Solving the Puzzle: 4 Tips for Injury-Free Running

By Matt Fitzgerald
Triathlete magazine
 
In March 2008, I ran a marathon for the first time in four years. The long hiatus was due to a maddening series of overuse injuries. During most of the four years between marathons I doubted I would ever again be able to train at a high level in this discipline, and indeed I quit running in despair at least half a dozen times.
What got me over the hump? It was not a single, all-encompassing cure. Since running-related injuries affect most triathletes, I would like to take this opportunity to share with you four key pieces of my injury-prevention puzzle.

First Piece: Targeted Stretching

Much has been made of recent research demonstrating that routine stretching does not prevent overuse injuries in endurance athletes. While it may be true that a general stretching routine does not prevent injuries in general, certain specific injuries are caused in part by abnormal tightness in particular muscles and tendons. Stretching everything is a little like trying to true a wheel by loosening the spokes on both sides. Stretch only what's too tight and you'll see better results.

Second Piece: Corrective Strength Training

Knee pain in runners is often linked to weakness in the hip abductors (the muscles that keep your pelvis from tilting laterally when you're supported by only one leg) on the affected side. A simple test you can use to determine whether your hip abductors are weaker on one side is to perform a single-leg squat with each leg.
As you lower your butt toward the floor, eventually your thigh will rotate inward, swinging your hip outward, which is a sign that your hip abductors have become overwhelmed and need help from other muscles. If this compensatory action happens earlier on one side than on the other, that side is weaker and you are more prone to knee pain in the corresponding knee.
I started to even out the strength of my hip abductors by doing single-leg squats, step-ups and other such exercises three times a week, challenging my right side more than my left so that the gap steadily closed.

Third Piece: Gait Retraining

Conventional wisdom holds that the running stride you're born with is the one you're stuck with. But the conventional wisdom is wrong. Recent research has shown that particular running-related overuse injuries can be overcome by making key modifications to one's stride.

The most common injury-causing stride flaw is overstriding, or landing heel first with your foot well ahead of your body's center of gravity, instead of landing flat-footed with your foot directly underneath your head. A simple way to correct his flaw is to tilt your entire body very slightly forward from the ankles (not the waist) as you run, as though you're constantly falling forward or running downhill.

This little tweak forces your foot to land flatter and closer to your center of gravity. Correcting the overstriding flaw makes it easier to maintain proper stability in your hips and pelvis on impact and reduces the likelihood of injuries, including iliotibial band friction syndrome and runner's knee.

Fourth Piece: High-tech Nutrition

Remarkably, doctors still do not know exactly what runner's knee is. They used to think it was chondromalacia, or damage to the knee cartilage, but many runners with chondromalacia run pain-free, and many runners with knee pain don't have chondromalacia.

The latest theory is that runner's knee, or patellofemoral pain syndrome, is caused by the body's failure to fully repair trauma suffered during runs by the patella and the fat pad underneath it. Every runner experiences such trauma in every run, but some runners (especially those who overstride and have weak hip abductors) incur more than others, and the more you run, the less likely it is that the affected tissues will achieve complete homeostasis between runs.

By changing my shoes, strengthening my hip abductors and retraining my gait, I succeeded in reducing the amount of damage my right knee suffered during a run. Thus, I was able to run more before the pain became debilitating. But I still wasn't able to run enough.

The final piece of the puzzle: I needed some means of repairing the damage more quickly between runs. I found this in a special supplement called hyperimmunized milk factor (HIMF). HIMF is a collection of anti-inflammatory proteins derived from cow's milk. By reducing post-workout inflammation, it facilitates faster tissue repair in athletes for whom inflammation has become chronic.

As yet there are only a couple of HIMF supplements on the market: MicroLactin, which is marketed mainly to arthritis patients, and RX-98, which combines HIMF with a whey protein isolate and is made specifically for athletes.

The Real Cure

Earlier in this article I said that there was no single, all-encompassing cure for my injury woes. But it might be better to say that the true cure was research and experimentation. Once completed, the injury-prevention puzzle looks a little different for each athlete, but the only way for any athlete to put it together is by making an unflagging effort to dig up measures that are worth trying and giving each a fair try.

Active Expert Matt Fitzgerald is the author of several books on triathlon and running, including Brain Training for Runners and Runner's World Performance Nutrition for Runners (Rodale, 2005).

Q&A: Are Super Flexible Runners More Injury-Prone?

[This Q&A from Core Performance is interesting for me because I'm pretty flexible and a PT once told me that it's harder for super flexible people to run fast, because they can't hold their pillar as strong.  So guess who is doing a bunch of core exercises this spring!  Look at the post before this for pillar strength info.  Also search "strength training" for more exercises. - TG]



Q: Can being super flexible make runners more prone to injury?
A: Superb flexibility doesn't necessarily make you more injury-prone unless you also lack stability. A combination of great mobility and poor stability is a recipe for injury because it's harder to control your movement when you run or do any activity.

If you have Gumby-like flexibility, use it to your advantage by spending extra time working on the stability of your hips, torso, and shoulders—also known as your "pillar." Every workout should include moves for your pillar like bridges and planks. Watch the videos below for a couple examples. For more exercises and advice on how to strengthen your pillar, click here.

Plank with Arm Lift (Click for details.)

Lateral Pillar Bridge (Click for details.)

Sue Falsone – As the Director of Performance Physical Therapy and Team Sports, Sue Falsone provides the critical link between therapy and performance. She develops and implements therapy regimens for athletes at Athletes' Performance.

Using the Mind to Heal the Body: Imagery for Injury Rehabilitation

Dryw Dworsky, Ph.D. & Vikki Krane, Ph.D.
Bowling Green State University 

from www.appliedsportspsyche.org

Being injured is no fun! Often it means that athletes and exercisers are in pain and they are not able to participate in the sport they love. Often when we think of being injured, it means that we need to wait for the body to heal. However, what if you learned that you might be able to speed up the healing process?

Research suggests that maintaining a positive attitude and using mental skills are related to a shorter rehabilitation. In fact, when Ievleva and Orlick (1999) compared slow and fast healers, they found that the fast healers:

• took personal responsibility for healing
• had high desire and determination
• had more social support
• maintained a positive attitude
• used creative visualization
• were less fearful of re-injury upon return to full participation

 The goal of this article is to introduce you to creative visualization and explain how you can use it to manage pain and complement your physical rehabilitation. First and foremost, you need to follow all instructions given by your doctor or therapist. Imagery is a skill you can use in addition to your physical rehabilitation exercises.

