Menu

Injury and Rehab

Hamstrings and Balance

,

Most runners have frequent and recurring hamstring problems.  It seems endemic to the sport.  And it’s debilitating – if your hamstring is talking to you, then in Bob Dylan’s words, “You Ain’t Going Nowhere.”

The anatomy and biomechanics of the lower extremity is complicated.  A chart noting interrelated muscular actions in Joseph Hamill’s Biomechanical Basis of Human Movement  provides a clear picture of how each muscle, joint, and tendon plays a role in proper movement in running gait.  The three hamstring muscles (semimembranosus, biceps femoris, and semitendinosus) form the “meat” of the posterior (backside) thigh.  And attached to these three, either directly or indirectly, are about a dozen muscles attaching to the hip and knee.  If that isn’t involved enough there are the anterior (frontside) muscles that serve as antagonists to the posterior muscles.  For example, the four quadriceps flex the hip while the hamstrings extend it.  It’s a beautiful system when it works as designed!

But few of us have perfect biomechanics and things happen, the most noteworthy being imbalances. These may be minor, for which we tend to compensate without notice.  But over time these imbalances build up and result in some muscles having to work harder than intended.  When that happens, the overworked muscles get stronger and the ones getting off the hook become comparatively weaker.

I had had an ongoing left hamstring issue for over six months.  I thought I was doing the right things: stretching, weightlifting several times a week, running hard-easy days, doing pool running, etc.  The hamstring would get a bit better and I wouldn’t feel it much while racing or doing track workouts.  Alternatively, it would get quite sore and I’d feel it from my first step.  I simply could not consistently train and race.  It was discouraging.  So, I made an appointment with Marilynne Johnson, one of the most experienced and respected physical therapists in the Burlington area.  Marilynne is a no-nonense PT.  She also knows the mentality of runners — they want to keep running even while rehabbing!  And she does her best to accommodate that. 

Marilynne quickly sized up the problem and then explained what was going on.  In my case, I had a proverbial imbalance: both my left and right hip flexors were weak and one was weaker than the other.  This was wreaking havoc with my left hamstring, which had to work too hard and was being repeatedly strained.  I was surprised when she pushed down on my knee and with very little force my leg gave way.  Again, I thought I had been doing the right things, but obviously not! 

Marilynne prescribed four bodyweight exercises and I left a bit unsure how to perform them correctly.  When I returned in two weeks, I admitted I had been inconsistent with the exercises and needed a refresher.  This time I wrote down the particulars and made sure I had a 90% understanding of the technique.  From that point and over the past ten weeks I have only missed one day doing these PT exercises.  I was honestly skeptical at first: they didn’t involve external weights; how much difference could they really make?  But Marilynne knew her stuff, and after a couple weeks I noticed a difference and then after a couple more a marked change, followed by more change.  Now I am able to lace up and start my runs without feeling the hamstring.  It’s still a bit sore if I sit for an extended time afterwards, but then I get up and stretch it out.  I expect to keep doing these.  The eight minutes they take are well worth it!

The whole experience has taught/reminded me of several things:

  1. I don’t know as much as I thought about how the body works!
  2. Don’t underestimate the value of PT exercises, as simple as it may seem.
  3. Balance is critical in all functions of life.  Running is no exception.

If one part of your body is holding you back, suspect there is an imbalance somewhere.  Get it checked out by an experienced PT or sports medicine practitioner.  And don’t wait six months like I did!

The Precious Moment

,

Last week I saw an email from Ralph, a long-time running friend, briefly describing a bike accident.  He was on a less traveled road approaching the Charlotte Town Beach.  The scenery approaching Lake Champlain on this downhill stretch is beautiful.  In its infinite wisdom, the Town of Charlotte decided this was a good place for a pronounced speed bump, just on the downhill side, with the aim of slowing traffic approaching the beach parking lot.  Good idea?  Maybe.  But for Ralph it proved otherwise.

