Creating A Full-Year Training Plan

I Resolve: to do my homework, learn a new word every day, lose weight, get more rest, be a better person, exercise. Every year there’s a new list of most popular resolutions, and every year I guess we all wonder how we’ll keep these resolutions.

Last year I vowed I would finally sign up for a yoga class. I talked myself right out of it, bought a book on the subject, and called it a day. No matter how I arranged my schedule, I didn’t seem to have time for yoga. Except that wasn’t true. I could have, and should have taken that class on a cross training day.

Last year was also to be the year I would register for the 50-mile segment of the Blue Ridge Breakaway cycling event. This was the first year they cancelled the Blue Ridge Breakaway. My husband and I decided 2017 would be the year I would not run a marathon so I could focus on shorter races. I ran my first 50k Ultra Marathon last year. Resolutions don’t always work out the way we plan.

This marks my fourth year-long training plan experiment. There have been mixed results.

It was just over 4 years ago that I discovered sports periodization: a system of training – actually, the planning of training – that encompasses weeks, months, or even years; a system that has ultimately been adopted by nearly every professional sport, and has even been applied to the athlete’s diet.

The idea is to divide the year into phases where each phase emphasizes a different training goal. For example, the year may include a period of time for building a strong base, improving speed and strength, flexibility, and time dedicated to active rest/recovery.

I’m especially dedicated to the endurance phase. I simply adore running to the point just shy of exhaustion day in and day out. And the more you run, the more your body allows you to run. It works out well that way.

One year I held onto a peak weekly mileage of 55-65 miles for 8 weeks. I did well in the half marathon before the peak, and flopped in the two marathons I ran after the peak. Last year I held a peak weekly mileage of 35-45 miles for most of the year. I did not do well in a spring half marathon, but then I survived a 50k. In retrospect it’s always easy to see the error of my ways, but I love these year-long experiments – not to say they aren’t exceedingly frustrating from time to time.

I can see that my best years have been when I’ve incorporated more variety into my training, which ultimately leads back to those phases, or periodization. The good thing about breaking the year into phases is that one goal (yoga for example) doesn’t have to become overwhelming. It becomes part of one phase; if you like it, keep doing it.


1. a firm decision to do or not to do something, or. . .

2. the action of solving a problem.

The first question to answer is what activities will best solve our problem and/or allow us to meet the goal of each phase of training? I’ve decided there’s more than one answer.

A handful of periodized programs can be found across the web, and it turns out they pretty well match a runner’s periodized schedule: Endurance/Base-Building, Strength, Speed, (perhaps a build-up for a key race), Rest and Recovery.

One of these programs is from OutsideOnline; a five-part (five-month) plan called “The Shape of Your Life.” Each month the training focuses on a different goal: 1) endurance, 2) strength, 3) flexibility, 4) speed and power, 5) balance and agility. Month six focuses on active rest and recovery – then you start the process again.

The value of changing the focus of each phase is that you can also change the sport, if that’s something that interests you more than doing the same sport all year. And even if you prefer to train all year in your dominant sport, cross-training can balance your program and help achieve the goal of each phase.

For example, running, swimming, rowing, basketball, cycling, dancing, and even yard work will build endurance. Each of these activities can also be used to build speed and strength when performed fast, or devote a phase to a different anaerobic sport, such as racquetball, tennis, sprinting, or weightlifting.

Cross-Train with the Right Sport

Runners: Cycling maintains leg strength and cardio fitness while giving you a break from impact on your joints.

Cyclists: Running and rowing develop strength in the torso, quads, and glutes.

Climbers: Calisthenics use body-weight resistance to build strength without adding bulk.

Swimmers: Rowing builds key strength in the shoulders, arms, legs, and torso.

Kayakers: Swimming works the arms, shoulders, and torso, improving power and range of motion.

(Bones weaken if you do only low-impact activities. Strengthen your skeleton by mixing in high-impact workouts like running, jumping rope, or playing ball sports.)

A Full-Year Periodized Schedule


Endurance, or aerobic, activities increase breathing and heart rate, which keeps your heart, lungs, and circulatory system healthy, improves overall fitness, and delays or prevents diseases (including various cancers, diabetes & dementia). If you’re always running out of energy after about an hour, you may not have created a strong foundation or you’ve skimped on the base-building phase.

”Technically, endurance is a combination of efficiency (lean body mass), physiology (a dense network of mitochondria that produces energy in the muscles), genes (a high percentage of slow-twitch muscle fibers), plumbing (an efficient heart capable of moving more blood per pump), and strength in those areas that help transfer force between the upper and lower body (the hips, lower back, abdominal, and other core muscles).” Outside Online

Duration: some programs specify a base building phase of 4-8 weeks, while others suggest as long as 6 months. Arthur Lydiard, Olympic and international running coach (also known as the “Father of Jogging”), has been quoted as saying to base build “As long a time as possible.”

For Runners: base building includes miles, and lots of them. Determine your peak mileage, how much time you want to devote to this phase, then choose a plan that matches the two safely. One approach is to follow your favorite marathon training program, eliminating or reducing the speed sessions, for as many weeks as desired (stop after 4 – 8 weeks, stop when you reach the program’s peak mileage, extend this phase to six months by duplicating weeks in the middle of the program, or by ramping up mileage more slowly).

Remember, this is the time for aerobic development. If you intend to increase your mileage to a new peak, you may not want to combine the stress of speed work concurrently.

Non-runners: swim laps, walk, cycle, play basketball, skate, ski, climb stairs/hills, dancing, or rowing. Even yard work, such as raking leaves, digging, mowing, chopping firewood, etc can be aerobic. Work up to a minimum of 150 minutes (2-1/2 hours) each week using any combination of activities that keeps you engaged. Start slow.


A low-volume, moderate to high-intensity weight training program, when added to an endurance training program significantly improves upper and lower body strength as well as running economy. Adding speed work will improve running strength, but this is different from maintaining a strong core. Incorporating a strengthening program to the endurance phase establishes a good base/foundation from which to build on during the strength phase.

Studies have shown that a strength training program added to the endurance runners’ training results in little or no impact on V02max, blood lactate accumulation, or body composition, yet improves speed.

Of two runners that are equal except for muscular strength, the stronger runner will be faster over any distance. Lowering the maximum strength required for each stride translates into improved efficiency and consequently greater endurance.

When muscles don’t need to work as hard, they don’t require as much oxygen or circulating blood, and will not put as much demand on the heart, resulting in a lower heart rate. Greater strength equals greater endurance.

A good weight training/strengthening program (upper and lower body specific exercises) should be a part of every training phase to one degree or another (running may be reduced during this phase while strengthening exercises are increased). Build a strong base during endurance and increase the effort during the Strength phase. Strength and Speed phases may overlap in some programs.

A sample strengthening session. Read more….

How to Build Strength to Improve Running Efficiency

10 Essential Strength Exercises for Runners


Anaerobic exercise (exercise performed without oxygen!) is defined as short duration high intensity exercise lasting anywhere from merely seconds to around two minutes. After two minutes, the body’s aerobic system kicks in. Anaerobic exercise is typically intense enough to cause lactate to form, and is used by athletes to promote strength, speed and power and by body builders to build muscle mass.