What is imagery?

• Imagery is creating a mental likeness to something you would like to have occur in real life

• Imagery involves using all of your senses to create or recreate an experience
• Using imagery can:
  • increase feelings of personal control
  • break up the monotony of physical rehabilitation
  • potentially enhance rate of healing

Lessons from Cancer Research on Imagery
Research has shown that cancer patients who use imagery gain many benefits. These include:

• increased coping with therapy

• promoted involvement in self-care
• improved mood
• improved quality of life
• increased sense of internal control
• improve immune response
• decreased post-op pain
• decreased post-op anxiety
• shortened hospital stays
• decreased amount of pain meds

*Each of these benefits will assist individuals who are rehabilitating a sport or exercise injury

How to Use Imagery:

• Relax (take a few deep breaths before beginning)
• Close your eyes and create a vivid and convincing image
• Maintain a positive attitude
• Have realistic expectations (imagery can help, but don’t expect a miraculous or immediate recovery)
• Use all of your senses to make the image as realistic as possible
• If your imagery session is not going the way you want it to, stop and start over… always be in control

USING CREATIVE IMAGERY

There are many uses of creative imagery. Whatever your goals, you can create an image that you find helpful. In the following, strategies focusing on pain management and healing are described.

Pain Management Imagery

• When our muscles are tense, pain often increases. So one way to reduce pain is to become more relaxed. Examples of relaxing images include:

• imagine tight muscles getting massaged
• see muscle fibers separating
• concentrate on feelings of warmth
• Sometimes it is helpful to distract yourself from thinking about pain. Some distracting images include:
  • being on the beach or floating in a pool
  • rehearsing sport skills
• Some people associate a certain image with pain (e.g., the color red, sparks or bolts of light). Use imagery to reverse these images.
  • if red is associated with pain, image the sore body part turning a soothing pale blue
  • focus on the bright light getting dimmer
• Additional examples of pain control images include:
  • feel heat/ice on sore body part
  • imagine swelling draining out of the body
  • imagine pain flowing out of the injured body part
  • if you have throbbing pain, image “pain bubbles” leaving the body with each beat

 Healing Imagery

• A healing image is one that symbolizes recovery
• It is an image that creates a mindset for healthy healing
• To develop healing images, ask yourself:
  • What images do you associate with injury and/or pain?
  • What images do you associate with being strong, mobile, or healthy?
  • What images remind you of healing?
• These images can be silly; remember that the image only needs to be meaningful to you.

 Examples of Healing Images include:

• Broken bone: cement filling in a break in a bone
• Torn muscle: muscle fibers braiding together
• Swollen body part: “bad stuff” draining out of the body
• Injured ligaments: ligaments getting thicker and stronger or tight muscles lengthening, stretching

A Sample Healing Imagery Script:
Take a few deep breaths … Concentrate on your breathing, feel the movements of your body … Just relax, sink into the chair/couch

Now focus your attention on your hurt knee … Notice what it feels like … See what it looks like, the swelling, bruising … Concentrate on reducing the swelling … Imagine a leak in your knee and see some of the fluid drain out … Concentrate on the swelling going down … See your knee returning the its normal size … Concentrate on the swelling going down … As your swelling reduces, notice your knee feeling more normal

Now turn your attention to feeling the knee getting stronger … See the ligaments coming together … Feel the ligaments getting tighter, growing together … Concentrate on the fibers getting bigger, stronger, tighter … Feel your knee getting stronger

Scan the muscles around the knee … Begin concentrating on your quad … Relax the muscle … Feel the muscle become loose and relaxed … To further relax the muscle imagine your quad being massaged … Feel the muscles being kneaded … Notice the relaxed feeling in your quad and all around your knee

Notice how your knee feels … concentrate on feeling relaxed … feeling stronger … You are getting better … enjoy the feeling

How to Cope With the 5 Stages of Injury Grief

I'm dealing with a chronic injury right now that may require surgery, so I've been crabby, sad, depressed, OK, frustrated - all of those emotions. I was just looking for the "Stages of Injury Grief" and found a couple that are interesting. For the record, I am in stage 4 and 5 - combined.

How to Cope With the 5 Stages of Injury Grief

By Mackenzie Lobby
Runner’s World

For many of us, running is like a best friend. We count on it to quiet our anxieties, focus our minds, and make us happier, healthier, and saner. So what happens when injury strikes and takes away our trusted ally? We curse, we pout, we may even cry and scream. Sound excessive or irrational?

It’s not—in fact, experts say experiencing these emotions is normal and healthy. “The sense of loss an athlete feels when injured can be very similar to the other types of mourning or grief that occur in our lives,” says Diane Wiese-Bjornstal, Ph.D., associate professor of kinesiology at the University of Minnesota and a leading researcher of injury psychology. “It’s a huge sense of loss that you feel.”

In order to deal with this pain and frustration—and move on to recovery—Wiese-Bjornstal recommends sidelined runners adopt a specific grieving strategy. It may sound familiar—it’s what you’d go through if you lost a job or a pet. And if you’ve been injured before, you’ve probably stumbled through it unknowingly. The key is taking a purposeful approach. If you can recognize each stage of mourning, and work actively to move through each one, you’ll heal faster. And that means you’ll be back on your feet sooner.

The Stage: DENIAL

Ignorance Is Bliss

After running a 2:35 marathon in 2006, Michelle (nee Lilienthal) Frey was recruited by Team USA Minnesota and offered a sponsorship contract. She spent the next two years preparing for the 2008 Marathon Trials, where she hoped to make the Olympic team. A year before the race, the bottom of her leftfoot began to hurt. “But I kept running on it,” she says. Runners often play this game of Russian roulette—limping through workouts, disregarding red flags. “Runners in denial know they’re injured but won’t admit it,” Wiese-Bjornstal says.

MOVE ON
Getting stuck here is dangerous. “By denying you’re injured, you can exacerbate the injury,” says Jim Taylor, Ph.D., a sports psychologyconsultant and sub-three-hour marathoner in San Francisco. “What was once a minor tweak could turn into a major injury.” Which is what happened to Frey—she was crippled by plantar fasciitis for one year. Listen to your body. At the first sign of a potential injury, be smart and back off . A few days on the couch is better than months of physical therapy.

