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Newsletter Archives: Volume 22, October 2000

Words from Jeff on Recovery:

Even if you've run twice as far as you've ever raced before in your life, you can be back to your normal running routine very quickly by following a few simple steps, before and after your race. By mentally and physically preparing for the morning after, you can reduce the negatives, while emotionally riding the wave of positive momentum from even the toughest of races.

The Post-Race Letdown

Even if you've run twice as far as you've ever raced before in your life, you can be back to your normal running routine very quickly by following a few simple steps, before and after your race. By mentally and physically preparing for the morning after, you can reduce the negatives, while emotionally riding the wave of positive momentum from even the toughest of races.

The Post-Race Letdown: Even with the best preparation, however, there will be a natural motivational lull. When you've spent months working toward a specific event and you've reached the finish line of a significant physical test, event the most focused athletes experience a psychological letdown. The challenge has motivated you to be regular with your exercise, to keep pushing your endurance limits on long runs, and to reach down deep for motivation and the strength to go on. Like any almost unique lifetime accomplishments, the day of achievement is an emotional peak day, followed by a downturn. As soon as you fully grasp the reality that the "accomplishment doldrums" will occur, you can prepare for them and desensitize yourself to the negative effects. Talk yourself through this: It's natural, after six months of preparation for the big day, to miss the focus, the commitment, and the reinforcement of others who supported me in my mission." But you can also tell yourself with honesty that in a few days you can be shrugging off the blues as you strike out in a new direction. So . . . let's get another mission started, NOW!

Select Another "Mission" Before the Big Day: Write the date of your next project on a calendar, journal, etc. The farther ahead of your first goal, the better, It's best to shift gears in selecting a different type of mission: a scenic trail run, a weekend trip to a big festival event, a group run with friends you haven't seen for a while, etc. If you've trained in a group, schedule an easy group run three to four weeks after the race, and you'll look forward to the reunion. It's okay to shift missions in midstream, but be sure to have a specific event always written on the calendar. If you wait until after your first "mission day" to choose another goal, your letdown will be more severe.

The Body Follows Your Mental Vision: The more you embrace your new mission in advance, the quicker you'll lose the aches and pains of the big race. Instead of wallowing in your misery, tell yourself that your muscles have achieved their "good tiredness" by overcoming a great challenge - and you're still glowing from it. The positive mental momentum from your accomplishment will pull you through the few days after when you may (or may not) feel that the legs don't want to run a step. 

How soon after a marathon can I realistically think of doing another one?

It depends upon how close you ran to your potential, or maximum effort, in the most recent marathon:

Running Form: the first segment of a new series

Running form is most efficient when you don't feel any noticeable effort, when running is almost automatic.

Over several years, your running form becomes more efficient- even if you still feel "clunky." In fact, when runners get injured or fatigue themselves excessively due to bad form, they have often changed their form in the attempt to "run better." It's almost always better to go with the natural flow of your legs and body - even if you don't look like a star. In other words, if nothing seems to be wrong with your form, don't try to fix it. 

Once a Body Is In Motion . . .
Distance running is not a strength activity. Instead of overcoming gravity, we're trying to minimize its effect by staying low to the ground and reducing extraneous body motion. By going slowly in the beginning, it's easy to get moving, and, once in motion, the body wants to stay in motion. There are three components I use to monitor and fine-tune running form: posture, bounce and overstride.

Posture: Relaxed and Upright
Don't try to be a Marine at attention. The best posture for running, walking or cruising is just good posture, with all elements relaxed and balanced s the foot comes underneath. A forward lean forces you to shorten your stride and creates extra tension on the lower back and neck. A backward lean is unusual but will also produce a shorter stride, loss of power from the running stride and possible tension in the lower back.

Some will argue that a forward lean will help you run faster, but I've found this to help only for a hundred yards or so. It forces you to work harder and therefore spends resources which are not available later in the run - causing you to lose more time than you gained during the short burst. The only exception I've found to this rule is when running on a gradual, downhill grade. A slight forward lean can help you run faster, and the boost from downhill gravity will offset the decrease in stride length. By having this slight monitor on downhill stride length, one can help counter the negative effect of overstriding, a temptation when running downhill.