Ralph’s front tire hit the bump at a slight angle, twisting the tire and sending him flying over the handlebars.  He spread eagled on the pavement, landing hard on his arm and side.  As he slid along, gathering road rash, he had a rush of thoughts and questions, foremost being “what just happened.”  In any event, the result was a fractured pelvic bone, determined later at the ER, and an arm that looked like Popeye’s.  Fortunately, four people on a bike tour happened to be there (in fact it was noticing the parked bikes as well as the vista that distracted his attention from the road) and came to the rescue.  The tour leader bandaged his arm and Ralph called his wife to pick him up.  He could not put weight on his leg and shortly after returning home, it was clear something was wrong and he should go to the hospital.  After extended time in the ER, including multiple x-rays and a CT scan, the damaged was assessed.  Ralph was issued crutches with express instructions not to put weight on that leg, and to return to speak with an orthopedic doc to discuss options.

I called Ralph and spoke with him at length about the incident.  His command of the details was impressive.  Obviously, he is off his feet for a while.  Ideally, he fully heals and is back in the game before too long.  He’s been told to expect a 12-week recovery. Ouch!! As we age, time off is the worst thing possible in our quest to ward off Father Time.

I reflect upon my own experience of falling down a flight of stairs in 2017 and breaking eight ribs in multiple places.  I vividly recall the plethora of thoughts rushing through my mind as I was falling and then the ensuing ambulance ride to the ER, five days in the ICU and rib-plating surgery (see February 25, 2017: Surprise #1 – The Fall).

Ralph’s tumble reminded me we live in the moment and that is the only place we live.   Those moments become memories, with some more momentous than others.  If only we could relive a few of them – ah, how things might have been different!  But it doesn’t work that way, and if we fixate on the past, we are likely to miss the precious moment that is here now, good or bad.  This is existential stuff for sure, but certainly relevant to our daily lives.

Today, I will go for a run and do my best to be in the moment, feeling the passion of being able to move freely and nimbly!  It won’t always be that way, age will eventually subsume all of us, and perhaps I will have my own bike mishap to recover from.   Meanwhile, I’ll support Ralph in any way useful as he works his way back.

Pliability

, ,

I’ve been reading Anatomy for Runners by Jay Dicharry (Skyhorse Publishing, 2012).  It’s conversationally written.  You can picture yourself in a seminar setting with Jay presenting PowerPoints, cracking jokes, and noting anecdotal evidence.  The book covers the entire gamut of running, with a focus on injury prevention.  It’s pretty opinionated but includes an extensive reference list from which he draws.  Dicharry is a seasoned clinician and has no doubt seen many versions of all the injuries about which he writes.  He discusses in depth a concept worth expanding on — pliability, which Webster defines as “flexible, supple, yielding.”   Dicharry uses it in the context of muscle function.

We all know what it feels like to be tight and stiff.  This, often in spite of regular stretching and taking it easy between hard efforts.   As Dicharry explains, the tension in muscles is not the same up and down the line.  And does not dissipate evenly.  Let’s look at hamstrings, the oft strained muscle in runners.  The biceps femoris attaches both at the hip and below the knee.  With insertion points crossing two joints, the tension varies along the hamstring.  For example, when running, one end of the biceps femoris contracts concentrically while the other end is eccentrically contracting.  Talk about inherent differences in tension along the hamstring!  So how can we realistically expect recovery will be the same along the entire muscle?     

Another reason for uneven recovery Dicharry discusses is accumulated scar tissue,  He notes  scar tissue results in a random orientation of muscle fibers.   Collagen, a primary component of muscle, provides a framework, when intact, has muscle fibers lining up in parallel so they pull in the same direction.  But when scar tissue sets in, a “sticky” grid impedes smooth muscle function.  Dicharry suggests this can be from not only traumatic injury but also the cumulative effects of hard workouts from which we have not fully recovered.  And that lack of recovery can build incrementally from week to week, month to month, and even year to year.  Further, this deviating grid ensures tension along the muscle will vary, meaning some parts have to absorb more tension than other parts along the muscle, which can then lead to strains and tears.  It’s a repeating cycle we are all too familiar with.  We have a strain, let it rest some, come back to action, and after a while incur an injury at or near the same location.  The key then is to break the cycle.  How can we do that?

There’s not a simple answer that applies the same for everyone.  But universal is a need to realign the collagen in parallel so the load can be more equally distributed, eliminating the stress points of reinjury.  Naturally, we’re better off if we can keep up with the damage as it incurs by mobilizing the scar tissue early in the cycle.  But each of us is where we are, with our own injury history and have to start somewhere.