The Stage: ANGER

It’s Not Fair!

Not being able to run a goal race as fast as you had hoped—or at all—can be disappointing, even devastating. “I was like, Why is this happening to me before the biggest race of my life?” Frey says. It’s this sense of injustice that triggers anger. “You feel betrayed by your body, your training, the universe,” Taylor says.

MOVE ON
A positive outlook—as hard as that may be to summon—may be your greatest weapon. Research reports that athletes who use positive self-talk and set goals for their rehab experience “exceptional recovery.” So be angry for a few days, then look forward. Set rehab goals so you can celebrate small successes. If your therapy program includes planks, aim to hold the position for 15, then 30, then 60 seconds. When you reach each goal, recognize the achievement.

The Stage: BARGAINING

Just Let Me Exercise

When injured athletes finally confront their injury, they sometimes become too gung-ho. “You think, I’ll do more rehab, more often, more reps, more weights, and then I’ll get back to running sooner,” Wiese-Bjornstal says. “But more isn’t always better.” In Frey’s case, she began to scramble to fix the problem, seeing an extensive circuit of doctors to get second, third, and fourth opinions. “That, in itself, was draining,” she says. “I panicked.”

MOVE ON
Taking action to fix your problem is good, but don’t go overboard. “You can’t microwave healing,” Taylor says. “You have to slow bake it.” Obey your rehab prescription the same way you would a training program. (You wouldn’t do three long runs in one week, would you?) “If rehab goes well, you can come back a better athlete,” Taylor says. “Don’t jeopardize that ultimate goal.”

The Stage: DEPRESSION

What’s The Point?

Wiese-Bjornstal’s research shows that athletes with severe injuries that require long amounts of downtime are likely to linger in this stage. The enthusiasm you initially had for your rehab routine fades. You miss the endorphin fix running provided, and you feel cut off from the running and racing community.

MOVE ON
Fill your newfound downtime with other activities that help fill the void of running. Schedule time consuming sports you enjoy but can’t fit in when you’re training—as long as they don’t exacerbate your injury—golf, say, or leisurely bike tours. Stay connected to the running community: Cycle alongside friends on their long runs; invite your running buddies to a yogaclass you’ve started taking; volunteer at a race.

The Stage: ACCEPTANCE

It’s Working!

“This is when you are properly sticking with your rehab plan and you’re seeing progress,” Taylor says. You’ve accepted the injury, and also that you’ll eventually be back on your feet. Coming to this mindset is critical to recovery. Research shows a direct relationship between stress and injury. Anxiety can cause muscle tension and suppress immune function, which can delay how quickly you get better. In this stage, you have a peaceful mindset that encourages healing.

After faltering her way through these stages, Frey says she’s confident that if confronted with an injury again, she’d reach acceptance—and recovery—sooner. It was a hard lesson to learn: She was the 10th fastest woman going into the 2008 Trials, but ultimately placed 85th. Her sights are now set on the 2012 Olympic Marathon Trials. By listening to her body, and not lingering in denial, she’s hoping to avoid the grief of injury.

How to Recondition After Injury

By Alan Peppard, P.T., A.T.C.
Running & FitNews ®
American Running Association

from Active.com

If you become injured, rest for a while and then find you are unable to return to your favorite sport or exercise without aggravating your injury, you will become frustrated. The injury-rest-re-injury cycle is common for athletic injuries, but you can avoid this cycle using the principles of reconditioning and working back safely to your former level of exercise or sport performance.

Reconditioning after injury means you should modify your normal workouts to control your intensity, judged by overall perception of effort (muscle tension or soreness, joint stress, breathing and chest sensations). Then, you should monitor residual pain in your injured area to an acceptable level.

When you are injury-free, normal conditioning requires you choose a level of exercise that causes enough overload to produce improvement in performance after recovery. If the intensity is too high you may become injured. There is a range of exercise intensity that will work properly to provide conditioning. We call this range the "intensity window." When you are not injured this window is wide. When you are injured this window is very narrow. Too high an intensity will prevent recovery and cause re-injury. During reconditioning you must be very specific in your choice of intensity in order to succeed in helping recovery.

It is helpful to think of pain in two ways. Type I pain is the pain felt during exercise. Type II pain is the residual pain, felt about 1.5 hours after exercise. These should be monitored to help select the right exercise window.

When you are not injured you can use overall Type I pain to regulate exercise intensity; you exercise to the point of slight discomfort or overall pain then go a little further, but short of producing specific pain in a localized area such as a muscle or joint. You have to continue to challenge your general exercise pain in order to achieve maximal performance gains.

Successful uninjured athletes continue to confront pain and push through Type I pain (when it comes to optimizing athletic performance, in the overall sense no pain no gain is true). Type I pain is relieved by rest soon after exercise and does not produce lasting effects.

When you are injured, no pain no gain doesn't work, and you will be frustrated if you try to use a similar approach during reconditioning. Instead of growing stronger you will become re-injured. Type II pain can become intense, even though you felt only slight pain during exercise.

When you are injured you should change your approach. Now you should focus on the injured area and use Type II pain instead of Type I to regulate your reconditioning. When you have no Type II pain or only mild pain relieved in one hour of light activity, you can slightly increase your exercise level. If Type II pain is intense, you should rest for up to three days, and then resume your reconditioning at a lower intensity.

To select appropriate exercise windows you should begin reconditioning with exercise involving static, pain-free stretching. When flexibility has returned you can begin weight lifting (or using resistance machines), using light weights at first and progressing slowly to heavier loads to increase muscle strength. When normal strength has returned you can practice the drills and moves associated with your sport, cautiously at first and gradually increasing intensity.

During each stage of your reconditioning you should take care to choose an intensity that does not increase Type I or Type II pain. As your recovery continues, your exercise window will grow wider and you will find at some point you can increase Type I pain with minimal or no Type II pain.

When you are injured you should recognize that your exercise window has narrowed, and you should take care to concentrate on monitoring your Type II pain. If you follow these guidelines you should be able to recondition an injury without stumbling into the injury-rest-re-injury pathway.

How to Beat Injuries

By Kristin Harrison from active.com

Dr. Lisa Cannada, a runner and orthopedic surgeon, offers advice on knee, foot and ankle pain.