To run fast you need strong muscles. Speed training builds stronger muscles, including the heart, improves running efficiency and form, creates mental toughness, and ultimately improves the runner’s pace. RunnersWorld says, “Research suggests that 30-second to five-minute bursts of intense exercise interspersed with rest periods will yield unique physiological changes—from faster fat loss and better blood sugar control to improved blood vessel function—that slow runs cannot deliver as efficiently.”

Duration: 4-10 weeks is the general guideline.

Runners: There’s lots of variations of speed training: intervals of various distances at the track, hill training, strides, tempo runs, fartlek runs, 3/1 runs (speed up the pace for the last quarter distance of the total run), etc. Reduce overall mileage during this phase to compensate for the added stress of speed.

Follow the speed workouts included in a shorter distance training program, such as for a 10k, 5k or shorter race, or simply incorporate weekly bouts of speed training (1-3x). This is also a good time to test yourself with shorter races or time trials.

Non Runners: Keep in mind that almost any sport can be performed in an anaerobic state (i.e., running/cycling/walking/swimming fast). Other traditional anaerobic sports include: Racquetball, Hiking (especially with a weighted pack and uphill), tennis, sprinting, weightlifting, possibly baseball/softball, ice hockey, and soccer.

8 Common Running Workouts, Explained (With Examples) 

Four Fast Speed Workouts for Any Runner 

Running 101: Basic Speed Workouts For Runners

Avoiding the “Black Hole” of Training

For runners, the next phase may be a second endurance phase that would re-build peak mileage in preparation for a marathon race (including a taper). Other athletes may focus on balance and agility, or a flexibility phase to improve range of motion, which just might incorporate that yoga class.

The last, or first phase depending how you look at it, should always be a period of active rest (3-6 weeks – more or less as needed).

There’s two types of active rest:

1. a significant reduction of training – for example, cut your training by a third or half – called a step-back week (like taking a deep breath before charging forward again), and

2. just as almost any exercise can become anaerobic, almost any exercise can be used for active rest. With a duration of about 20 minutes, walk or run at a very slow pace, swim, cycle or complete a series of easy stretches. Easy movements (that don’t stress the system) aid recovery, in most cases, more so than being sedentary.

I’ve been working on my full-year plan all week. The post-marathon rest and recovery period from last year inadvertently lasted all the way through the holidays leaving me with a longer than usual base building phase this year – probably six months. This should give me the advantage of warmer weather, however, for the strength & speed phase when I can cycle outside and every ride will become incredibly anaerobic tackling those hills I haven’t seen since last summer. The last endurance phase will build-up mileage for another 50k race this fall, and maybe this will also be the year for yoga.

Other approaches to Sports Periodization:

The Greatest Fitness Tips. Ever.

Here’s how to reach peak shape for any sport with one 12-week program.

FIRST MONTH: Complete a full-body weight-lifting circuit twice weekly. Do your cardio workouts on three other days, going long once. Each week, increase the duration of the long day’s workout by 10 percent. During the fourth week, cut the workout load by 50 percent.

SECOND MONTH: Follow the first month’s plan, but cut back to lifting once a week and add another day of cardio. During the eighth week, which is for recovery, cut everything in half.

THIRD MONTH: Stop lifting and use that day for cross-training. Ramp up speed by completing one cardio day each week with intervals at your intended race pace. Your long cardio day remains the same for the first two weeks, and for weeks 11 and 12 you cut its duration in half. During week 12, taper by doing only 50 percent of week 11’s work.

Here’s a simple way to periodize your training: Alternate three-week phases in which you perform three sets of 8-12 repetitions in the first phase and four sets of 4-6 repetitions in the second phase. Adjust your weights accordingly so you’ll use lighter weights for three weeks and then heavier weights for the next three weeks. This approach will help you increase strength, raise your metabolism, and improve muscular endurance. — Craig Friedman, Performance Specialist, Athletes’ Performance

Simply alternating cardio and strength days, while important, is not enough. As a diagram, periodization might look something like those blocky steps and valleys you see on preset treadmill programs—go hard, ease off; go hardest, ease off; go hard; ease off. The popular training programs developed by Joe Friel—author of The Mountain Biker’s Training Bible and The Triathlete’s Training Bible—present a monthly workout schedule in which the third week is the hardest of the four. The key is to create a program with multiple layers of periodization, taking the staggered approach within each workout, each week, each month, and ultimately through the duration of your program. “Periodization is the most likely way to achieve athletic success,” says Friel.


The Secret Garden Cottage

Just over a year ago my husband and I moved to our ‘forever’ home – the place we intended to live to our last days. Forever had lasted about six months when I had an idea.

What if we had misjudged what a forever home should be like? Was it possible we wouldn’t want a home this large? What if one of us – or both of us – didn’t want to climb stairs forever, or putz in a garden with so much grass? And if these things happened to become true, we surely wouldn’t want to do another renovation when forever had perked along for several more years.

We wouldn’t have to live in it right away, I had argued to my husband. It could be a vacation rental for awhile, or forever, if we decide not to downsize again. But, better to find a little house now. . . just in case.

We called Julie, our long-trusted realtor, and began a search for an adorable cottage. She established our MLS ‘cart’ and (intuitively) named it Secret Gardens. It had been a few weeks into the search when she sent me an email that said, “Oh my . . .”

It was the perfect little house in idyllic Lake Junaluska sitting at the end of one of the oldest streets, and next door to a garden containing plants that were once abundant, but are now rare. My heart swelled when I walked through the front door.

One family had owned it since the mid-40s as a summer cottage, and mostly left it in its original state. Character absolutely oozed out through the woodwork.

By the time we drove the 5 minutes back home, I had reworked the floor plan ever so slightly and convinced my husband to make a full-price offer. Full price wasn’t enough.

A few weeks later Julie discovered the lady that had won the bid (with her over-ask offer) was going to flip our little house. The three of us worked up a proposal, which my husband presented to this nice lady. After several conversations, he convinced her to sell us our house back.

And for the past few months we’ve been living in the fabulous land of RenovationOz.


“Authentic and original adorable 1945 Lake Junaluska Cottage located on Stuart Circle in walking distance to all that wonderful Lake Junaluska Assembly has to offer. The Summer cottage boasts wood floors. pine paneling, 3BR/1.5BA and two fireplaces. The livable cottage needs tender loving updating and is being sold as is/where is and priced accordingly. Seller states that the electrical and plumbing have been updated. The home is adjacent to the beautiful Corneille Bryan Nature Center.”  MLS description


These two rooms were added onto the original cottage at some point along the way. We’ve opened the wall between the two rooms to create one large space, and a doorway and window along the back wall of the kitchen have been removed.





This room was probably the original living room before the addition. Although barely visible, there was a very dainty crown molding that the over-ask buyer had already removed. She had also replaced the window with french doors, which we thought was a splendid idea.


Although previously used as a bedroom, it was necessary to walk through this room to reach the rest of the house, including the bathroom!


My husband added a Victorian-style ventless heater to this fireplace, and I’m contemplating re-painting the brick. The doorway leads to the hallway.


New french doors will lead to a deck that was in-progress before this week’s snow storm. The crown molding is a larger replica of the original molding, which I had never seen before, but reminds me of fish scale siding. The original hardwood floors were re-finished last week.

The Library’s crown molding ready for paint.



The hallway bath keeps the same footprint, but will get a new tile floor.



This room is next door to the master bedroom, and will become the master closet/laundry room.