Correcting Forward Lean
By becoming a puppet on a string Create a mental image during the form drill of yourself suspended from the very top of your head by a giant string (as if you were a puppet). The effect is to lift you upright - head in line with shoulders and hips and everything lined up with each foot as it assumes the body's weight. A good puppet image also helps you to stay light on your feet.

The first effect of being a good puppet is to have your body line up without any tension - you're in balance. Walk around with the image of the puppet on the string until you feel relaxed in this upright position. Then start running slowly. On your days for form work, you may then accelerate for 50 to 150 meters, running as a lightly balanced puppet. Not only does the posture correct itself, but your chest is forward as are your hips, allowing for a quick touch-off with the feet. You may have to make little adjustments, but when you're lined up in a relaxed mode, running will be easier and you'll feel less effort in the legs.

Check back next month for info on other form considerations: Bounce and Overstride.

The Athlete's Kitchen
Copyright: Nancy Clark 11/00
Weight Management Update: News from The American Dietetic Association's Annual Convention

Weight management is a big issue for many active people. At The American Dietetic Association's Food and Nutrition Conference (held in October, in Denver) several ADA members presented research that applies to weight management for active people. Here are some of the highlights from this year's meeting.

Healthy Dinners: A Restaurant and Institutions' survey reports about 70% of the population doesn't plan dinner until 4:00 PM or later most days. This is bad news for the many athletes who exercise after work, have not planned dinner, and arrive home "too hungry" to cook a good meal. The result: super-size portions of fast (and fatty) foods, a lack of vegetables, and an eating pattern that can lead to weight gain.

One solution: The Univ. Nebraska Cooperative Extension in Lancaster Country has a website that provides information about making healthful food in a hurry. The program, "Cook It Quick" ( www.lanco.unl.edu/food) can help you get organized, plan meals in advance, and perhaps improve your evening food intake.

Fad Diets: The "Zone Diet" is NOT more effective than a typical weight reducing diet in promoting weight and body fat loss. A Ball State University study compared the dieting success of two groups of overweight women who were assigned to either a 40-30-30 (C-P-F) Zone Diet or a 60-15-25 traditional reduced calorie diet for 6 weeks. Both groups demonstrated similar results with losing body fat.

The bottom line: Total calorie intake, not type of calories, is the key factor determining weight and fat loss. The Zone simply offers a confusing program that helps dieters create a calorie deficit. A higher carb intake would better fuel muscles.

Body Composition: Many active people are curious about their body fatness and wonder what percent of their weight is excess flab. They also may wonder about the accuracy of the currently available methods to measure body fat.

A study from Indiana Univ. of Pennsylvania compared body fat measurements among 30 female college athletes. Their fat was calculated by: skinfold measurements, hand-to-foot bioelectrical impedance (BIA), foot-to-foot BIA (such as the Tanita scale), Futrex (one measurement on the arm), and underwater weighing.

When compared with underwater weighing (the "gold standard" for measuring body composition), skinfolds overpredicted body fat by 3%--and that was the most accurate of the methods! Foot-to-foot BIA overestimated fatness by 9%. (That's enough to upset an athlete!)

The bottom line: If you have your body fat measured, recognize you may get an inaccurate number. The best use of body fat measurements is to compare repeated measurements taken over time, using the same method and measurer. The numbers will accurately reflect the relative changes in fat.

But rather than play a numbers game, why not focus on how you feel and how well you perform? That's what really matters. Leaner does not necessarily mean better.

The Cost of Thinness. Synchronized figure skating is a quickly growing branch of figure skating. Like ballet and gymnastics, it is an "appearance judged" sport where leanness is valued. The question arises: What is the cost to being "perfectly thin"--that is, to being thinner than Nature's design?

A survey of 126 members of the US Synchronized Skating Team suggests most of the (already lean) skaters expressed interest in losing weight--about 7.5 pounds, on average. Their desire for "the perfect thinness" contributed to restricted food intake. Analysis of three-day food records suggests an average intake of only 1,550 calories (at least 500 fewer than might be expected). The resulting diets were below the recommended intake for the overwhelming majority of nutrients.