As a new runner, I'm not sure when to run through the pain and when to stop and see a doctor. How can I tell the difference between muscle soreness and an injury?

Just because you feel uncomfortable tightness or some minor pain while running doesn't necessarily indicate you have an injury. You could simply be doing something different--running on a new type of surface or terrain, for example--that works your muscles in a new way. If you only feel pain while you are running, and it goes away within two weeks, it's most likely a strain or soreness.

But there are times when it's crucial to see a doctor, as you could have a variety of more serious conditions. Here are four easy ways to know when you should schedule an appointment:

1. If the pain wakes you up at night.
2. If you have to alter your gait while running to ease the pain.
3. If the pain is constant and occurs during your non-running activities (walking around the office, sitting at your desk, etc.), or if it interferes with your daily life.
4. If the pain lasts during running for more than 10 to 14 days.

My knees hurt when I run. What can be causing this and what can I do about it? It seems every female runner I know suffers from knee pain.

The No. 1 cause of knee pain for female runners is anatomy. Most women have a larger Q-angle--the angle between the pelvis and the knee--than men. This increased angle can cause a wide variety of problems, from placing stress on the knee to causing foot pronation (an inward roll of the foot).

The easiest way to minimize knee pain caused by your Q-angle is to strengthen the quadriceps muscles. By strengthening the quads through weight exercises such as leg extensions, you can reduce the stress being placed on the knees.

I recommend strength training three times a week to see improvements. Also, building up your quads is vital if you do a lot of hill running. Running downhill is one of the easiest ways to hurt your knees if you don't have the strength in your quads to support them.

Overuse is another major cause of knee pain. Never increase your mileage by more than 10 percent per day or week, no matter how good you feel. Other common causes of knee pain include being a "weekend warrior" and attempting too much without ample training, bad running form or something as simple as tasks around the house that involve squatting or lifting small children.

After my last marathon, I developed a severe case of iliotibial (IT) band syndrome and spent three months in physical therapy. I'd like to run another marathon, but don't want this to happen again. What can I do about it?

I get so many visits from patients with this problem. IT band syndrome is inflammation in the tendon that runs from the hip to just below the knee. Highly painful around the knee for many runners, the problem most commonly occurs during marathon training.

It happens for a variety reasons, including running constantly on the same angle--like the same side of a slightly canted street during all of your runs. But the biggest cause is increasing your mileage too quickly. Remember the 10 percent rule!

Adding activities like swimming and using an elliptical machine can help keep your endurance up without aggravating the condition. If the pain lasts longer than two weeks, see a doctor. Physical therapy may be recommended.

To prevent this condition, you need to stretch the IT band regularly--not just after you run but at least five days a week. Adding cross-training into your regular schedule can also help. If you don't take preventative action and you let IT band syndrome become severe, you may end up sidelined from running again.

Many people in my running club have problems with plantar fasciitis. What causes this and what can be done to prevent it?

This is the worst! Plantar fasciitis, which can cause a burning or stabbing sensation in the heel, is most common in people with flat feet. Anatomy and wearing the wrong shoes for your foot type are common causes.

Here's a simple way to know if you have an inflammation of the plantar fascia tissue: if the pain is at its worst when you first get up in the morning. Because these tissues in your feet contract as you sleep, the pain can be significant until your feet limber up, and then it will reduce in intensity.

If you have this type of pain for more than two weeks, go see your doctor. They can provide you with an easy cure: a night splint, which stretches the tissues as you sleep.

After a long run, do ice baths help reduce muscle soreness and inflammation? If so, how soon should you take one for it to be effective?

You don't need to take an ice bath unless you are in the top five percent of elite runners, who build up a lot of lactic acid in their muscles. (Most of us never have that much lactic acid in our bodies.) I feel stretching and taking an anti-inflammatory are much better at reducing soreness and inflammation for the average runner. If you are training for a marathon, regular massages can help reduce muscle soreness.

Dr. Lisa Cannada, an orthopaedic surgeon specializing in trauma at St. Louis University and a spokesperson for the American Academy of Orthopaedic Surgeons (AAOS), has been an avid runner since high school. Now 46, she runs between 20 to 30 miles a week and has completed races ranging from the 5k to the marathon. She says she understands running injuries because she's had nearly every kind out there.

Fitness Fallacy

From Joanna Zieger's blog - Fast at Fourty (which is an awesome blog!)

This article was written with Dr. Phil Skiba, my coach and an extremely nice guy (http://www.physfarm.com/)

“I don’t want to lose my fitness” is perhaps the most commonly uttered statement by triathletes. I have no actual data to support this, but given the number of times I have heard it (and expressed it myself) I am reasonably confident that it must be true.

I think triathletes have a dreaded fear that between the time they close their eyes at night and awake in the morning they have lost inordinate amounts of fitness. A day off is a triathlete’s nightmare – we feel the fitness being sucked out of our bodies moment by moment.

The meaning of fitness varies from person to person. Are you fit because you can ride a century? Are you fit when you race to your potential? Are you fit because you can achieve most of your workouts?

No matter what your definition of fitness is, it does not disappear as quickly as the sunburn from your last race. Breaks in training occur for a number of reasons, whether it is from injury, work, travel or simply some needed time off. And, unless you have taken an excessive amount of time away from training, you are not going to come back as a deconditioned couch potato.

Here are the facts. Most people confuse the terms "fitness" and "performance status". In other words, when we perform well, we typically say we have a very high level of fitness. That is true, to a point. However, it is just a little bit more complicated than that.

When we train, our bodies become more fit, but we also get more tired. In the midst of a heavy training block, think about the yearning for that late afternoon nap or begging off dinner with friends because coming home at 10 pm is too late.

When we train or race a lot, our fitness becomes somewhat "masked" by how beat up we feel. The perfect example is the post Ironman fatigue and soreness syndrome. You couldn’t and shouldn’t train in the days following an Ironman. This time off doesn’t mean you are losing huge amounts of hard-earned fitness. it's just that your fitness is being hidden by tiredness, which would lead to a decrease in performance status if you tried to race again too soon. (It’s also being hidden by the not-insignificant damage Iron-distance racing does to the body. It would not be unreasonable to consider yourself “mildly injured” and in need of recovery immediately following a long-course race.)