The future Master Bath (no kidding).


A few inches stolen from the hallway allows for a new shower and two vanities in the master bath.


We uncovered the original exterior wall behind this closet and evidence suggesting this may have been the kitchen at one time. Now it’s the master bedroom.

Eliminating the closet creates room for the bed on the back wall.


Stuart Circle is one of the oldest streets in Lake Junaluska. A stone park sits in the middle of the one-way circle where perishable foods were once stored (in the large opening on the left) so that the cool spring water kept things fresh.


The cottage’s property line ran through the Corneille Bryan Native Garden (marked by the red flag above the sign).

Hopefully I’ll be working on the big reveal next weekend – although we said that about this weekend as well. . .  


Building Strong

Strong means different things to different athletes. The strongest among us are usually described in terms of their knockout rate, explosive dead-lift strength, or that rare football player that is said to “produce the most locomotive force of any human on the planet” – the label given Houston Texans’ defensive end Jadeveon Clowney in 2014. But strong, no matter the sport, seems to have at least one thing in common. Hard work.

Weight lifters hold a unique perspective on the pursuit of strong. The strength coaches of some of the most seriously strong of these athletes discussed what they believe separates the strong from the weak (10 Things the Strongest Athletes in the Weight Room Have in Common). They say the attributes of the strongest athletes include perseverance, consistency, having a plan, and working toward a goal. Very few athletes – even the ones who are gifted – are particularly strong from the get-go. They work at it for a long time.

I can vouch that it is possible to be a fairly good runner for some period of time with barely an ounce of true strength. A couple of years had passed after my first marathon before I discovered the plank or felt any need whatsoever to do one. Eventally I suffered through an endless list of injuries.

Writing a series on the anatomy of a runner has taught me that one of the major causes of injuries is muscle imbalance. Muscle balance is considered to be the harmonious action where muscles that surround a joint work together with normal opposing force to keep the bones involved with that joint centered. An imbalance occurs when an opposing muscle is incapable of contributing its share of the load, which may cause joint inflammation, tissue damage, pain, or abnormal muscle movement. Strength training is a simple remedy for the imbalances caused by the repetitiveness of our sport. Perhaps our individual rate of injury coincides with the time it takes our muscles to fall out of balance, and you need not be a runner or even an athlete to suffer these ill effects.

The strengthening program I’ve used for several years comes from Coach Jay Johnson. His Core H and Better Myrtl are a series of mostly 1-minute exercises specifically for runners that definitely create a burn.

Maybe they look easy enough. No kidding, they’re tough. The thing is that at the height of marathon training I don’t always have the energy (or the commitment) for tough. This year I decided there must be a fix for those few weeks of the most intense running of the year that would maintain strength without zapping me mentally or physically – a minimalist approach of sorts. Turns out I wasn’t the only one thinking this way.

Strength coaches tell us that when we don’t hold onto the strength we’ve built in the off-season, it takes a long time to build back up to where we were. “In-season training doesn’t need to be hard and heavy—just enough to maintain and pick up where you left off” – Tony Bonvechio, strength coach and co-founder of The Strength House.

Brad Stulberg writes Outside’s Science of Performance column (and author of the new book Peak Performance: Elevate Your Game, Avoid Burnout, and Thrive with the New Science of Success). Last month he wrote “The Minimalist’s Strength Workout: Five exercises that will guarantee you have the strength to adventure all weekend, well into your eighties.”

The article came out at the peak of my last marathon training program, and I immediately added the minimalist’s five to my weekly routine. I saved them for late afternoon 2-3 times each week rather than following a run, and it made all the difference in the world.

Having fully recovered from my latest marathon, I’ve reverted back to the Core H and a Better Myrtl program (Coach Johnson has since updated the Better Myrtl with a  Strength & Mobility version) although the minimalist exercises still have a spot in my routine. I’ve come to appreciate their simplicity and their added-value, and finally I’ve been able to pick up where I left off in the last off-season.

Following is a brief guide to each of the five exercises, but it’s worth reading Stulberg’s full article here.

(Erin Wilson)

Grip the bar with your palms facing out and hands slightly wider than shoulder-width apart. Pull yourself up so your chin is above the bar. Hold for one second. Then extend all the way down so your arms are straight and elbows are locked. Throughout the movement, focus on keeping your core taut. You’ll know you’re achieving this because your legs won’t be swinging around. 3 sets x 6 reps.

(Erin Wilson)

Stand with your legs slightly wider than shoulder-width apart, feet pointing slightly out. Hold a kettlebell by the horns, or a dumbbell with palms facing up, close to your chest. Squat down, keeping your heels on the ground. At the lowest point, your butt should be parallel to or just below your knees. Then push up to a standing positioning, locking your knees at the top. 3 sets x 8 reps.

(Erin Wilson)

Begin with your chest down and palms pressing into the ground, thumbs at or a little outside of your nipples. Press up, locking your elbows at the top. Lower your back all the way down, so your chest hovers just a centimeter or two off the ground. Press up. Repeat. Be sure to tuck in your stomach and keep your core tight throughout the movement so you have minimal arch in your spine. 3 sets x 16 reps.

(Erin Wilson)

Stand straight, toes pointing forward, feet about six inches apart. If you’re using dumbbells to increase the challenge, hold an equal weight in each hand at your sides, arms straight. Step forward with either foot so your knee is above your ankle. Push through the heel of the forward leg to return to an upright standing positioning. Repeat, this time stepping down with the opposite leg. 3 sets x 8 reps.

(Erin Wilson)

Stand on one leg, keeping your knee slightly bent. If you’re using dumbbells, hold them on the same side as the leg you’re standing on. Bend forward at the hip, extending your free leg straight behind you for balance. Continue lowering until your chest is parallel with the ground, dumbbell almost touching the floor. Then press back to an upright position. 3 sets x 8 reps.


Additional Reading:

Champions Are Made In The Off-Season

General Strength and Mobility Training

Periodization: you can’t train the same way all of the time.

The 18th Annual Chicago Lakefront 50/50 Ultra

My husband said it was just like learning to ski. You start out on the easy green slopes, work your way up to the blue, and years later when you’ve finally reached the bottom of a double black diamond, you throw your hands up in the air and scream “I did it!” That’s when the emotion of the whole journey sets in. He is so right.

A few minutes after crossing the finish line, I burst into tears. After a big bear hug, my husband gave me a kiss, propped me up and stepped back to take a picture. I finally told him to forget it, I couldn’t stop crying.

My focus for the past couple of years has been all about ’speed‘ – how everybody else has it, and I don’t. The thought of putting my toes on another starting line and running my hardest to match a finish time I held in my head – a time that probably should have been debunked long ago – it made me crazy. I love to run. I just wanted to run.

The biggest confession of this race is that there were only 8 weeks left for training after the stress fractures on my feet healed; hardly enough time to build up to the mileage of most ultra training programs. So I trained for a marathon. Some runners have claimed this approach spelled disaster for their 50k, and some runners say a marathon training program works just fine for the 50k. There was only one way to find out.

I thought I’d struggle with two things: surviving the extra time on my feet beyond where my training had taken me (one 20-mile run), and convincing my mind to stay out of it.

I knew I could keep my brain placated by feeding it sugar, so for the first time (perhaps amazingly), I experimented with GU gels during my training runs and discovered the exquisite burst of energy achieved from the GU that touted 20mg of caffeine. My husband bought me a bag full of those little pouches of GU, and although I could only stomach two during the race, they did their job.