Dicharry describes some ways to mobilize scar tissue.  Deep tissue massage by a trained massage therapist is certainly an effective way, but one with the cost of time and money.  Perhaps the easiest way is to incorporate foam rolling before and after exercise as well as strategic rolling on a softball or lacrosse ball.  The latter is painful but can be applied from the hip at the tensor fascia latae — the top of the ITB and the glute medius as well as along the hamstrings, quads, and calves right down to the Achilles.  As to foam rollers, I recently saw an ad for a vibrating roller.  I was skeptical at first, especially since it was promoted by TB12, Tom Brady’s sports equipment and consulting arm.   But I looked at the options beyond TB12’s $150 model and found some good ones for $100.  Looking through the reviews, I think this could be a good addition to an array of home exercise equipment.  Whatever we do, we will benefit by smoothing out the rough edges of our muscles and increasing our pliability. 

It’s a Stretch!

, ,

In our Biomechanics of Human Motion class, we’ve been looking at the topic of flexibility and range of motion – i.e., stretching.   I thought I knew a thing or two about this topic.  In reality, I knew a smidgeon.  Humbling!

Let’s walk through what we’ve covered in class.  As with most biomechanics, it’s important to start with the micro and build up from there.  In describing this, I’ll draw heavily on Joseph Hamill’s book Biomechanical Basis of Human Movement, 4th edition, p. 116-118.   This text is an amazing compendium of everything biomechanical, from anatomy and physiology to muscular force production.  Not an ideal nighttime read, but after a good night’s sleep and with a strong cup of coffee, this book has plenty worth exploring.

Hamill defines flexibility as “the terminal range of motion of a segment,” such as a hip or leg.  This is comprised of both active and passive elements.  For example, during the running stride, our hamstrings actively engage to pull our leg behind us and then passively engage as we reach the top of the range to terminate the forward “swing phase” in preparation for the quads to pull the leg down.   If we are inflexible, then this total range of motion is limited and we begin the “stance phase” (when our foot meets the ground and pushes us forward) before enjoying the benefits of a full stride length.  This results in less “float” (the time we’re airbound), which gives muscles a chance to momentarily relax and regenerate force.

There are two main components that contribute to flexibility:

  1. Joint structure
  2. Soft tissues (muscle and fat) and connective tissue, primarily tendons and ligaments  

Healthy joint structure does not always follow the textbooks.  We’re not all built exactly the same.  Some of us have larger bony projections than others, with the fit of the femur onto the tibia, for example, varying among people.  While important, joint structure is not the major determinant of flexibility.  Rather it’s the muscle and connective tissue length and elasticity, which can be enhanced with stretching.   It follows that if we increase our range of motion, this will help our running.  

I’ve been testing this out the past four months incorporating a pretty rigorous stretching routine 5-6 days a week encompassing all the major lower extremity muscles including the soleus, gastroc, hamstrings, quads and various hip flexors.  This isn’t new – I’ve been stretching for years.  But what has changed is that instead of holding stretches for ~5 seconds, I’m holding them for a full 30 and doing multiple sets.   These are easy stretches – pain, no gain!  The second and third sets show noticeable increased range.  After three sets, change is minimal, so I call it quits.   Suffice it to say, this stretching routine is a big commitment.  It takes 20-25 minutes, so about two hours a week in total.  When time is tight, it cuts into my running mileage. 

Has this helped my running?  I think so.  For example, last month I ran the New Hampshire 10 Miler at a pace four seconds per mile faster than at that race three years ago.  The age grade tables say to expect a 14 second per mile decline over those three years, so for my age that’s an 18 second per mile delta and for 10 miles a three-minute age-graded improvement.  I’ll take it!  But perhaps more important, it feels better running.  I start training runs less stiff and after a mile or two more easily up the tempo.  When racing, assuming a good warmup I generally feel ready to run with a bit more “bounce” in my step.  That’s not to suggest the racing is easy!  We test our limits, whatever the time and place achieved.  