To perform well, consistently, you need regular bouts of rest. If you are going out and killing bike ride after bike ride, and run after run, you don't really know how well you can perform, because you are constantly fatigued. This is why athletes sometimes have a great race after a layoff due to that minor injury, work craziness, or interference from other life factors. The layoff allowed the athlete to shed a great deal of fatigue. This is why tapering for a race works. You shed your fatigue, preserve most of your fitness, and are then able to smash a race.

Now, if you were to do some fancy math, you would find that you did lose a small amount of fitness during a training layoff. However, if you are training a lot, this loss is tiny in comparison to how much fatigue you lose. Depending on the sport, the average age group triathlete can shed two thirds of their fatigue in between 2 and 7 days. In comparison, it can take longer than 30 days to lose two thirds of their fitness. Get the idea? Your fitness hangs around a long time.

In my own training, I can attest to this very notion of fitness hanging around. I took a break after the Rev3 debacle for some quality healing time. I started a comprehensive therapy program in the gym and when I restarted training, it was maintenance and sanity training rather than specific race training. Lo and behold, over the weekend I PR’ed a tough run.

It's a different matter if you have suffered through some major illness, of course. 7 days of absolute bed rest with the flu or something is going to have a much more significant effect in terms of loss of fitness and performance status

The take home message is "don't sweat the small stuff". Those couple of days you need to take off when the in-laws arrive probably just serve to help you really crush your next workout!

Making up for lost time (Psst...You can't)

I thought this was a GREAT post from Joanna Zieger's blog, Fast at Fourty.....

It was pointed out by my father that many of my posts deal with injury and illness. I explained that the original intention of this blog was to chronicle my story of healing from the crash in November. My purpose was two-fold; writing about the aftermath of a serious incident would serve as an outlet for me as I convalesce and hopefully my ruminations would help others faced with difficulty.

Athletes are not patient people, and we are accustomed to things happening in a time-frame that we dictate. The body does not work in such a manner. Believe me, I have tried to force my body to heal on my timetable, but, alas, I have lost that battle. And, while I am no stranger to injury, each time one surfaces I have been forced to re-evaluate my coping mechanisms and how I handle my return to training.

Over the last few weeks, as I hurriedly prepare for races while still rehabbing my ribs, I realized that in training you cannot make up for lost time. Training is not akin to cramming for an exam. Post-injury training requires a special type of regimen.

Amnesia
Before you can restart your training program, you must acquire amnesia. Memories about what you did before the injury need to be erased, because when you get back out there, you will re-injure yourself trying to attain those standards. I know this from experience.

I, myself, have cursed many times on the bike in the months since the accident when my Power Tap blatantly lies to me about my power. Why is it so mean to me? Despite my many recalibrations, the numbers staring back are not what they were.

After many discussions with Coach Phil, we set new standards in training as I work my way back to health and fitness. While the big picture does loom, I have smaller goals, in the way of power and running pace, which let me know that I am progressing. And, when the time is right, my Power Tap will once again show me numbers that will make me smile.

Go it alone
I am lucky to have training partners that are supportive, funny and always go the extra mile (or 10) in training. Between my dizzy spells last year and my injuries this year, I am fortunate they are still willing to train with me.

However, some days, it is best to go out solo and not get caught up in the workouts of other people. Injuries often make workouts unpredictable – some days feel great while others leave you wondering who stole your legs.

Training by yourself during this time of flux allows for greater concentration on form and if a workout goes awry nobody has to know but you.

Be flexible
As I mentioned above, workouts tend to become erratic after an injury. A great day or two is often followed by a dreadful workout. Or maybe, after several pain free days, you wake up with the injured area feeling sore.

A plan is imperative during the recovery process to prevent re-injury, but sometimes a workout must be shuffled to another day or forgone altogether.

Just this weekend, I had to cut my long ride short on Saturday and compromise on Sunday by doing a shorter long ride in the morning and doing a shorter long run in the afternoon.

A final note
Coming back from an injury is never easy. Hopefully, these suggestions will make it easier. The bottom line: you cannot rush your body nor can you expect to start off where you left off.

Know Your Options For Treating Overuse Injuries

There is some interesting stuff in this article, but it is one person's opinion. I have had good luck with ART and highly recommend it. They give Cortisone shot a D, but it has been highly effective for me in dealing with plantar fascitis, but not with my knee pain. From what I understand (and I am NOT involved in the medical profession AT ALL) is that it reduces inflammation and gives the body a chance to start healing itself if you rest properly. As far as NSAID's, I have heard that Advil-type is better then the Aleve-type. But that they are only good for a short time and then they will interfere with the healing process. As the PT says in the article, check with your doctor before trying anything!

Physical Therapist Nate Koch reviews and grades several treatment options for common overuse injuries.

Written by: Nate Koch, PT, ATC

Competitor.com

Overuse injuries have been rampant in triathlon since its inception and will continue to do so long into the future. One study in 2003 reported that overuse injuries accounted for 68 percent of preseason and 78 percent of competition season injuries. The term overuse injury can encompass just about any injury in the sport that does not involve a collision. Some examples of overuse injuries are Achilles tendinosis/tendinopathy, plantar fasciosis, anterior knee pain, ITB syndrome and sciatica. The medical terminology that describes the overuse injury and available treatments can be overwhelming.

Recognizing that all injuries and potential treatments cannot be addressed in one article, the most common treatment options for overuse injuries are highlighted below.

Eccentric Exercise: An eccentric muscle contraction occurs when a muscle and its associated tendon have to work while the muscle is being lengthened, such as by doing a negative lift in the gym. A physical therapist or athletic trainer can give you instructions on proper form, resistance and frequency.

Pros: A plethora of high-quality research supports the clinical effectiveness of eccentric exercise over other treatments in the management of tendon injuries. It’s the most low-tech, cheapest and most effective treatment available. It can be done at home in most cases, and instruction by a clinician is covered by insurance.

Cons: Requires a visit to a physical therapist or a certified athletic trainer to receive instruction on technique and proper progression.

Grade: A+

ASTYM: Augmented Soft-Tissue Mobilization is typically performed by a physical therapist, physician or athletic trainer. The clinician must be certified in this technique. Specifically designed solid tools take the place of the clinician’s hands to stimulate healing in abnormal tissue without damaging normal tissue. ASTYM treatment couples the use of these tools with specific exercises designed for each particular injury.