I also vowed to try a little of every type of food offered at the aid stations, which included trail mix, M&Ms, pretzels, chocolate chip cookies and several varieties of potato chips. In 6 hours, 16 minutes and 59 seconds, I never hit the wall. My legs were a different story entirely.

As much as I like to groan over the elevation of my typical training run, some coaches say running up and downhill causes a change in which muscles are used and the percentage they are used, while running on a flat surface uses the same muscles. . . which could cause problems if your legs aren’t adapted to long hours on a flat terrain using the same muscles. My legs went stiff somewhere along the middle miles.

Ready, Set your Watches. . . Everybody!

The race course included 3 out-and-back segments along Chicago’s lakeshore path. A light rain fell in the same place for 2 out of the 3 segments. There was a warm(er) spot, an area that was strikingly frigid, a tunnel that was gruesomely muddy, and the wind grew steadily to over 14mph as the race lingered into early afternoon (welcome to Chicago!). The 50-mile runners had started two hours earlier, which left a constant shuffle of runners along the same path; back and forth, out and back, hour after hour.

There were a few onlookers here and there that cheered us on. One guy held up a sign for hours that read: Run like zombies are chasing you! Otherwise, we were mostly left to our own thoughts and the quiet, peaceful attempt to run further than I’ve ever run before. I absolutely loved it.

Everyone wanted to know if I would run another 50k. Yes, definitely.

A finish time of 6:16:59 and a 3rd place finish in my age group of 50-59.

Confessions of the 50k

The 50k: it’s not about the distance, really. It’s how you get there.

My husband says the title of this post should have been, “The 50k, finally.” I admit it has taken me a few years and several false starts to get here. For more than a few years he really thought the race itself would kill me. I really thought the training would kill me.

Hal Higdon’s training programs have always been my go-to marathon plans. His 50k program lasts 26 weeks. Six months. The first 18 weeks follow a typical marathon training plan on steroids with three 20-mile runs and one full marathon (26.2 miles for those non runner readers). Then we get to the really fun training weeks where the long runs are simply described by how many hours one should run in one session. When I trained for the 50k a couple of years ago, it wasn’t that I got injured. I just wore myself out.

Luckily for me I’m retired so that I can run every morning. This is handy when you still want to have a life. I followed a Canadian marathoner last year. She ran before work, sometimes during her lunch break, after dinner wearing a headlamp, and followed a long-run route that crossed a frozen lake. We’ve all been there. You just do what you’ve got to do. Even in retirement our alarm routinely rings at 5:30a so I can finish a run before lunch. And if you’re determined to be the best you can be, this doesn’t last for 12, 18, or 26 weeks. If you want to be really good, you follow this schedule to some degree or another all year.

Earlier this year I remembered reading from a fellow runner (Dan’s Marathon) about the ChicagoUltra. The full 31.1-mile course is on the Chicago Lakefront path – imagine flat, scenic, flat, a slight breeze, flat . . . sheer bliss. Even better when I realized this could be an anniversary race of sorts. I ran my first marathon in Chicago in 2007. How perfect to run my first ultra in Chicago ten years later. . . maybe nothing’s worse than a nostalgic runner.

My husband and I decided on a training plan that wouldn’t kill me and I began training in May. Some number of months later, there was an out-of-state family emergency.

It came on a Wednesday. No problem I thought, and I reworked my schedule to accommodate two days off in the middle of the week. Then the same family emergency came again the next week.

It was at the end of the second week that I told my husband I had really screwed up. I had run 80% of the week’s miles in three days for two weeks in a row: Friday, Saturday and Sunday, with the long run on Saturday both weeks. One week later I ended the Saturday long run with stress fractures in both feet.

In my last post I wrote about stress fractures of the lower leg: “Studies released this year build on a growing body of research that suggests it’s not how much you train in isolation, but how the training load changes (training load errors).”

The strategy for this year will go down as “go for broke.” I went into full recovery mode training thinking there was nothing to lose. I had already been cycling for cross-training, so I ramped up the cycling schedule, added extra long walks as soon as I could walk without it hurting, and spent serious recovery time focused on being off my feet. Four weeks later I was able to restart my training.

I’ve emotionally held my breath for every run. Going back to Hal’s programs, I settled on another one that would pick up where I had left off, and hopefully prepare me for the race without re-injuring my feet. Last Saturday I finished my longest training run, and (as of now) I’m still injury-free.

My dad has once again agreed to babysit the dogs, I’ve paid my money, and I’m finally registered for my first 50k.

My husband used to warn us about getting too excited about a successful meeting with investors years ago in our start-up businesses by saying, “It’s a long way from the cup to the lip.” In other words, lots of things can go wrong in a short space of time.

Today is the first day of a shortened 2-week taper, and although lots of things could go wrong, I’m still on a strategy of go for broke. Race day is Saturday, October 28th. Stay tuned.

The Anatomy of a Runner: lower leg

The sixth in a series of posts about the anatomy of a runner. A runner’s most common injuries in the lower leg include fractures or stress fractures of the bones, strains, ruptures or tears of the muscles, a Charley horse or cramps, shin splints, and to a lesser degree deep vein thrombosis in athletes, and the dislocation of the fibula head. Each of these injuries are discussed in this post, including why it hurts, where it hurts, treatment options and prevention.


Located between the knee and ankle, the lower leg consists of four compartments that contains muscles, nerves and blood vessels separate from their neighbors. Each compartment is surrounded by tissue known as fascia. Muscles in these compartments control the motion of the foot and ankle while the two bones of the lower leg provide attachments to thigh muscles, and bears most of the body’s weight.

F374E56D-5BC2-477E-A9CA-892AB3EEE6CAThe human legs are exceptionally long and powerful as a result of their exclusive specialization to support and locomotion — in orangutans the leg length is 111% of the trunk; in chimpanzees 128%, and in humans 171%. Humans also use 75 percent less energy walking upright than chimps use walking on all fours primarily because chimps use large hip muscles while humans use smaller muscles, like those in our lower legs. (Wikipedia)

Note: For the purposes of this discussion, the ankle and Achilles’ tendon will be covered in a future post.




Tibia: a Latin word meaning both shinbone and flute (flutes were once fashioned from the tibia of animals).

Fibula: a Latin word that designates a clasp or brooch. The fibula was likened by the ancients to a clasp attaching it to the tibia to form a brooch.

The two bones of the lower leg, the tibia and fibula, are two of the body’s long bones, given this name because they are longer than they are wide, they are the major bones of the limbs, and are responsible for the bulk of our height as adults.

The tibia, the larger of the two bones, is familiarly known as the shinbone, and bears most of the body’s weight. The fibula runs alongside the tibia on the outer side, and swells into a bony knob on the outside of the ankle known as the lateral malleolus. (The medial malleolus, felt on the inside of the ankle, and the posterior malleolus, felt on the back of the ankle, is part of the tibia.)

The fibula, also known as the calf bone, is mainly a muscle attachment point and plays a significant role in maintaining balance, stabilizing the ankle, and supporting the muscles of the lower leg. Compared to the tibia, the fibula is about the same length, but is considerably thinner.

