusion.

One of the more recent studies, reported in the Harvard gazette (August 2015) examined whether the iliotibial band actually stores and releases elastic energy to make walking and running more efficient (similar to an elastic band – as with the Achilles’ tendon).

To understand what role the IT band plays in locomotion, the researchers developed a computer model to estimate how much it stretched during walking and running ― and by extension, how much energy it stored. Then, using a custom-built frame, Carolyn Eng, the first author of these studies, manipulated human and chimpanzee cadaver limbs measuring how much the IT band changed in length for each shift in joint angle.

The study concluded that part of the IT band stretches as the limb swings backward, storing elastic energy. That stored energy is then believed to be released as the leg swings forward during a stride.

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Computer simulation of a human leg running (Credit Carolyn Eng)

The view that the IT band acts as a ‘spring’ contradicts all previous understanding that its primary function is to stabilize the hip, but then it seems almost everything we thought we knew about ITBS is subject to change – and then change again.

Why it hurts: ITBS is no longer thought to be a tightening of the iliotibial band, but instead a layer of tissue under the iliotibial band that becomes inflamed (possibly causing a layer of fat and loose connective tissue to become pinched between the iliotibial band and the knee, causing ITBS).

What we do know is that ITBS is an overuse injury most common in runners and cyclists where the overuse creates stress the body cannot repair, and soft tissue breakdown occurs – the result of weak hips, running only on one side of a crowned road, or only one way around a track.  Studies also demonstrate that weakness or inhibition of the lateral gluteal muscles can be a factor.

Training errors can also cause iliotibial band issues – too much too soon or abrupt changes to intensity, as well as anatomical issues, such as leg length discrepancies, high arches, supination of the foot, excessive foot-strike force, knees that lean inward, and muscular imbalances within the hip.

And ITBS can be a common injury in activities such as gardening, hiking, treading water, running up and down stairs, excessive up-hill and down-hill running, and is increasingly recognized in other sports including soccer, weightlifting, and skiing. In other words, there are a plethora of causes for ITBS.

A good discussion of IT band pain can be found on runireland.com and at painscience.com.

Note: Up to 50 percent of cyclists experience knee pain. In one observational study of 254 cyclists over six years, 24 percent of the cyclists presenting to a sports medicine clinic for knee pain were diagnosed with ITBS.

Cyclists can develop ITBS if the saddle is too high, too far back, or if there is excess internal rotations (toed-in) of the lower leg – all of which put additional stress on the iliotibial band.

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Courtesy: moveforwarddpt.com

Where it hurts: An injured IT band can cause pain on the side of the hip, down the outside of the leg, and eventually on the outside of the knee, which is then considered IT band Syndrome (ITBS).

The epicentre of ITBS pain is on the outside of the knee – specifically the spot on the side of your knee, around the most sticky-outy bump (a technical term I’ve recently discovered), that is sensitive to pressure, while the kneecap is not particularly sensitive when pushed firmly straight into the knee.

  • It really hurts to go down stairs (or downhill running) but not so much going upstairs.
  • Doing a deep knee bend doesn’t necessarily hurt.
  • The onset of pain happened rather quickly – over a few hours rather than days.
  • Pain is worse after sitting for long periods of time.
  • Left unchecked, ITBS will produce a pain so great that running is impossible – bringing the body’s largest joint to its knees (so-to-speak).

Recovery:

First, the recovery steps that are not controversial:

  • Rest & Ice to reduce inflammation;
  • Stop the perpetuating factors that caused the irritation;
  • Sleep with a pillow between the knees to decrease tension on the IT band through recovery;
  • Add strengthening exercises for the hips to your exercise program.

Massage vs Stretch: for many years IT band stretches were suggested to relieve the pain associated with ITBS and to reduce the tightening of the fascia.

It is unclear that the IT band itself will stretch, however, leading some experts to  suggest it is most effective to stretch and strengthen the surrounding gluteal, quadriceps and hamstring muscles, which can cause tension on the IT band.

(A February 2017 study says the iliotibial band tensor fascia lata complex  (ITBTFLC) “is capable of tissue elongation under normal physiologic loads that simulate a clinical stretching protocol. It is uncertain whether this “stretch” translates into sustained, clinically meaningful tissue elongation.”)