Pros: The treatment provides relatively quick pain relief, which can take between one and 10 visits. Can resume normal exercise immediately after treatment. Covered by insurance. Can be used for prevention, to eliminate weak links and keep old injuries from recurring. Outcome studies provided by the company Performance Dynamics are favorable. Research has shown this treatment does actually change the injured tissue.

Cons: The treatment causes tissue soreness and possibly bruising. You must find a licensed clinician, and more research is needed on humans.

Grade: A

Graston Technique is typically performed by a chiropractor or physical therapist—. The clinician must be certified in this technique. Steel instruments are used to enhance the clinician’s ability to detect adhesions, scar tissue or restrictions in the affected areas. The instruments break up the scar tissue so that it can be absorbed by the body.

Pros: It provides relatively quick pain relief in one to 10 visits. You can resume normal exercise immediately after treatment, it’s covered by insurance and the outcome studies provided by the company, Graston Technique, are favorable.

Cons: The treatment causes tissue soreness and possibly bruising. You must find a licensed clinician. The majority of the research on this technique has been performed by the ASTYM folks, but more research is needed on humans.

Grade: A-

ART: Active Release Technique is typically performed by a chiropractor or physical therapist, who must be certified in this technique. It is a patented soft tissue system/movement-based massage technique. Clinicians use their hands to evaluate the texture, tightness and movement of the soft tissue. Abnormal tissues are treated by combining precisely directed tension with specific patient movements.

Pros: This treatment can provide relatively quick pain relief in 10 or fewer visits. It is non-invasive with no side effects. You can train immediately afterward, and it’s covered by insurance.

Cons: The treatment can be uncomfortable as a result of pressure. Research is limited and frequently has at least one methodological flaw, with most research being case studies and anecdotal reports. Research does not prove a positive change in the injured tissue. Much more research is needed to prove its short and long-term benefits.

Grade: B

PRP: Platelet-rich plasma injections are performed by a physician only. This procedure requires injecting some of the athlete’s own blood directly into the injured tissue. The plasma portion of the blood contains platelets, which release protein growth factors responsible for initiating the body’s healing process. The goal is to restore injured tissue to its normal state, not reduce inflammation.

Pros: While more research is necessary, the current research is encouraging, showing positive change in the injured tissue. It can be done in a physician’s office setting. The injury can improve after one injection, and there is minimal risk for complication.

Cons: Research is limited, and the procedure is not typically covered by insurance. It’s an expensive treatment that must be performed by a physician. Only light exercise is recommended. There can be injection site soreness. Complete healing can take four to six months and may require several injections.

Grade: B

IONTO: Iontophoresis is a localized medication in a patch form delivered directly to the injury location via electrical stimulation. This procedure is typically performed by a physician or physical therapist.

Pros: There are fewer side effects than with oral medication and cortisone injection. It’s typically covered by insurance. It’s a painless procedure that may provide pain relief within the first five sessions.

Cons: The pain relief is only short-term. The research has shown varied and inconsistent results. The treatment does not result in a positive change in tissue.

Grade: C+

LLLT: Low Level Laser Therapy is sometimes referred to as cold laser therapy. It uses low-level lasers or light-emitting diodes to stimulate or inhibit cellular function. The exact mechanism is unknown, and it is theorized that the laser light can penetrate deep into the injured tissue. It’s typically performed by a chiropractor or physical therapist.

Pros: There is no pain or discomfort with delivery of this treatment, and it only takes between two and six minutes.

Cons: Research is limited and is typically done by manufacturers. There is limited agreement among clinicians on the most efficacious dosage and parameter choices. The results are varied and inconsistent. It is typically not covered by insurance.

Grade: C

NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs. You can get NSAIDs over the counter or as a prescription from a physician. Some examples are aspirin, ibuprofen and Aleve.

Pros: They provide quick pain relief and are easily available.

Cons: They provide only short-term pain relief. Some side effects are gastrointestinal distress, increased incidence of hyponatremia in endurance athletes, myocardial infarction and bleeding. They do not result in a positive change in tissue.

Grade: C-

Cortisone Injections are performed by a licensed physician and involve an injection of cortisone directly into the injured tissue. It’s usually mixed with a numbing agent like lidocaine. It’s used to suppress inflammation. The physician may use fluoroscopy (X-ray-guided technology) or a diagnostic ultrasound to determine the best location for the injection.

Pros: It provides quick pain relief and is covered by insurance in most cases.

Cons: The relief is short-term. It comes with a recommendation of time off from training. The side effects are potential fascia/tendon rupture and skin irritations. While it may decrease inflammation, it does not result in a positive change in tissue. Plus, it can be an expensive procedure.

Grade: D

This should be a last resort before looking into surgical options. Definitely consider PRP before taking this step.

Before deciding on a treatment option, it is best to consult a sports medicine clinician. Furthermore, in order to optimize your treatment choice, it is crucial that a biomechanical assessment be performed by a licensed physical therapist to determine the underlying cause of injury. Remember that these treatment tools are only as good as the hands that wield them. Most of these injuries are preventable, fixable and require a team approach to most effectively recover.

My experience treating endurance athletes leads me to recommend ASTYM and eccentric exercise as the most effective treatments of overuse injuries from those discussed above. While ASTYM and Graston are very similar, I give a slight edge to ASTYM since it was developed by a physician and physical therapist, and they continue to advance the research. ASTYM is taught more as a treatment process or philosophy. Our athletes and clinicians prefer an active treatment approach that allows continued training, focuses on normal tissue healing and is backed by research.

Nate Koch is a physical therapist and certified athletic trainer. He owns Endurance Rehabilitation in Scottsdale, Ariz.

Becoming Your Own Massage Therapist

This is something I've wanted to write about for a while. And here it is, and article in the NY Times! I'll post later some of my favorite self massage moves and tools. But the foam roller rocks - especially on the IT Band! -L

Photographs by Darren Hauck for The New York Times

THE THERAPIST CAN WAIT Michael and Briana Boehmer use foam rollers for a do-it-yourself massage that helps prevent sore muscles from workouts.

By DIMITY McDOWELL

Published: December 1, 2009
NYTimes.com

AS a former cross-country runner for the University of Wisconsin-Madison, where a free massage was part of an athlete’s weekly schedule, Briana Boehmer remembers the benefits of having qualified hands work her sore muscles.