A cavity is found in the center of the bone that serves as a storage area for bone marrow used to store energy in the form of lipids. The overall mass and thickness of the bone increases under stress, such as from lifting weights or supporting body weight.


Why it hurts: A tibial fracture is the most common injury of all long bone fractures resulting from automobile collisions, sports injuries, or falls from a height.

Where it hurts: Symptoms may include tenderness directly over the shin bone, deformity of the leg, swelling and bruising, an inability to bear weight. If a fracture is suspected, seek medical advice immediately.

Treatment depends on the location and severity of the fracture, but usually includes immobilization and limitations in weight-bearing activities. Because there is less blood supply to the mid and lower parts of the tibia they tend to heal more slowly. Some fractures may require surgery.


Overuse stress fractures are more common among runners and endurance athletes and account for up to half the injuries sustained by military recruits; causes include 1) insufficiency: when osteoporotic bone is subjected to normal stress, and 2) stress: when normal bone is subjected to excessive load.


Why it hurts: Stress fractures (also called hairline fractures) are overuse injuries of bone: a result of repetitive sub-threshold loading that, over time, exceeds the bone’s intrinsic ability to repair itself.

The term ‘overuse injury’ is falling out of favor within the research community, however, since the true cause of the injury has been more accurately described as ‘training load errors’ rather than overuse.

Since the fibula is not primarily responsible for weight-bearing, a stress fracture here is not as common as a fracture of the tibia. Much of the fibula’s surface is used for muscle attachment, which results in traction and twisting forces being placed on the bone. It’s this tug and pull, however, that could cause a stress fracture to develop over time on the fibula.

Athletes with excessive pronation, where the weight remains on the inner side of the sole, are more susceptible to a fibula fracture because the peroneal muscles work harder and longer during toe-off in the running gait cycle.

  • A fracture is thought to occur from a sudden change in frequency, mileage, pace, or terrain. Studies released this year build on a growing body of research that suggests it’s not how much you train in isolation, but how the training load changes (training load errors). For example, athletes (in this case elite rugby league players) who increased their training load by 60 percent as compared to their weekly average over the previous four weeks were more likely to get injured.
  • Lack of rest after long runs, running shoes greater than 6 months old or with more than 300 to 500 miles, and running on hard or cambered surfaces are other extrinsic factors that may also play a role in the development of a bony stress injury.
  • A runner’s gait may lead to higher load rates that put a runner at risk, including excessive hip movement (adduction), rear foot eversion (turning inward/outward), and stride length (stride will be covered in detail in a future post).
  • Muscle fatigue may also play a role in stress fractures since both muscles and bones serve as shock absorbers for the body. As muscles of the lower leg become fatigued they lose their ability to absorb shock, creating greater stress on the bone, and increasing the risk of fracture.
  • High-arched runners are more at risk for bone-related injuries like stress fractures in the shin and foot, and shin splints – by almost 50% more than low-arched runners – because they run with “stiffer” legs giving them less up-and-down motion causing the forces to be absorbed by the bones. (Low-arched runners have a higher relative muscle to lower-body stiffness making them more prone to soft-tissue and joint injuries like Achilles tendinopathy/tendinitis and runner’s knee – both according to observational findings from studies dating to the late 1990s and early 2000s).
  • In a recent study by Burgi et al., there were twice as many tibial stress fractures in women with low vitamin D concentrations.
  • Previous stress fractures also predispose stress fractures.
  • Female Athlete Triad: Energy deficiency is the main cause of the Triad. An energy deficiency is an imbalance between the amount of energy consumed and the amount of energy expended during exercise. The Female Athlete Triad is a syndrome of three interrelated conditions that exist on a continuum of severity, including: 1) Energy Deficiency with or without Disordered Eating, 2) Menstrual Disturbances/Amenorrhea, and 3) Bone Loss/Osteoporosis. Gender specific topics, such as the Female Athlete Triad, will be covered in detail in a future post.


Where it hurts:

  • D27315E0-977B-4F5E-A47F-FD4EBC130589

    Gradual onset of localized pain on the inner aspect of the shin bone. Pain is often sharp, increases with activity, and decreases with rest. Occasionally pain may be felt at rest or even at night. Walking may aggravate symptoms.

  • Although pain may radiate away from the injury, tenderness will be felt when firmly touching the site of injury.
  • A tibial stress fracture may also present as calf pain or on the front of the shin (as opposed to the inner side of the shin).
  • A stress fracture of the fibula will present as the gradual onset of pain in the calf. Pain may also present at the ankle, depending on the specific location of the fracture.
  • X-rays usually do not show new stress fractures, but can be used several weeks after the onset of pain. A CT scan, MRI, or 3-phase bone scan is more effective for early diagnosis with the MRI being the most effective.
  • Another diagnostic measure often used is the tuning fork test where a tuning fork is applied to the fracture site to produce pain. There is little supporting evidence for the tuning fork although one small study found it had a positive predictive value of 77%. Personal experience also supports the effectiveness of this diagnostic tool.

Treatment: Depending on the severity, complete rest may be advised using a brace, walking boot, crutches, or air cast. An air cast has pre-inflated cells that put light pressure on the bone, which promotes healing by increasing blood flow to the area.

  • POLICE is the new acronym (as opposed to RICE or PRICE).
    • Protection: is a method of off-loading stress from the injury using crutches and/or a supportive tape.
    • Optimal Loading: encourages healing by gradual loading of the tissue to promote the cellular responses required for healing.
    • Ice: used initially for pain relief then let the body do the work. Avoid heat and massage.
    • Compression: for support. Do not over-compress. Supportive tape, such as K-tape or a flexible elastic bandage, will partially off-load the injured tissue and provide flexible support during movement without constricting.
    • Elevation: raise and support the leg to reduce swelling; lower gradually to minimize fluid flooding back to the area. The goal is to reduce swelling, not inflammation, which is vital to healing. Don’t compress and elevate at the same time.
  • Cross-training to maintain fitness during recovery is possible and even preferred if it can be completed without pain to the injury. Cycling, the elliptical, or water exercises may be good alternatives. Avoid rocky terrain when cycling with a stress fracture; in fact, a stationary bike is the best alternative. Training, or ‘loading’, should complement the healing process by providing an acceptable level of stress to the injury – not pain. Consult your physician.
  • Recovery lasts 4-8 weeks or longer; healing will continue even after the injury is pain-free.
  • Although there’s little scientific evidence to support the practice, runners everywhere use the “hop” test to determine if a stress fracture has adequately healed enough to return to running.
  • Gradual return to training is recommended. One option is to use a reverse marathon taper program, or alternate running with cross training days to create a slow build-up of mileage.
  • Consult your physician if pain persists despite home treatments, or if a complete fracture is suspected.