While some physiologist swear stretching the IT band is 100% ineffective in treating ITBS, my research took a significant turn when a post on LinkedIn caught my attention, “Ilio-tibial Band: Please do not use a foam roller!” , which suggests it is actually massage that should be avoided at all costs – and it was in the comments  readers wrote in response to this LinkedIn post that I discovered even more controversial thoughts on ITBS.

I would suggest, in the absence of a more direct and agreed upon plan of action, that we all do what works best for us as individuals (remember N=1). I dealt with ITBS for several years before learning what worked best for me, which includes massage of the IT band (from the hip all the way to the outside of the knee) to relieve the soreness and relax the tendon (or whatever it is that’s sore), strengthening of the hips, and prevention.

Stretching the band provides temporary relief from the pain, but deep massage will relax and release the tension on the band (it can feel like a guitar string just under the skin). Massage can be uncomfortable at first so you want to be careful that you don’t make the soreness even worse: start with a minute and work up to 3 – 4 minutes at a time working (or using a foam roller, if you dare) up and down the outside of your thigh.

Massaging the band whenever it becomes sore will effectively prevent the progression of ITBS and the resulting pain in the knee, although it is important to understand what is creating the injury in the first place.

Running can be maintained during ITBS recovery only to the point the pain returns (i.e., if the pain returns after 3 miles of running, reduce your daily mileage to less than 3 miles so the entire run can be finished pain free). In my worst case of ITBS, I discovered I could run exactly 18 minutes before the pain returned, so I stopped at 17 minutes regardless of how much distance had been covered.

In some cases, the IT band has become so severely injured that running is impossible, and recovery and strengthening efforts only exacerbate the problem. In this case, total rest is recommended. Cross training may be considered, keeping in mind that some sports, such as hiking and cycling, may be counterproductive.

Runner’s Note: A review in the National Institutes of Health states that biomechanical studies have shown that faster-paced running is less likely to aggravate ITBS, and faster strides are initially recommended over a slower jogging pace.

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TREATING THE IT BAND; THE OTHER RUNNER’S KNEE (asimplehabit.com)

Patellofemoral Pain Syndrome (aka runner’s knee):

IMG_3216.JPGAlthough pain in or around the center of the knee has become known as runner’s knee, it can affect almost anyone – athletes and sedentary folks alike. Some say runner’s knee isn’t a specific injury but rather a broad term that describes the pain you feel if you have one of several knee problems.

Wikipedia says, “The diagnosis of patellofemoral pain syndrome is made by ruling out patellar tendinitis, prepatellar bursitis, plica syndrome, Sinding-Larsen and Johansson syndrome, and Osgood–Schlatter disease.”

Why it hurts: The medical cause of PFPS is thought to be increased pressure on the patellofemoral joint, although it is generally accepted that PFPS is brought on by many of the same issues, such as weak hips or muscle imbalances, training that progresses too fast too soon, extensive periods of sitting, a tilted patella, and other factors that place extra stress on the bone including flat feet, abnormal rotation of the hips, and tightness of the IT band or hip flexors, and wearing down, roughening, or softening of the cartilage under the kneecap. Obesity can also play a role in causing PFPS.

Where it hurts: The epicentre of PFPS pain is somewhere under or around the kneecap. It’s uncomfortable pushing your kneecap straight into your knee, but there is no particularly sensitive spot on the outside of the knee.

  • A deep knee bend definitely hurts.
  • The onset of pain happened slowly, possibly while ascending stairs or running uphill,
  • it definitely hurts when going upstairs, but may hurt going up and down.
  • Sitting with bent knees hurts, and hurts worse after standing up.

Recovery efforts begin with R.I.C.E. to “quiet the knee” followed by identifying any irregularities, such as pronation or supination. A physician should be consulted sooner rather than later to make a proper diagnosis and treatment plan.

Note: Chondromalacia Patellae and Patellofemoral Pain Syndrome/Runners Knee are terms often used interchangeably to describe anterior knee pain regardless of the cause of the pain. Although PFPS/Runners Knee may lead to Chondromalacia Patellae, the latter is a chronic degenerative condition affecting the articular cartilage on the under surface of the kneecap (although this too is different from the degeneration of knee osteoarthritis).