Regrettably, stretching is one of the last things runners take time to do.  The aim of this post is to get you excited about regular stretching!   There are two types of stretching — dynamic and static.  Each have their place with easy dynamic (moving) stretching good before our runs and static (holding) afterwards.  The order is important.  The research shows dynamic stretching before runs positively impacts running – getting us ready to run – whereas static stretching negatively impacts us.  The reasons for this are somewhat technical, but the short of it is our muscles and joints loosen up during exercise and thus are more receptive to stretching.  This allows for a more relaxed and deep stretch, which if done consistently can permanently increase our range of motion (assuming we consistently follow the program.)   

As with all things running, training is a complete package, balancing aerobic and anerobic running with strength and flexibility work.  It’s hard to maximize our potential at any age without a serious commitment to all four aspects.  I’ll look for you on the stretching mats at the gym!

Take a Knee

, , ,

Football season is about to begin.  You may recall, when a player’s knee hits the ground and he’s touched by a defender, play is called dead.  Often the quarterback “takes a knee” to stop the clock.  But this post is not about football!  Rather a look at our marvelous and incredible knees, the mid-point of our lower extremities — the runner’s drive train.  Since knees are the most common site of running injuries, it’s worth reviewing how they function.  

Pictured below, the knee is the largest joint in the body.  The knee actually has three joints:  the tibiofemoral (largest, lying between our thigh and lower leg and generally thought of as the knee joint), the patellofemoral (kneecap), and the tibiofibular (below the kneecap and not directly part of the knee movement.)  I’ll focus first on the tibiofemoral joint here, which functions as a hinge.

Unlike the hip joint, where there is significant bony structure, most of the knee’s stability comes from soft tissue – ligaments, tendons, muscles, cartilage, menisci, bursa, and fat pads.  This constitution allows for significant range of motion – for example, we can bend our knee to touch our butt with our foot. 

When looking at knee anatomy, physiology, and biomechanics, one quickly realizes how much is going on.  Being in the middle of our lower body kinetic chain, if something is not right in the hips or ankle/feet, it usually wreaks havoc in the knee.  Amidst all the knee hardware is a lot of viscous synovial fluid, the lubricant that reduces friction.  We think ice is slippery.  But the inherent friction in a normal knee joint is 20 times less than walking on ice!

First, let’s address a misconception that running is inherently bad for our knees, that we wear down our precious cartilage with each step.  It’s not that simple!!  In fact, the research shows a runner in good health and lean weight will likely have more cartilage than a person who does not perform weight-bearing exercise.  This follows Wolff’s Law, which holds that bone (and other types of connective tissue, such as cartilage) adapt to loads under which they are placed.   Further, cartilage has no blood or nutrient supply – this is provided by the synovial fluid that bathes the cartilage within the knee capsule.  And that bathing is enhanced by vigorous movement.  So weight-bearing exercise stimulates the integrity of cartilage rather than damaging it.  

But here’s the rub: the bones and cartilage can’t do it alone.  The knee’s stability relies heavily on strong muscles, tendons, and ligaments to ensure undue weight is not placed directly on the articulating surfaces of the knee joint.  Running exerts a force roughly three times body weight on the knee, so all of these components need to be doing their job to avoid damage.   It’s true undue stress can wear down our cartilage.   Also as we age, we experience a slower rate of tissue replacement and repair, decreased water content (healthy cartilage is 80% water!) and have less robust muscles and tendons.   We cannot defeat all of these aging processes but the rate of change can be mitigated.   Strength training is one way to do that.  For example, properly performed squats strengthen all the muscles surrounding the knee.  However, one of the last things runners seem to take time for is resistance training.  

Virtually all runners have had a bout or two (or more!) with knee pain.  In fact, the knee is the most prevalent site of runner injuries, clocking in at about 40% in any particular year.  Runners may have acute knee injuries, from a fall, an awkward twist, or from activities other than running.  But the most prevalent issue for runners is chronic pain, with patellofemoral pain syndrome (PFPS) at the top of the list.  

The patella (our kneecap) is tightly surrounded by muscles, tendons, and ligaments.  It covers the patellofemoral joint (PFJ) and serves as a fulcrum when we bend and straighten our knee.   The pain, often called “runners knee,” is due to the underside or sides of the patella rubbing against the bone below it. The alignment of the knee and the strength of the muscles surrounding it, in particular the quadriceps, can help keep the kneecap on track and ward off PFPS.