  • Avoid sudden ‘peaks’ in training. It’s not necessarily high training loads that cause injuries, it’s how you get there.
  • Don’t increase training too fast, and allow adequate recovery between hard bouts of exercise.
  • 80% of training volume should be low intensity and only 20% high intensity. Adding more high intensity sessions won’t necessarily improve performance.
  • Incorporate calf muscle strengthening exercises to your routine.
  • Ensure a balanced diet, including calcium, vitamin D, and vitamin K – deriving these vitamins through diet rather than supplements is preferred.
  • Replace worn shoes. Experiment with various shoe styles to find what works best for you, or consider seeking the advice of a professional. It has been noted that some runners experiencing multiple lower leg injuries find relief in a gradual introduction to barefoot or minimalist running. The “less foot supportive” running styles are believed by some to result in less transmission of the forces that are known to lead to running injuries, such as stress fractures. Consider consulting your physician, a physiotherapist or a running shoe specialist.
  • Vary running surfaces between hard and softer surfaces.
  • Evidence suggests the risk of stress fracture may be lower among adult runners who have had a broad athletic background that includes childhood participation in “ball sports,” providing incentive to avoid sport-specialization in young athletes.
  • Sixty percent of osteoporosis risk is related to the amount of bone mass accrued by early adulthood, suggesting some athletes may be pre-disposed to injury. Read more: Bone Health in Endurance Athletes Runners Cyclists and Swimmers
  • Stretching leg muscles during warm-up before exercise has shown no significant effect on preventing tibia stress fractures even though studies show that calf tightness plays a role. Tight calves cause a premature lifting of the heel while running and transfers a significant amount of force into the forefoot. Try incorporating a stretching routine on non-running days to loosen tight muscles.
Courtesy: OctaneFitness

Shin Splints (Medial Tibial Stress Syndrome – MTSS)

Medial tibial stress syndrome (MTSS or shin splints) is characterized by pain in the anterior/front, or sometimes on the inside front of the lower leg, and is a common injury among athletes in sports that involve running. Athletes have long used the term shin splint to reference pain generally felt along the shin bone, regardless of its specific location.

Why it hurts: Numerous studies since 2012 have investigated different aspects of MTSS and yet it is still unclear exactly how the injury occurs. These studies have proposed MTSS is caused by muscular or tendon strain, overuse of the muscle tissue surrounding the tibia (shinbone), or that it is a precursor to Periostitis (a condition caused by inflammation of the connective tissue that surrounds bone).

The accuracy of all these studies have been argued. In fact, anatomical research studies question whether underdeveloped muscles, muscle strains and overuse factors could even be considered risk factors since no tibialis muscle attachments exists in the areas where most shin splint symptoms present.

Traditional thought has been that shin splints occurred more often in inexperienced runners increasing mileage too quickly although, unfortunately, MTSS also occurs in trained distance runners and in athletes who have none of the suspected risk factors.

Risk factors include a pronated foot type, high body mass index (BMI), running on a canted surface, an excessively fallen arch (excessive navicular drop), and a foot tilt in relation to the ankle (medial calcaneal tilt).

Where it hurts: Pain presents along the length of the shin bone. Pain with weight-bearing is typically worse in the mornings and exacerbated by the end of exercising, when climbing stairs, and at night.

Treatment: few well-designed studies of MTSS treatments have been conducted, which leaves us with traditional treatment options as opposed to scientific data. Nonetheless, athletes across all disciplines have found relief in one or more of the following areas:

  • Reduce training, or cross train through recovery as long as there is no pain.
  • Avoid hills, which can aggravate the shins.
  • Taping the shin with an elastic bandage, K-tape or by using a neoprene sleeve will compress the muscles and limit muscle movement to provide support and some pain relief.
  • Run on more forgiving surfaces; avoid cement.
  • Consider specialized shoes or orthotics to correct pronation issues.

Is it a stress fracture or shin splints?

The pain of shin splints is generally described as diffuse tenderness along the length of the shin bone – although pain from a tibial stress fracture will also be felt throughout the shin bone (considered radiating pain) making the two conditions difficult to differentiate. With a tibial stress fracture, however, the pain is most prominent when pressing your finger on the specific spot of the fracture whereas there is no ‘specific’ spot of tenderness with shin splints.


Calf Muscles

The gastrocnemius is the larger calf muscle, forming the bulge visible beneath the skin. The gastrocnemius has two parts or “heads,” which together create its diamond shape. The soleus is a smaller, flat muscle that lies underneath the gastrocnemius muscle.

Note: Calf muscles, also known as the “second heart,” contribute to proper circulation in the body. When calf muscles contract during movement, fluids are pumped toward the heart. Standing for extended periods of time without moving results in fluids draining to the feet and ankles causing swelling. This swelling makes the feet, ankles and lower legs feel achy and tired.


Calf Muscle Injuries

Calf injuries usually occur from a sudden pushing-off movement or from excessive over-stretching of the calf muscles as with jumping activities or quick changes of direction.

Calf muscle strain: Stretching the calf muscle past its normal length results in tearing of some calf muscle fibers, and can vary from mild (slight pain) to severe (complete tear of the calf muscle). “Pulling” the calf muscle also stretches the calf muscle beyond its limit resulting in a strain.

Calf muscle tear: All calf muscle strains tear the muscle fibers although a more serious injury may result in a partial or complete tear of the calf muscle.

Calf muscle rupture: A complete tear of the calf muscle results in severe pain and an inability to walk. The calf muscle may collapse into a compact ball that can be felt through the skin.

Calf muscle myositis: a rare condition causing inflammation of the calf muscle as a result of infections or autoimmune conditions.

Rhabdomyolysis: Calf muscle breakdown due to long-term pressure, drug side effects, or a severe medical condition. Rhabdomyolysis usually affects multiple muscles throughout the body.

Where it hurts: Symptoms may vary significantly but usually involve a sudden sharp pain at the back of the lower leg. The calf muscle will often be tender to touch at the point of injury, swelling and bruising may appear within hours or days. Calf injuries are graded from 1 to 3, with grade 3 being the most severe.

Grade 1: a twinge of pain in the back of the lower leg or a feeling of “tightness”, it may be possible to continue exercise without pain or with mild discomfort. Post-exercise, however, there will likely be “tightness” and/or aching in the calf muscles which can take up to 24 hours to develop.

Grade 2: sharp pain at the back of the lower leg and usually significant pain on walking, swelling in the calf muscle with mild to moderate bruising, although bruising may take hours or days to be visible. Pain will be felt when pushing the toes and foot downwards towards the floor.

Grade 3: often referred to as “ruptures” is associated with severe immediate pain at the back of the lower leg. Likely exercise can not continue and walking is difficult or impossible due to weakness and pain. Considerable bruising and swelling may appear within hours. The calf muscle can not be contracted at all and a gap in the muscle can usually be felt.


One of several ways to support a calf injury through taping:


  • P.O.L.I.C.E./P.R.I.C.E. is essential. (Optimal Loading should only be used if it can be performed pain-free, and depending on the Grade of the injury. A Grade 3 injury will likely follow P.R.I.C.E.)
  • Use a compression bandage immediately to stop the swelling – applied for no more than 10 minutes at a time (restricting blood flow can cause more damage). A calf support or sleeve can be applied for longer periods of time.
  • Wearing a heel pad to raise the heel and shorten the calf muscle will take some of the strain off the muscle. (Use heel pads in both shoes to avoid one leg being longer than the other, creating an imbalance and possibly leading to other injuries / pain, such as in the back.)
  • Resistance bands can be used initially after injury, followed by calf raises and eventually single leg calf raises – only if they are not painful. Once you can perform 3 sets of 20 single leg calf raises pain-free, gradually incorporate easy running. Incorporate plyometrics or hopping exercises to correct any muscle imbalances and prevent the injury recurring.


Strong Calf Muscles Will Make You Faster (Runner’s World)

Charley Horse / Cramps / Exercise-associated muscle cramps (EAMC)

Exercise-associated muscle cramps are a common condition experienced by recreational and competitive athletes alike.