Does Running Cause Knee Problems and Eventual Arthritis?

A 2006 study measured the changes in the cartilage volumes in the tibia, patella and medial and lateral meniscus (the cartilaginous tissues that provide structural integrity to the knee) after the extreme dynamic loading that occurs in long-distance runners. It also examined the rate of recovery from the alterations occurring at the knee joint due to loading during distance running. This study revealed that after 1 hour of rest no significant reduction of cartilage volume was measured for the patella, the tibia or the lateral and medial meniscus.

Although there were significant changes after a 5, 10 and 20 km run, the conclusion on the basis of the study was that the cartilage is able to adapt well to the loads caused by running and that the articular structures were found to recover rapidly so that exercise could be continued after a short rest without reservation.

Every source seems to agree on several things we can do to help prevent long term damage to our knees due to injury and/or prevent the onset of osteoarthritis regardless of our chosen sport.

Avoid Carrying Extra Weight: Increased body weight, which adds stress to lower body joints, is a well established factor in the development of osteoarthritis. Your knees, which carry the brunt of your weight, are particularly at risk. For every pound you gain, you add 4 pounds of pressure on your knees and six times the pressure on your hips.

Research shows that excess body fat produces chemicals that travel throughout the body and cause joint damage, which would mean obesity plays a systemic, not just a mechanical, role in osteoarthritis onset.

Avoid Overuse/Injury: While running itself doesn’t increase the risk of osteoarthritis, running injuries can – especially when you delay treatment or rush recovery. If an injury is not properly cared for, the non-healing of it can cause the degenerative process of arthritis to start in the joints.

Train smart: don’t ramp up too quickly, don’t train if you’re injured.

Be Strong: Studies show that weakness of the muscles surrounding the knee is associated with osteoarthritis, especially in women, and makes the pain and stiffness worse after onset. Strengthening exercises for thigh muscles are also important in reducing the risk.

Strengthen the Knee

Minor increases in the strength of the quadriceps has been shown to help reduce the risk of knee osteoarthritis and its progression as well as reduce pain. Those suffering from arthritic knee pain can also benefit from exercise due to the support it provides to the joint area.

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This post is meant for informational purposes only. Please consult a physician to discuss your specific injuries.

 

Other Posts in this Series:

The Anatomy of a Runner

The Anatomy of a Runner: it’s all about that bass (the Upper Leg & Glutes)

The Anatomy of a Runner: be still my beating heart

The Anatomy of a Runner: Mind the Hips

The Anatomy of a Runner: Mind the Hips

The third in a series of posts about what makes runners uniquely equipped to run. Although this post was intended to cover the hip and the knee, the two topics proved difficult to combine because the big joint turned out to be bigger than I thought it was going to be.

FUNCTIONAL OVERVIEW

The hip joins the leg to the trunk of the body at the hip joint. The femur, the biggest and strongest bone in the skeleton, terminates in a ball that fits into the socket of the hip, and articulates with the pelvis to form the hip joint.

The primary function of the hip joint is to support the weight of the body in both static (standing) and dynamic (walking or running) postures, and retain balance.

The hip joint is one of the largest joints in the body and a major weight-bearing joint – stresses on the hip can be 5 times a person’s body weight during walking.

Increasing the extension of the hip joint improves speed for runners while disease or injuries of the hip affect a runner’s gait and places abnormal stress on other joints, such as the knee.

Mind the hips and the feet will take care of themselves.

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Wikipedia

Dean Kamen (son of Jack Kemen, an illustrator for Mad, Weird Science and other EC Comics publications) introduced his invention as “the world’s first self-balancing human transporter.” Kamen’s model for the Segway was — the human body.

Usually we don’t fall on our faces when we stand up and lean as far forward as possible. Your brain knows you are out of balance – fluid in the inner ear shifts triggering you to put your leg forward and stop the fall. If you keep leaning forward, your brain will keep putting your legs forward to keep you upright, and instead of falling we walk forward, one step at a time.

Like the base of a Segway, a runner’s hips should remain solid, level and neutral. That’s not to say runners don’t compensate for certain genetic tendencies, but most experts agree we should shore up any posture issues, including anterior pelvic tilt, before beginning a running program. (Read more at Runners World here).