The bottom line: The cost of being "perfectly thin" is commonly sub-optimal nutrition. If you, too, are restricting your intake to achieve the "perfect body," be sure to meet with a sports nutritionist who can help you balance thinness with an optimal diet. Otherwise, lack of protein, calories, calcium, and iron may contribute to a plague of injuries and cut short your athletic career.

Amenorrhea / The Female Athlete Triad: Among female athletes, the prevalence of amenorrhea (the absence of three consecutive menstrual cycles per year) can be as high as 66%. Amenorrhea can be caused by many factors: inadequate nutritional intake, disordered eating, low percentage of body fat, low body weight, high stress, and/or over-training. The effects can be crippling: stress fractures, bone loss, scoliosis, and early osteoporosis.

The combination of 1) menstrual irregularities, 2) disordered eating, and the consequent 3) loss of bone density is termed "the female athlete triad." In a study of 30 female distance runners, 28 (93%) were affected by at least one component of the triad, and 5 (17%) were affected by all three. Ninety-three percent of the women underconsumed calories (they reported eating 1,800 calories, yet burned 2,950 calories), 50% reported a history of drastic weight loss methods, 60% had menstrual irregularities, and 60% had low spinal bone mass.

The bottom line: Female athletes need to understand the health consequences of this abnormality. They also need nutrition education to help them attain a healthful leanness so they can reduce their risk of stress fractures and stay off the injured list.

Eating Disorders: Speaking at a symposium on eating disorders, Jessica Setnick, MS, RD of Dallas TX emphasized the value of seeking professional help instead of struggling alone with food. If someone you know is struggling with an eating disorder, you should encourage him or her to see a registered dietitian who specializes in management of eating disorders. (The referral network at www.eatright.org can help you find a local RD.) Contrary to popular belief, the RD's job is not to "fatten up the clients and make them eat more" but rather to help clients by answering their food and nutrition questions. The RD can provide accurate information that dispels erroneous food beliefs and legalizes all foods. For example, Jessica reported many people believe some foods are "bad" for them. She clarified that misconception by stating "the only bad foods are those that are moldy or poisonous, or foods to which you are allergic." Good point!

Nancy Clark, MS, RD, personal nutrition counselor at SportsMedicine Associates in Brookline MA, teaches casual and competitive athletes how to eat to win. Her best-seller Nancy Clark's Sports Nutrition Guidebook, Second Edition is reputed to be among the best books on this topic. It is available by sending $22 to Sports Nutrition Services, 830 Boylston St. #205, Brookline MA 02467 or via http://www.nancyclarkrd.com.

Injury of the Month: Ilio-tibial Band

Note: This information is advice given from one runner to another and is not meant to be taken as a medical consultation. Your best strategy in diagnosing and treating any injury is to see a doctor who wants to get you back out there running. He or she will keep trying various treatments until something works. When that type of doctor tells you that you need to stop running for a while (because it is a stress fracture, etc.), you should do just that. Ask the most experienced runners in your area for the names of medical specialists in the area of your injury, who've helped other runners heal quickly. When a doctor barely listens to you, and quickly tells you to stop running, it's time for a second opinion. Sometimes even the best doctors miss something. There are times when you should talk to 2-3 highly recommended specialists to get the whole picture.

The Good News
Almost all of the runners I've communicated with about I-T Band injuries have been able to run during the recovery period, once the healing had started. Many of these folks have continued their marathon training program after making the adjustments for the injury. Once you've determined that the healing has begun and your training stays below the threshold that could further irritate the injury, you'll probably be able to continue your running. The first priority, however, is being conservative enough (with slower pacing, more walk breaks, and days off from running) to allow the healing to continue.

Where does it hurt?
Almost always on the outside of the leg, from the knee to the hip. The pain from I-T Band is most often felt on the outside of the knee, slightly below the intersection of the two leg bones. For some, pain may be centered just above that point. In rare cases it may hurt on the outside just below the hip, and occasionally the pain may radiate up and down the outside of the leg at various times. We will concentrate on the most common site, the outside of the knee.