(December 3, 2009)

Happy Muscles: Suggestions for Quick Relief

Now that she is 30 and starting a corporate wellness business with her husband, Mrs. Boehmer no longer enjoys such a perk, so she massages her muscles herself. She works out about seven hours a week, training for triathlons and duathlons, and begins and ends each session by kneading her back and legs on a foam roller, which she calls her “best friend.”

“It’s like getting a massage without having to pay $85 an hour,” she said. “I can’t afford the real thing right now.”

Devices for self-massage have become more common as more people compete in endurance sports and, more recently, as the recession has made professional rubdowns look prohibitively expensive. Trainers usually recommend a massage every week or every other week for people who are training for a marathon or triathlon, but the costs do add up: according to the American Massage Therapy Association, the average price of a massage is $63 an hour.

Though a massage may sound like a luxury, it can become a necessity as part of a training regimen. When the same muscles are forced to do the same motions over and over, they become tight and injury-prone.

For instance, “riding on aerobars on the bike sets up a huge muscle imbalance in the upper back and shoulders,” said Tim Crowley, a triathlon coach in Marlboro, Mass. “Hip flexors, hamstrings and glutes become extremely tight and immobile from running.”

While it’s hard to say how many people do self-massage, many athletes swear by it, and a growing range of products and how-to videos is available in stores and online. A foam roller, which costs about $25, is just one of a family of products, manufactured or improvised, that can relieve tight muscles.

“In the late ’90s, you could only find foam rollers through physical therapy catalogs,” said Keats Snideman, a massage therapist and conditioning coach in Tempe, Ariz., who produced a DVD about self-massage. “Now you can buy them anywhere, and exercises with them are all over YouTube.”

In addition to the many name-brand products that are sold specifically as massage aids, old-fashioned household objects will do, too. Most small balls, including golf, tennis, baseball and lacrosse balls, can unkink sore muscles.

Rich Poley, author of the book “Self-Massage for Athletes,” favors using your own hands. But he is also a fan of the Knobble II, a mushroom-shaped device that can be used to press on muscles at specific trigger points to try to break up knots, and the Thera Cane, a hook that can be used to reach points on the back.

For all its advantages, self-massage has its limitations. Cassidy Phillips, founder of Trigger Point Performance Therapy, considers it the equivalent of oral hygiene. “You brush away some plaque yourself,” he said, “but you still go to the dentist for a thorough cleaning.” His company, based in Austin, Tex., sells self-massage tools for athletes.

Clearly, a massage from a trained therapist can be more effective — and relaxing — than a self-administered massage. A therapist also has a comprehensive knowledge of anatomy and can help with injuries, like muscle strains, that may not respond to self-massage.

“A foam roller can’t alleviate deep trigger points the way an experienced thumb or knuckle can,” said Collette Glass, a sports massage therapist in Atlanta.

Yet Mrs. Glass, whose livelihood depends on athletes who need her care, is a proponent of self-massage. She and her husband, Dr. Josh Glass, a sports chiropractor, hold self-care seminars in the Atlanta area several times a year. “The message we stress through the whole demonstration,” she said, “is that self-massage keeps you out of our offices.”

Any kind of massage —the professional type and the D.I.Y. — can stimulate blood flow and break up scar tissue, thus reducing an athlete’s risk of injury, Mrs. Glass said. “In massage, shortened, overworked muscles get flushed out and return to a normal length, which helps them properly recover,” she said. When she was training for Ironman triathlons in 2006 and 2008, she said, she used a roller every day to soothe her iliotibial bands (tendons that run along the outside of the upper leg).

Jenni Gaertner, a physical therapist and competitive cyclist in Coeur d’Alene, Idaho, also advocates a combination approach. “I go to a massage therapist only during racing season, because it can be so expensive,” she said. “But I use a foam roller year-round and prescribe it to patients and teammates.”

ABBY RUBY, an athlete and coach from Manitou Springs, Colo., massaged her muscles daily while training for a 100-mile trail run in Leadville, Colo., this year. She doesn’t leave home without her tools: half of a foam roller and a small ball from Trigger Point Performance Therapy. “I sit on the ball on flights to release my piriformis,” she said, referring to a muscle deep within the hip and buttock region.

Convenience and affordability are the selling points for Ms. Ruby. “When I need a massage, I need it now, not next Wednesday at 3 p.m.,” she said.

Kinesio Tape

Kinesio Tape is kind of trendy right now. You've probably seen people wearing it at local races and wondered what the heck it is!







The idea behind Kinesio® Tex Tape is that it does two things:

It works like a sports tape - so it offers support and re-education of the neruromuscular system if you have an injury.
From Wikipedia: Kinesiology taping differs from the use of traditional white athletic tape and McConnell tape. White athletic taping technique is the most common in North America. White athletic tape is extremely rigid and requires a pre-wrap prior to application. Used for acute and preventative injuries. Left on for a short period of time, typically applied immediately prior to an activity and taken off immediately thereafter. This technique may cause skin irritation due to moisture entrapment, high latex content, skin compression, joint compression and muscle compression.

It also improves blood/lymph circulation - relieving pain and reducing swelling.
From Wikipedia: The wave pattern found on the tape's adhesive has a lifting effect on the skin which can reduce swelling and inflammation by improving circulation and reduce pain by taking pressure off pain receptors.

I've used it many times in my injury prone life! First, when I was having knee pain because my kneecap was not tracking correct, It was used on the side of my knee to help push the kneecap into the correct position. I've also used it after knee surgeries. When there was continued swelling it was placed on top of the inflammed area to help the lymph nodes drain the fluid. I've found it to be effective in both situations. It can be used anywhere on your body.

If you want to read more about it, you can check out these sites:
www.kinesio-tape.com
www.kinesiotaping.com

The American Physical Therapy Association Book of Body Maintenance and Repair

This is a really helpful book. Especially before I became an expert on knee pain from dealing with my own problems! Good to have on hand.