Do you have Anterior Pelvic Tilt?

THE HIP

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Photo courtesy: Functional Anatomy of the Hip Complex by Coach Sean Cochran

MAJOR PLAYERS:

Viewing the hip joint in terms of layers, the deepest layer is bone, then ligaments and tendons, and finally muscles.

Tendons allow for the power of movement across the joints; ligaments support joints by attaching the bone ends and allow a stable range of motion. Muscles are on top, which, in the case of the hip, consists of over 20 muscular attachments.

1) HIP BONES

Anatomy Of The Hip And Pelvis Hip AnatomyThe hip joint is a ball and socket joint, formed by the head of the Femur (thigh bone) and the acetabulum of the pelvis.

Cartilage, a stiff but flexible connective tissue allows smooth movement of the joint. Less rigid than bone, you can think of cartilage as the tissue that forms the more flexible structures of the body – the septum of the nose, the external ear, the trachea.

Cartilage is good with weight-bearing, which is why it is found in our joints, although cartilage has almost no blood vessels and is very bad at repairing itself. Bone is full of blood vessels and is very good at self repair.

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Mendmyhip.com

Where friction occurs between muscles, tendons, and bones there is a structure called a bursa: a thin sac of tissue that contains fluid to lubricate the area and reduce friction.

Injuries of the hip bones can be a result of arthritis or a fracture of the bone, but can also be a tear in the labrum (the cartilage between the bones), inflammation of the bursa sac, or the impingement of the iliopsoas tendon.

Hip pain across the front of the hip is worse than pain on the side – the general rule being that hip pain over the front of the hip joint is more serious than pain on the outside of the joint.

A FRACTURE is a break in a bone.

Where it hurts: Pain coming from the bones of the hip joint, or the cartilage between these bones, most often hurts in the groin area. Tenderness on the bone is indicative, although the bone is difficult to push on because of the overlying muscle.

Symptoms of a broken bone include pain (intensified when the area is moved or pressure is applied), swelling, bruising, and loss of function. Fractures may also cause the area around the bone to appear distorted or deformed.

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Stress Fracture Symptoms & How To Speed Up Recovery”  draxe.com

STRESS FRACTURE is a hairline crack in a bone that worsens over time.

Where it hurts: Deep pain in the area that worsens with running or hopping and gets worse over time is suspicious for a stress fracture. In addition to pain (increasing with activity and decreasing after rest), symptoms include swelling and tenderness.

Stress fractures of the hip and pelvis are common injuries for runners, and can initially feel like a pulled muscle sometimes delaying a correct diagnosis.

A stress fracture in the neck of the femur hurts mostly in the groin area, is made worse with every step during the foot-strike phase of running, and may also hurt at night.

X-rays usually don’t show a stress fracture for 3-4 weeks, requiring the use of a MRI for diagnosis.

Runner’s Note: Women who miss menstrual periods are at increased risk of developing stress fractures.

LABRAL TEAR: Just like the ball and socket joint of the shoulder, the hip joint has a labrum – a circular layer of cartilage surrounding the outer part of the acetabulum (the socket of the hipbone, into which the head of the femur fits) effectively making the socket deeper to provide more stability. Labrum tears are a common injury to the hip joint.

Where it hurts: Symptoms of a labral tear include pain in the groin area, stiffness, and mechanical issues in the hip such as clicking, catching, or locking. Labral tears can heal with rest, but may require surgery.

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BURSITIS: an inflammation of the bursa, fluid-filled sacs located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation.

The bursa that sometimes causes problems in the hip is sandwiched between the bump on the outer hip (the greater trochanter) and the muscles and tendons that cross over the bump.

This bursa, called the greater trochanteric bursa, can get irritated if the iliotibial band is tight (the ligament that runs along the outside of the thigh and discussed further in the post about the knee).

Another bursa sits in front of the hip joint, and a third bursa over the bump of bone in the buttocks.

Why it hurts: Bursitis is caused by overuse, a tight hamstring or tight iliotibial band.

Where it hurts: If you feel burning, rubbing, a popping sensation, or have tight leg muscles and feel a dull ache on the outside of your hip during or after a run, you could have bursitis.