What gets injured?
A strong muscle just below the hip, the tensor fascia, is connected by a long band of connective tissue that acts as a tendon, going down the outside of the leg and connecting to the shin bone below the outside of the knee. Even when the wobbling proceeds for some time, this band of tendon tries to keep the leg from excess motion. Once the tendon itself loses its strength and continues to be pushed beyond it's capacity, it gives way at the point of most stress. This is most commonly where the tendon connects below the knee. A bursa sac, which tries to smooth out the operation of the knee and protect the tendon from the bone, may also become irritated. Some runners strain the tendon itself, others pull away the connections below the knee, the tendon and the bones. A second area of irritation is that just above the knee, due to the friction of the tendon repeatedly rubbing the bone slightly above the knee joint on the outside.

Can I run my marathon this season?
Maybe. If you back off soon enough, it's possible to run enough to do the marathon, while it gets better. You will have to reduce the speed of every running segment and put more walking into your runs, more often. The longer you continue to irritate the injury, the longer it will last. Even after you start back, you must monitor the injury for the next few months. Even after the pain goes away from an injured area, there is still damage inside.  One run that is done too fast (or without enough walk breaks) can bring back the damage, often worse than it was before.

How does it get injured?
As long as the leg muscles are resilient, and you're not doing very much more training than you've done in the recent past, the leg system will stay in its track and adapt to slight increases. When you push your main running muscles too far, the primary running muscles get too tired to move you ahead and stay within the natural range of your foot and leg. In other words, your legs start to wobble. The further you go when wobbling, the more you will injure the area. You may not be able to pinpoint what caused the problem, but here are the most common causes:

• Running too fast on a long run or race than you should have on that day ( i.e., trying to stay up with running friends that are going too fast for you). Most runners are running too fast on long runs even though they feel fine at the beginning.
• Not slowing down the pace, from the beginning of a long run or race:
• when you increase the distance of the long run
• when it's hot and humid or the course is hilly
• when your muscles are already tired
• when you feel the first signs of irritation of what could be an injury
• Not taking walk breaks, as you need them, from the beginning of all long runs
• Not increasing the frequency of the walk break as the long run distance increases
• Not increasing the frequency of walk breaks when you're more tired or feel the symptoms of injury
• Not increasing the frequency of walk breaks when the temperature and humidity are high
• Doing too many of the following within a 2-3 week period: long runs, races, fast runs.
• Wearing the wrong pair of shoes or ones that are too worn out, particularly in the midsole (a shoe expert can help you determine)
• Doing side-to-side sports: tennis, basketball, rollerblading
• Not doing the maintenance training during the week, i.e., just running once between long runs or not at all
• Skipping a long run and trying to keep up with your group on the next long run
• Not taking enough days off from running, especially after the first signs of injury
• Running on a surface that is too soft or is slanted, i.e. a beach, soft grass, or a paved surface with a slant 

Treatment
I've spoken with hundreds of runners who've run through I-T Band injury. You want to get permission from your doctor to do this. The healing needs to have started, and you must stay below the threshold of irritation. In other words, you need to keep from further injuring the area. If running 4 miles leaves it feeling worse the next day, run no more than 2-3 miles, every other day. If it stays injured when walking 1 minute after 3 minutes of running, then run 1-2 minutes and walk 2-3 minutes. It never hurts to be more conservative in your running when injured. By running too much you'll prolong the duration of the injury. Most of the time, you don't realize what is too much until you've injured yourself. That's why it's always better to back off at the first hint 

1. Take enough time off to get the healing started (usually 3-5 days)

2. Take vitamin C. When I have an injury such as I-T Band, I take 1000mg of Vitamin C, 3-5 times a day. Consult with a sports nutritionist for further information about vitamin C and other nutrients which can speed healing.  