Another debilitating source of knee pain is osteoarthritis, a self-perpetuating condition where depleted cartilage results in bone-on-bone friction.   Ideally a strength training program begun early in a runner’s career can help avert this condition.  In any event, osteoarthritis is a complicated condition warranting its own blog and that will be forthcoming.

Suffice it to say, knees are vital to lifelong running.   And it behooves us to give them their due attention and care!  

Water Works!

, ,

Growing up I liked playing Monopoly. Most everyone wanted to buy Boardwalk, Park Place and the expensive properties hoping to put houses and a hotel on them. And collect big $ when someone landed on them. But I also liked Water Works, one of the utilities. The payback was decent – averaging about $28 and up to $48 rent (based on a roll of the dice) on a $150 investment. Chances were in the course of a couple of trips around the board someone would land there. Nothing fancy, but a dependable return. And that is what deep water running offers to runners. I was reminded of this twice in the past two weeks. 

The first time I had gone for a fairly hard run in the cold rain.  Came back to the gym, warmed up and thoroughly stretched, planning on a hard track workout the next day.  But that night I didn’t sleep well and woke up with some back pain.  It seemed wise to delay the track workout a day.  So I headed to the gym and since the pool schedule didn’t allow for a water run, I jumped on the StairMaster.  If anything, that made things worse and as the day progressed the back hurt more.  Sleeping that night was uncomfortable and in the morning just walking was painful.  Clearly running was off the table.  So I headed to the pool!  

I slowly walked from my car to the Y and did 45 minutes in the 88 degree program pool – it’s like a bath but on that day welcomed.  I felt the back in the water but it wasn’t getting worse.  After sitting on a heat pad most of the day while working, by evening things were maybe 30-40% better.   The next day, I headed to UVM and did an hour in the pool (78 degrees so I wear a shorty wetsuit – no legs) followed by stretching and light weights (on parts other than the back.)  More heat pad and by evening I felt 80%+ recovered.  Rested well that night and in the morning went for a very easy 5-mile run, mostly on dirt.  No problems!   The following day I ran 8 miles, including two-miles of tempo near the end. Felt nearly 100% – saved by the water!

But then three days later after a solid 7-mile run, I came back to the gym for some stretching. I regularly perform one-legged balances on an inverted Bosu ball while doing dumbbell presses with a 10-pound weight in the opposite hand. But for some reason I picked up a 15-pound weight, lost my balance and took an awkward step off the ball jamming my ankle. I quickly felt something pinch in the area of the ankle dorsiflexors, the muscles that allow you to lift your foot upward when running. Sure enough, after a couple hours it began to throb and it was clear running wasn’t going to be an immediate option.

This was Tuesday and my dilemma was I had an important team race on Saturday. Nobody wants to totally rest during the days leading up to a race. So I was in the pool. Two solid pool workouts the next two days along with stretching and foot orbits had me at 90%, enough do an easy four miles the day before the race. By race day there was hardly a trace and I felt nothing (in the ankle!) during or after the race. Once again, water worked!

Suffice it to say, I will make an ongoing argument for deep water running.  I’ve been doing this for over 25 years.  Usually twice a week between running days and more when injured, using an aqua-jogging belt so the effort can go into running and not into staying on top of the water.  Maybe some find it boring, though with new technology you can get wireless headphones and listen to podcasts or music through your phone sitting on the pool deck.  Time passes by looking around and counting your cadence (the only real measure besides heart rate to monitor.)  It’s not “running” but is the closest thing to it I have found.  And many top echelon runners have also found this method useful in bridging their training gaps.

I have tried, regrettably with little success, to interest fellow runners in deep water running as both a regular part of their routine and a bridge to maintain fitness when running is not an option.  Most runners attempt to “run through” their injuries, big and small, or take time off, which I submit for masters runners is problematic.  We’re already losing muscle and CV function and total rest only exacerbates that. I’ll keep preaching water running to my friends and clients.  And will be waiting for someone to write a guest blog post about how they have found it to be the magic elixir of sorts.  For sure, there’s nothing like a good run.  But if you can’t (or shouldn’t!) do that, deep water running is a great alternative.  Water works!   

To Race or Not Race: That Is The Question!

, , ,

Is it a stretch to suggest this Shakespearian corollary applies to competitive runners? Most of us have at least some of our identity connected to this sport we love. Not seeing our friends at races and toeing the line attacks our sense of self.   George Sheehan probed this years ago in his first book Running and Being.