IMG_3220Note: Bursitis can occur around any joint in the body, but the joints that are most active are the more common sites for bursitis, including the hip, knee, heel, shoulder, elbow, and wrist.

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HIP (TROCHANTERIC) BURSITIS EXERCISES (Summit Medical Group)

Hip Bone-Related Recovery: Most hip bone related injuries can be treated with cold/hot compresses (to reduce inflammation/pain) and rest from running, however, some are more severe and crutches or even surgery may be necessary. Consult your physician.

As stated earlier, labrum tears may require surgery. These injuries typically occur because of an error in training (doing too much too fast).

2) HIP LIGAMENTS & TENDONS

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The stability of the hip owes greatly to the presence of its LIGAMENTS, which shape and stabilize the hip by limiting hyperextension and attach the pelvis to the femur.

Why it hurts: Ligament strains or ruptures occur if the joint is twisted or overstretched.

Where it hurts: Usually a “snapping” or “cracking” occurs when a ligament ruptures, which is followed by bruising, swelling and pain. Movement of the hip will usually be limited due to pain.

The most commonly injured TENDONS in the hip are the iliopsoas tendon, iliotibial band tendon (IT band), and the ischial tendon — although the most commonly injured tendon of all of these is the iliotibial band (which will be covered in-depth when this series reaches the knee).

Why it hurts: Tendons in the hip area that attach the hip muscles to the bones can become brittle with age, overuse, or from old injuries that have not properly healed.

Tendon injuries in the hip can range from a mild strain to a full rupture (three different grades of injury determined by the severity of tissue damage). Other soft tissue damage in the immediate area may also occur with a tendon injury.

Unfortunately, tendons by nature receive very little blood flow, which prevents them from getting adequate oxygen and the nutrients necessary to repair themselves.

Where it hurts: pain and tenderness likely in the injured area of the hip and/or groin.

Recovery: X-rays, MRI or CT-scans may be required to properly diagnose certain hip ligament and tendon injuries. Consult a physician, sooner rather than later.

3) HIP MUSCLES

The hip muscles provide dynamic support to the joint and occur in three planes: 1) the iliopsoas in the front, 2) the tensor fascia lata on the side, and 3) the gluteus muscles on the back of the hip joint.

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[Runningplanet.com offers a comprehensive description of all of the hip muscles and their contribution to running.]

The muscles of the thigh and lower back work together to keep the hip stable, aligned and moving – including the four basic movements of the hip: bend, straighten, taking the leg away from the body, and bringing the leg back toward the body (flexion, extension, abduction, adduction).

The gluteus maximus also keeps the head of the femur from sliding forward in the hip socket; if it can’t do this, pain results from the femoral head pressing against the soft tissues in the front of the hip joint.

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The Iliacus and Psoas Major

1) The iliopsoas muscle is actually made up of two separate muscles located in the front of the hip area: the Iliacus and Psoas, which are responsible for lifting the upper leg to the torso, or flexing the torso towards the thigh (as in a sit-up).

Why it hurts: Iliopsoas tendonitis is mostly caused by repetitive hip flexion or overuse of the hip area, resulting in inflammation.

Iliopsoas Syndrome is caused by a sudden contraction of the iliopsoas muscle, which results in a rupture or tear of the muscle, usually at the point where the muscle and tendon connect.

Athletes at risk include runners, jumpers and participants of sports that require a lot of kicking. Also at risk are those who participate in strength training and weight lifting exercises that require a lot of bending and squatting.

Where it hurts: Pain and tenderness of the muscle are common symptoms of both conditions; however the onset of pain associated with iliopsoas tendonitis is gradual and tends to build up over an extended period of time, whereas the pain associated with Iliopsoas Syndrome is sudden and very sharp.

Tendonitis of the iliopsoas muscle group also hurts in the groin, but unlike a stress fracture, it tends to hurt with lifting of the leg, such as during the striding phase of running.

Recovery: A self-treatment recommended for a soft tissue injury of the iliopsoas muscle, like for other soft tissue is a RICE regimen lasting for at least 48 to 72 hours after the onset of pain. “Rest” includes avoiding running or hiking (especially on hills), and avoiding exercises such as jumping jacks, sit-ups or leg lifts/flutter kicks.