3. Stretch the tendon. The I-T Band is one of few running injuries that is helped by stretching. Start with the stretches recommended ended below. You can stretch before, after, and during a run and even in the evening or while sitting at your desk at work. Stretching primarily reduces the tension on the tendon so that it doesn't hurt for a while. By keeping the I-T Band flexible you also reduce the continued pulling on it and may help it to heal to some extent. Experiment with different stretches for the area. The best ones are those that release the I-T Band at that time, giving you instant relief. Compare stretches with other I-T band sufferers, but very few runners will use the same stretch routine. You will find that different stretches help at different times, even on the same run.

4. Ice massage. Freeze a paper cup and every night, rub the ice directly on the area of pain until it gets numb (usually about 15 minutes). Be advised that there's usually no healing effect from ice in a plastic bag, towel or frozen gel pac. It helps to ice the injury immediately after a run, but even if you miss this opportunity, ice it well at least once a day.

5. Run on level surface. Uneven surfaces will fatigue the muscles and tendons and increase the chance of I-T Band irritation. A road that is slanted can cause I-T Band problems on one run.

6. Get the right shoe and possibly an orthotic. Even the perfect shoe (whatever that is) will lose support from the midsole, usually without any outward sign on the shoes. To run on these shoes usually aggravates the injury. Shoe experts (such as the ones in really good running stores) can advise you in finding current shoes which can give the support or cushion your foot needs. Overpronated floppy feet show some shoe wear on the inside of the forefoot and benefit from motion control shoes. You'll have to give them feedback how the shoes feel and whether there are any discomfort areas. The shoe should be an extension of your foot without any extraordinary pressure or tension. Floppy feet which overpronate (showing shoe wear on the inside of the forefoot) need motion control shoes that sacrifice some cushion for stability. This type of foot can sometimes benefit from an orthotic. Try stable shoes first and if they don't control the pronation by themselves, follow your doctor's advice and try other solutions before getting an orthotic. Remember, if you don't have a shoe that controls you enough, the foot device won't be able to do its work. Rigid feet (which show wear on the outside of the forefoot) need shoes with cushion and flexibility. If the shock is not absorbed by the flex of the foot and the cushion of the shoe, the I-T tendon will take more abuse, tighten up, and increase the intensity of the injury.

7. Massage. Cross friction massage may speed up the healing. Consult with a running massage expert and you can learn this simple technique. Massage to other muscle areas may also speed up the healing process.

8. As a last resort. . . Under doctor's direction: anti-inflammatory medication and/or cortisteroid injection (i.e. cortisone) may get the healing started. Get several opinions before you agree to this, and go to the most experienced and competent doctor you can find.

Snips

• Tip of the Month from Nutrition Action Health Letter (December 2000, Volume 27/Number 10, p. 16, www.cspinet.org): Microwave a halved and seeded acorn squash for 15 minutes, face down in a shallow dish of water. Saute two chopped, unpeeled Jonathan or other tart apples in 1 Tbs. canola oil, 1 Tbs. brown sugar, and 1/2 tsp. cinnamon until soft. Spoon the apples into the cooked squash..
• Runners Live Longer! (from the American Running Association's Running & Fit News, November 2000, p. 3, http://www.americanrunning.org) Keep moving, one way or another, and long life is much more likely to be your good fortune. In a study from Denmark that confirms your assumptions about running, 30,000 men and women aged 20 to 93 were observed over a period of 14 years. Those who exercised consistently were half as likely to die from any and all causes compared to those whose lives were sedentary. The greater the activity the lower the risk, for all age groups and both sexes. Keep running and life long and well. (Archives of Internal Medicine, 2000, Vol. 160, No. 11, pp. 1621-1628).
• Passion Play ("Health and Fitness Fast Facts" by Alisa Bauman, Runner's World, December 2000, p. 28, http://www.runnersworld.com) It's no secret that running may improve your sex life. In a study done at the University of Newcastle in England, men aged 55 to 65 who ran more than 40 miles a week had higher levels of testosterone and growth hormone than sedentary men, indicating that the runners had healthier sex drives. There's also proof that your sex life may improve your running. In a survey of 2,000 London Marathon entrants, runners who had sex the night before the race finished faster than runners who abstained.

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