However, to shift from the existential to the practical side of the question, we competitive runners find ourselves in this predicament, probably several times a year. We train to do well in peak races that have meaning for various reasons.   For me I look forward to doing well in the USATF-New England Grand Prix series and the BAA Distance Medley (5K, 10K, Half). I know the best runners will be at the Grand Prix races and I want my age-class competition to know I need to be reckoned with! At root, these rivalries are supportive and rewarding. Camaraderie develops because we have each made sacrifices over an extended time. And races are a celebration of that. The BAA races are all large (~10,000 runners) events drawing an international field and there’s a definite “buzz” being part of then.

If you’ve followed my blog, 2017 has been a year marred by a bad fall in February resulting in rib surgery and not being able to run for three months and then only incrementally returning to training. I essentially lost seven months of high-level racing, which I missed dearly.   I was looking for some redemption in the fall and beginning to feel the chops returning in September. I had increased the quality of my workouts, throwing in speed and some hills, had shed several pounds, and lined up at the Lone Gull 10K Grand Prix race on September 24 ready to race. It was a warm day so I scaled back expectations a bit, but otherwise met my goal. I saw the BAA Half Marathon two weeks later as an additional statement of my return. But as I warmed down from Lone Gull, my left hamstring felt tight then started to hurt.   As I made the long drive to Vermont later that day, it was throbbing. Clearly I had done something.

On the surface, it didn’t seem this should be happening. I had progressively upped my mileage, including 14-15 mile long runs every other week along with regular strength work. But the quality had been lacking.   So during the prior month I started doing eight to ten 100-150 meter striders several times a week. And was doing 800-meter repeats on the track at least weekly. I had also moved from my Boston apartment the prior month and was moving things to Burlington, Vermont where I had recently bought a condo. On top of that I was in the final stages of retiring from the Boston non-profit I had been with for 10 years. Certainly the running was helping to moderate and manage these changes, but the overall stress level was high. Something was bound to give. And it turned out to be my hamstring.

I proactively approached the recovery by water running the next four days along with light stretching and weights. The hamstring mostly calmed down, so I went for a run but felt it quickly tighten up and begin to hurt. So I walked a bit and headed back to the pool. Fortunately, my massage therapist had a slot that afternoon. He did his thing and suggested I had strained but not torn the hamstring as he was not finding “hot spots” indicating a tear. That was good news, but based on my symptoms I surmised I had a 1½ grade strain. The literature says it takes 1-3 weeks for Grade 1 strains to heal and 4-8 for a Grade 2, so that left me thinking I needed three to four weeks of active recovery (including light running) to fully resolve the issue. I kinesio taped the hamstring and in several days was able to run six miles at a gentle pace, though with some tightness and post-run soreness.

But the BAA Half was looming – two weeks after Lone Gull. At stake was a third straight age-class title, which would qualify me for a waiver from the $200 fee for next year’s medley and a guaranteed entry. In spite of walking/jogging the BAA 5K in April and a pretty slow BAA 10K in June, a respectable Half would give me a chance for the title. I was feeling game to give it a try. But then three days before the race, I came down with a nasty cold that developed into a hacking cough, making it hard to sleep. I went for a five mile run on Friday and barely moved! To meet my goal I needed to run 2 ½ minutes per mile faster on Sunday.

Sometimes you have to step back from the moment to gain perspective.   I assessed I had a 25% chance of running the BAA Half at my goal pace and not setting the hamstring back; a 50% chance I would finish the race at a slower pace (which would hardly be satisfying) and leave the hamstring more sore, setting back full recovery at least a couple weeks; and a 25% chance I would further injure the hamstring and set my self up for an extended recovery.   While I have taken many risks in my life, I generally live by the law of averages. I didn’t like the 25% chance of doing no harm. So I didn’t run. My choice was borne out by the six-mile run I did during the time of the race at a pace well over a minute slower than I would have attempted at the race. The taped hamstring felt stiff throughout the run, and was a tad sore afterwards. Pushing it for more than twice the distance would almost certainly have resulted in one of the 75% negative outcomes.

I thought I might question my choice. But I’m actually relieved I could make this decision and look forward to resolving this issue over the next two to three weeks and get back to serious training and racing.