If self treatment is not successful or the injury is interfering with normal activities, consult a physician.

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Summit Medical Group
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imgarcade.com

2) The tensor fascia latae (TFL) keeps the iliotibial band taut and braces the knee, especially when the opposite foot is lifted.

When weight is on one leg, the tensor fascia latae contracts, pulls down on its own side of the pelvis and lifts the opposite side, as the opposite leg swings forward.

Athlete’s note: The tensor fascia lata is also heavily utilized in horse riding, hurdling and water skiing.

Why it hurts: Weakness in the rectus femoris muscle, the top quadriceps muscle along the front of your thigh, and excessive tightness and shortening of the primary hip flexor (a common occurrence in those of us who sit for long hours). Read more at lower-back-pain-answers.com.

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The TFL along with part of the gluteus maximus form the two arms of the letter “Y”. The long vertical portion of this complex is the iliotibial band.

 

Runner’s Note: TFL issues can be more exaggerated in runners who are heel strikers because the quadriceps, and especially the rectus femoris, are severely underused. Read more.

Where it hurts: A tight or shortened TFL causes pelvic imbalances that lead to pain in hips, as well as pain in the lower back and lateral area of knees.

The gluteals or the piriformis muscle can suffer from the unnatural “pull” from an excessively tight TFL, resulting in pain felt in one or more of the following areas…

  • Deep in the hip joint, the groin, or wrapping around the outer hip;
  • Deep in the gluteal muscles, the sacroiliac joint, or traveling down the leg.

Recovery/Treatment: Massage therapy of the tensor fascia latae is the best treatment. Use a pillow between the legs when lying on your side during recovery, maintain mobility and flexibility of the entire hip by stretching the hip flexors. For more information, click here.

Additional Reading:  “One Tensor Fascia Latae, please.”

Note: although self-massage can be very effective with an ITBS injury, the location of the greatest pain in a TFL injury can be difficult to reach due to the bones of the hip. The assistance of a qualified massage therapist may prove beneficial.

RUN FASTER: it’s all in the hips

Research shows the main difference between walking, running and sprinting to be at the hip. The ankle and knee joints go through about the same range of motion for all three activities, but when increasing speed, the hips must be more active.

Because distance runners don’t normally sprint, there is little need for the muscles around the hips to be strong. Another problem is that runners tend to only run straight ahead so that the hips have no reason to work in multiple planes of motion.

The most immediate improvements for distance runners is to perform agility drills. These multi-directional movements will force the hip muscles to activate, become stronger and correct muscle imbalances – just as any cross-training effort improves the opposing, lesser used muscles.

Hip Mobility

Test it With:

Prisoner Squats. With your feet shoulder-width apart and your hands clasped behind your head, sit until your thighs reach parallel. If you can’t get that low, your knees collapse inward or your heels lift, that’s an “F.”

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Fix it With:

Plate Squats. Perform Squats while holding a 10-pound plate with your arms extended in front of your chest. Make sure your thighs reach slightly below parallel. Perform 3 sets of 10 reps.

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Runner’s Note: Ideally the hip joint acts as a fulcrum as your body moves forward when you run. Adequate mobility is needed to take advantage of this forward propulsion. This results in a sufficient stride angle during running gait.

“Usain Bolt Flies on Big Stride Angle” from somaxsports.com.

The stride angle is the maximum opening between the front and back thighs. The stride angle is critical for running speed because research has shown that for every degree you increase your stride angle, you increase your stride length by 2%.

Stride, angle and rate will be covered when The Anatomy of a Runner series touches ground in our post: Stride Right.

HIP EXTENSION: Rather than trying to lunge the leg out as far as you can, kick the leg back as far as you can, increasing the hip extension. Propulsion in running occurs in extension. Achieving maximal hip extension allows the feet and the rest of the lower body to work correctly, producing a faster pace.

A video on improving hip extension to become a faster runner. Also found at philly.com

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11 Exercises to Boost Hip Strength For Cyclists by Active.com

 

Hip Strength For Runners at runnersconnect.net.

IMG_3202It’s All In The Hips” by Runners World

This post is meant for informational purposes only. Please consult a physician to discuss your specific injuries.