Why it hurts: Theories abound, but the most prevalent causes have been attributed to dehydration or electrolyte imbalances – although neither have held up to scientific scrutiny. The American Academy of Orthopedic Surgeons’ information on the subject included inadequate stretching, poor conditioning, fatigue, age, intense heat, dehydration, and depletion of electrolytes among risk factors, but these too could not be proven.

Studies comparing the hydration and electrolyte levels of athletes experiencing cramps and those without cramps exhibited similar levels of both. Also of note is that digesting fluids and/or electrolytes takes too long to enter the body’s circulatory system to have an immediate effect for treatment.

The conclusions most accepted from these studies is that EAMS has been found to occur most often in less well-trained athletes, appears to be more common in some families, and in those more susceptible to heat illnesses. It is also more common in men than in women, and in fatigued muscles.

Where it hurts: Muscles that are the most prone to cramps are those that cross two joints. Examples of such muscles are the hamstrings, gastrocnemius (one of the calf muscles) and the quadriceps group which includes the rectus femoris (the longest of the quadriceps muscles).

The hamstrings span the hip and knee, the gastrocnemius spans the knee and ankle and the rectus femoris crosses the hip and knee.

Treatment: Stretching the affected muscles is the fastest way to stop cramps, as painful as this may be. One theory for the success of stretching is that tendon nerve receptors are stimulated to shut down the cramp signal.

Eating bananas will not prevent cramping, and as stated, cramping has no relationship to hydration or electrolyte levels. Increased hydration does not prevent cramping and can have other more lethal results (hyponatremia). Pickle Juice may be a surprising remedy, but it has been used to stop and prevent cramps since the 1950s. Recent studies show that it not only works, but it works in as little as 35 seconds. Coaches and athletes have found similar success with mustard and sour candy.

Recently, Roderick MacKinnon, a Nobel-prize winning neurophysiologist, avid kayaker and fellow cramp sufferer, has put his professional skills and desire toward understanding EAMC and the mechanism by which pickle juice resolves the problem. MacKinnon discovered two taste receptors in the mouth that are stimulated in response to the pickle juice, and corresponded this to the food versions of these stimulants, which turns out to be cinnamon, capsaicin, weak acid and ginger. He’s now formed a company that sells “Hotshot,” – a 1.7 ounce drink consumed 15-30 minutes before exercise to boost neuro muscular performance and prevent muscle cramps according to their website.

Isometric Stretching to stop leg cramps: watch the video at

Compartment Syndrome

Compartment Syndrome is a condition of increased pressure within the lower leg compartments resulting in insufficient blood supply to tissue.

Why it hurts:

Acute Compartment Syndrome is commonly due to physical trauma, such as a bone fracture or crush injury, and includes severe pain, poor pulses, decreased ability to move, numbness, or a pale color. Treatment includes surgery.

Chronic compartment syndrome is caused by repetitive use of the muscles resulting in increased tissue pressure within the compartment. Muscle may increase up to 20% during exercise causing pressure to build in the tissues and muscle. This condition is often triggered by running or cycling, is more prevalent in those under the age of 35, and in males. Pain is felt during exercise and may include numbness, but typically resolves with rest.

Where it hurts:

Chronic Exertional Compartment Syndrome symptoms involve tightness, or a tingling sensation in the area most affected followed by a painful burning sensation, sometimes also described as aching, tightening, cramping, sharp, or stabbing – the pain may also be confused with the pain of shin splints, stress fractures and tendinitis. The differentiating symptoms of compartment syndrome is a moderate weakness and numbness. There may also be difficulty dorsiflexing the foot and ankle (moving it upward), or the foot may seem to “flop”. Feet and even legs may fall asleep due to reduced blood supply.

Symptoms occur at a certain threshold of exercise that will vary individually from 30 seconds to 10-15 minutes, after a certain distance or at a certain intensity of exertion after exercise begins, progressively worsens as exercise continues, and subsides within 10 to 20 minutes of stopping the activity. Over time, recovery time after exercise often increases. Taking a complete break from exercise or performing only low-impact activity might relieve symptoms, but usually only temporarily. Once running is started again, for instance, symptoms usually come back.

Compartment Syndrome may occur in conjunction with other injuries as well, such as fractures. Consult your physician sooner rather than later.

Treatment: A conservative treatment includes rest. Elevation is not recommended; the affected area should be kept level with the heart. Splints, casts, or tight dressings should be avoided. Do not tape or use compression of any kind.

In some people, compartment syndrome is an anatomical problem that cannot be “deconditioned” and will persist with physical activity. If the symptoms persists, a surgery known as a fasciotomy would be recommended, and is the most effective treatment option. Failure to relieve the pressure may result in serious complications.

Prevention: Exertional compartment syndrome is a form of overuse injury. Build mileage slowly ensuring adequate rest and recovery days are included in your schedule. Determine the point in which the pain arrives and stop running just prior to this threshold, slowly building time/distance. Low intensity cross training can be used to maintain conditioning while giving the body a rest from repetitive loading.

Note: A military study conducted in 2012 indicated that symptoms subsided in individuals with lower leg chronic compartment syndrome when taught to change their running stride to a forefoot running technique. (Wikipedia)

Antero-lateral dislocation of the fibular head (sometimes called a stuck fibular head)

2E0F7002-AD08-40D0-90AB-722ACFBB220FProximal tibiofibular joint dislocation is an uncommon injury, and is most often found in sports involving aggressive twisting of the knee, such as soccer, the long-jump, snow-boarding and horse-riding, although runners have also been affected.

Where it hurts: Lateral knee pain that is aggravated when pressure is applied over the fibula head. Limited knee extension; clicking or popping can be heard. Ankle movement may exacerbate the pain. Some runners complain of pain in the upper outside of the calf muscle (behind the fibula bone).

Treatment begins with a reduction of the dislocation: while the knee is flexed and the foot is dorsiflexed (flexed in an upward position) and externally rotated, pressure is applied over the fibula head until a “pop” is heard.

Alternatively, using a rolled towel placed high under a bent knee, bend the lower leg back onto the towel to apply pressure onto the fibula head. View a YouTube video here.

Reduce or eliminate training during recovery. K-tape or a Robert-Jones bandage has proven effective for support.

Venous Thromboembolism and Marathon Athletes

Venous Thromboembolism (VTE) is the collective term for deep vein thrombosis and pulmonary embolism where awareness is key to its prevention.

The risk of VTE is related to (1) the efficiency of blood flow, (2) the integrity of blood vessels, and (3) the physical composition of blood itself. Although rare, athletes, particularly those who travel or stay sedentary for prolonged periods of time in between training sessions, may develop blood clots.

It’s important to know that clots can occur anywhere in the body, including upper limbs. Because of overall conditioning (muscle tone and low body mass index), a high level of baseline fitness, and pain tolerance, athletes may not seem at risk for VTE. This is where we’re reminded how a health professional would view an athlete’s risk: being fit does not mean to be healthy.