Amazon.com Review

Whether you've been injured or want to avoid injury, the American Physical Therapy Association Book of Body Repair and Maintenance can help you. Part 1 is the first place to go if you've been hurt. It presents nine common injury sites--back, neck, jaw, shoulder, elbow, wrist and hand, hip, knee, and ankle and foot--describing the anatomy and function of that area of the body, what can go wrong, and what to do if you experience pain or injury there. Part 2 explains how to avoid injury through proper posture, gait, body mechanics (how we use our bodies in daily activities), body weight, and footwear. You also get a program of beginning strength training and stretching, plus tips for avoiding injuries in sports, exercise activities, and in the workplace. Part 3 presents 200 clearly illustrated exercises for strength (beginning level) and flexibility that can be done at home. Some require dumbbells or ankle weights; most need no equipment. Many are done seated or lying down, so even if you haven't fully recovered, you can start to rehabilitate those areas that are ready. The illustrations are line drawings, large enough so that you can learn the exercises easily with the book open on the floor. This book is practical and helpful--don't wait until you get hurt to read it. --Joan Price

Anit-Inflammatories and Exercise

NSAIDs and Exercise

NSAIDs are now starting to be used as an ergogenic aid to enhance performance especially before and during long endurance races and longer training sessions. Is this safe?

By Anna L. Waterbrook, M.D.
Member AMSSM

From beginnertriathlete.com

Non-steroidal anti-inflammatories (NSAIDs) are a class of over-the-counter (OTC) and prescription medications that include Ibuprofen (Advil and Motrin), Naproxen (Aleve), Aspirin and others. They work by inhibiting the production of prostaglandins, natural substances produced by the body that control a number of different processes including pain and inflammation. They also help to keep the blood vessels of the kidneys open and protect the stomach lining. They are commonly used for the treatment of various causes of pain and inflammation.

NSAIDs are used by athletes to treat many conditions including acute musculoskeletal injuries, such as a sprained ankle or muscle soreness after an intense workout. However, they are now starting to be used as an ergogenic aid to enhance performance especially before and during long endurance races and longer training sessions. 30-50% of participants in Ironman races and marathons are reported to take NSAIDs. The theory behind this practice is that the prophylactic inhibition of the production of inflammatory mediators will lead to decreased muscle soreness, fatigue, and ultimately shorter recovery times and improved performance.

Do NSAIDs enhance athletic performance?

Currently there is no convincing evidence that NSAIDs enhance performance or recovery time.

David Nieman, Dr. PH., of Appalachian State University, studied the effects of two different doses of ibuprofen and a control group during a 100-mile trail running race. He found that “…ibuprofen use compared to nonuse by athletes competing in a 160-km race did not alter muscle damage or soreness, and was related to elevated indicators of endotoxemia and inflammation.” In addition, he found no difference in race times or rate of perceived exertion between the three groups.

McAnulty, et al, studied the effects of inflammatory markers in a group of ultramarathon ibuprofen “users” versus “non-users”. He found that some inflammatory markers were actually increased in the ibuprofen user vs. the non-user group.

Donnelly, et al, studied the effects of ibuprofen and exercise to prevent delayed-onset muscle soreness and its effect on known markers of muscle breakdown, which can be seen in the blood and urine. He found no change in either of these parameters in the ibuprofen vs. no ibuprofen groups.

However, these are all relatively small studies with several limitations in the way their research was conducted. More research still needs to be done until any final conclusions can be made.

What are the side effects of NSAID use?

There are several side effects to NSAID use. The most dangerous is bleeding from the gastrointestinal tract. This is usually associated with chronic use, but can also be seen acutely. Prolonged use can also lead to kidney damage.

NSAIDs have further been shown to increase gastrointestinal permeability and contribute to the development of hyponatremia when taken by endurance athletes during long races.

Safe uses and indications for NSAID use

So, with all of these possible side effects and lack of scientific evidence that they help to enhance athletic performance, should one ever take NSAIDs? In general, moderate use after exercise to treat acute musculoskeletal injuries or muscle soreness for a short period of time is usually safe. People who have a history of gastrointestinal bleeding or kidney problems should check with their physicians before taking any NSAIDs.

Bottom Line

Take care of your body including proper training, rest, nutrition, hydration and recovery. Occasional NSAID use AFTER exercise is probably helpful and safe if used for a short time period for an acute injury. It is probably safer to avoid taking it as an ergogenic aid to improve athletic performance before or during races. Always seek physician recommendations and expertise if you are ever in doubt about what is best for you.

Anna L. Waterbrook, M.D.
Board Certified in Sports and Emergency Medicine
University of Arizona
Arizona Institute for Sports Medicine
Tucson, AZ

Heat vs Ice

Good article from the Running Doc at runnersworld.com. It was posted September 8, 2009.

Acute Injury: Heat or Ice?

Although there appears to be a controversy about heat vs. ice, there really isn't. Most who treat athletes on a regular basis agree that from the first day through the first 24 hours, ice is the treatment of choice. Heat tends to further injure friable blood vessel walls thereby promoting leaking of fluid and increasing swelling. Ice, on the other hand, also vasodilates and does not injure the vessel wall, and, in fact, helps its integrity. Ice is truly a great vasodilator. Although initially vasoconstricting in the first few minutes, it then promotes vasodilation, as evidenced by the red area on the skin after icing.

After 24 hours we want to continue vasodilation to bring in blood flow with nutrients and cells to promote healing. The vessel wall has regained its integrity and both ice and heat work: after a 20 minute treatment, both result in an area that looks red due to increased blood flow. Which should you use then? I prefer ice because it temporarily deactivates receptors in the vessel walls, thereby keeping the vessels open for an additional 45 minutes following a twenty minute treatment. When heat is applied, as soon as the heat comes off, the vessel area begins to cool the receptors and the vessel walls are reactivated to normal blood flow. Therefore, ice gives you a longer treatment for a 20 minute application. Contrary to grandma's old advise of doing contrast ice then heat, etc., ice works better, 3 times a day for 30 minutes. The contrast baths only had you doing more treatment. And more treatment is always good to a point. You can ice up to six 20 minute treatments a day for the most effect.

Be careful of burning the skin with either treatment. My favorite way to ice is with a zip lock bag filled with ice and water. The water raises the temperature to 32 degrees so no need for a cloth between the ice and the skin and no freezer burn to the skin. I have also found using a bag of frozen peas useful but just as those frozen chemical packs, they can get too cold so be careful about having a cloth between your skin and the pack.

Enjoy the ride.

Ask the Running Doc
Dr. Lewis G. Maharam is the world’s premier running physician. He is medical director of Competitor Group’s Musical Marathons and The Leukemia & Lymphoma Society’s Team in Training program, and serves as Chairman of the Board of Governors, International Marathon Medical Directors Association. He is former medical director of the New York Road Runners and ING New York City Marathon.