Virchow’s triad of risk factors for venous thromboembolism (VTE). Factors in red are associated with heightened risk in marathon athletes. Note that athlete-specific factors are present in all 3 sections of the triad; a cumulative risk of VTE in certain individuals is entirely possible. (Photo courtesy:

Why it hurts: The body is designed with a natural balance between factors that cause the blood to clot and other factors that cause the blood to dissolve clots. Veins carry blood back to the heart from the rest of the body where clots can form in the deep veins of the legs, arms, pelvis, abdomen, or around the brain, which are called deep vein thrombosis (DVT). If a piece of the clot breaks off from a leg or arm and travels to the lung, it can cause a clot in the lung, called a Pulmonary Embolism – a life threatening medical emergency. Seek immediate medical attention if you have symptoms of a Pulmonary Embolism.

Deep Vein Thrombosis leg symptoms are often mis-diagnosed in athletes as muscle tears, a Charley horse, twisted ankle or even shin splints.

Chest symptoms of a Pulmonary Embolism may be attributed to a pulled muscle, inflammation of the joint between the ribs and breast bone (costochondritis), bronchitis, asthma, or even early signs of pneumonia.

Athlete-specific risk factors are common in endurance runners, such as inflammation, dehydration, low heart rate (bradycardia) and low blood pressure.

Where it hurts:

Deep Vein Thrombosis: 

  • Swelling, usually in 1 leg, often visible in the calf and ankle;
  • Leg pain, tenderness, or the sensation of chronic cramping that does not ease with ice, stretching, or painkillers;
  • Inactivity may exacerbate the pain, and activity may alleviate pain;
  • Reddish or blue skin discoloration (often obvious when bathing with hot water);
  • Leg warm to touch;
  • Unexplained upper arm or neck swelling (upper extremity deep vein thrombosis);

Pulmonary Embolism:

  • Sudden shortness of breath or breathlessness on exertion;
  • Rapid heart rate;
  • Cramp in side or chest, painful breathing.


  • Refrain from training for 1 month after diagnosis.
  • Anticoagulation therapies prescribed by a doctor increase the risk of bleeding: contact, impact, and high-intensity sports that increase the risk of physical trauma should be avoided.
    • High risk: cycling (on- and off-road cycling), boxing, rugby, baseball, soccer.
    • Low risk: power walking, running (moderate), swimming, controlled conditioning exercises in the gym.
  • Wear individually fitted compression stockings to reduce the long-term risk for post-thrombotic syndrome.

Prevention: Defense Wins Games

  • Take breaks and stretch legs when traveling long distances;
  • Stay well hydrated (during and after a strenuous sporting event, and during travel);
  • Know the symptoms of DVT and PE and seek early medical attention if they occur;
  • Be aware that DVT and PE can occur even in athletes;
  • Know the risk factors for blood clots, including whether you have a family history of blood clots;
  • In case of major surgery, trauma, prolonged immobility, or when in a cast: talk to your doctor about your specific DVT risks.
  • Learn more, or join the awareness campaign for athletes at


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

Additional Reading/References:

Miller K. Plasma potassium concentration and content changes following banana ingestion in exercised males. J Athl Tr. 2012;47:648-654.

Miller K, Mack G, Knight K, et al. Reflex inhibition of electrically-induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc. 2010;42:953-961.

Miller K, Mack G, Knight K. Electrolyte and plasma changes following ingestion of pickle juice, water, and a common carbohydrate-electrolyte solution. J Athl Tr. 2009;44:454-461.

Miller K. Electrolyte and plasma responses following pickle juice, mustard, and deionized water ingestion in dehydrated humans. J Athl Tr. 2013 (in press).

Miller K, Knight K, Mack G, et al. Three percent hypohydration does not affect the threshold frequency of electrically-induced muscle cramps. Med Sci Sports Exerc. 2010;42:2056-2063.

Braulick K, Miller K, Albrecht J, Tucker J, Deal J. Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency. Br J Sports Med. 2012;47:710-714.

Physical Medicine and Rehabilitation for Stress Fractures Stephen Kishner, MD, MHA et al 2017

Stress Fractures: Diagnosis, Treatment, and Prevention: American Family Physician

Proximal Tibiofibular Dislocation.” Emergency Medicine Journal : EMJ 23.5 (2006): e33. PMC. Web. 17 Sept. 2017.  

Runner’sWorld: How to take care of your calves

Runner’sWorld: Build Stronger Lower Legs 

Exercise Associated Muscle Cramps, Peter G Gerbino Sports Medicine and Rehabilitation Journal Review Article Published: 19 Dec, 2016

Advances in Understanding Medial Tibial Stress Syndrome, Debbie Craig Sports Medicine and Rehabilitation Journal Review Article Published: 20 Oct, 2016 

Exercise May Reverse Age-Related Bone Loss in Middle-Aged Men, Press Release July 2015

Will 1 Minute of Running a Day Really Strengthen Your Bones? Digging into the research behind a seemingly improbable health claim. By Alex Hutchinson JULY 26, 2017,

Malisoux, Laurent et al. “Injury Risk in Runners Using Standard or Motion Control Shoes: A Randomised Controlled Trial with Participant and Assessor Blinding.” British Journal of Sports Medicine 50.8 (2016): 481–487. PMC. Web. 20 Sept. 2017.

Phys Ed: Do Certain Types of Sneakers Prevent Injuries? New York Times BY GRETCHEN REYNOLDS JULY 21, 2010

Can Arch Height Predict Your Running Injuries? By Alex Hutchinson JULY 21, 2017

Bone Health in Endurance Athletes: Runners, Cyclists, and Swimmers

Small Change, Big Gain

A few weeks ago The Fartlek was asked to contribute to an info graphic about the small, daily habits that lead to a healthier and better life. The instructions were pretty simple. They were looking for favorite personal wellness tips from several health conscious bloggers to use in the graphic – anything from a morning exercise routine to an afternoon meditation session, or even a favorite pre-bedtime smoothie.

The exercise resulted in an interesting thought process for me. What would you say are the most important daily habits that lead to a healthier life? Is it diet, a particular  exercise routine? My dad could be granted a patent on the unique combination of ingredients for his morning smoothie. My husband would say that ‘healthy’ is a lifestyle; that an exercise routine has to become an integral part of your day.

My answer came from the perspective of my favorite sport of running, although I realized everyone’s answer would vary depending on their own personal goals.

The challenge seems to be the same for everyone: to find a routine/diet/exercise that works and somehow convince our minds to stick with it. Within that challenge are three things that help me stay on track from day-to-day which could be applied to health-conscious folks of every age:

1. follow an easy-day/hard-day schedule – for example, in my sport of running, a slow, easy run would follow a hard, speedwork session; this schedule can keep things from getting too monotonous as well.

2. respect the rest days – your body becomes stronger with rest, so the best way to continually improve and avoid injury is to give the body adequate recovery time; something that becomes even more important as we age.

3. eat fresh and be adventurous with ingredients – use fresh, not packaged ingredients and vary what you eat from day-to-day instead of getting stuck in a routine of the same meals. My favorite saying is “good in, good out” because it’s so true, but studies also show that athletes who eat the most variety of healthy foods perform the best.

The hardest thing seems to be simply getting started with a healthy routine, whether that’s exercising or eating right. We have to remember that most of us never reach our full potential because our minds won’t let us – our most difficult challenge is harnessing the mind.

One of the most effective ways to ‘override’ these negative thoughts is to establish a routine you can stick with, and remember that N=1. In other words, you are your own best test subject. What works for others, may or may not work for you. Experiment until you find your best solution.

What’s your #SmallChangeBigGain? (Elysium Health)