I know other runners have stories like this. Sometimes we take a chance and win; sometimes we lose. But the important thing is the long view — to stay in the game. That was my motivation today.

The Gift of Injury

, , ,

Going through some papers, I came across this piece I wrote 21 years ago, about midway through my running career. I am not sure what I did with this and if anyone else ever read it, but it reminded me how critical a juncture this was. The injury was patellar tendinitis, reportedly the 5th most common running injury. I did not run for over three months. But upon returning, I did so progressively with a commitment to avoid this going forward. Thus began my consistent use and tracking of running equivalents, mostly water running and Stairmaster and by incorporating REQs an adherence to daily workouts. It also marked the start of taping my knees with Leukotape right below the kneecap to take pressure off the patella tendon. The physical therapist used this during rehab and I just kept doing it. I buy Leukotape in bulk and don’t leave home without it. I tried the Cho-Pat, but find tape works much better. Also at this time, I began a regimen of weight exercises for my legs and knees four to five times a week. Specifically for the knees I use the quad machine, but rather than isotonic (up and down) reps I choose a weight that I can hold straight out with each leg for a count of 10, lower it slowly, then do the other leg. I call these isometric “holds” and do 10 to 15 per leg. Over time, this has built the quads above my knee, helping to keep the patella tracked.

There can be a silver lining in the cloud of injury, and I certainly found that with this bout of patellar tendonitis. Along with ITB syndrome and patellofemoral pain (runner’s knee), sore knees comprise three of the top five running injuries. So it behooves us to strengthen this vital part of our kinetic chain!

The Gift of Injury
(From November 22, 1995 – Thanksgiving Day)

I have been running for 18 years, typically 1,800 to 2,000 miles a year, five to six days a week. Fortunate to avoid a major injury, I have rarely been off my feet for more than a week. It’s been a large part of my life. In fact, I have wondered (without much interest in finding out!) what life without running would be like.

So, I was not elated to hear my doctor prescribe a likely two-month layoff to recover from persistent knee pain. And even that might not do it. It was not good news. But I had been dealing with this for over a year and it was affecting training, race times, and my enthusiasm for running. Running was still a tonic—something to look forward to and organize the day around, a way to stay fit, a social link, and stress releaser. The timing of this was bad. I was heading into a busy work cycle and was several pounds above normal weight. So with some trepidation, I agreed to the prescription of rest from running and rehab.

That evening, I thought about how to constructively approach this. There was a lot I could do: swim, pool running, bike, lift weights, some StairMaster – anything limiting direct pounding on the knee. But none of these seemed to be the elixir to replace a brisk seven to 10 mile run.

First, I decided it was a good opportunity to really learn to swim. I had been working on my stroke off and on during the past year, but it was still a mess. And lingering memories of nearly drowning as a kid kept me from relaxing and exerting myself in the water. It was time to get beyond that!  Second, I vowed to work out every day. Because of work that meant early morning workouts. Third, I knew it would be tough to keep from gaining weight. But instead of aiming to hold steady, I challenged myself to lose the extra weight, so when I was ready to run again, I would tread lightly.

So how has it gone these past two months? Swimming, surprisingly and pleasantly, is coming around with the help of a swim video, lifeguard tips, a pull buoy, and consistent training – at least four times a week. To vary the workout, I even started doing flip turns (my first were a real joke!) I discovered that as with running, going faster has benefits. With swimming, it leads to a sensation of gliding through the water and with proper rotation and reach, better stroke efficiency and reduced drag. My times are approaching 30 minutes for a mile (I figure about a 7:00 minute/mile running pace equivalent), which for “real” swimmers is not great shakes. But it’s all relative. A year ago, 40 minutes for a mile was a dream. Most notable though I’ve begun to look forward to the pool workouts, which with water running last about an hour. I’m not sure why this is, but swimming typically leaves me more refreshed than running. I’ve stuck to the schedule and have missed only one day since going on this program. On non-swimming days, I find a combination of StairMaster, stationary bike, weights, and stretching works well.

The extra weight went away, at least in part due to the early-to-early schedule. Late night cravings for pretzels, etc., have been largely displaced by early bedtimes. Also, I cannot eat thinking I will work it off doing a long run the next day. The fact is these activities do not burn calories the way running does. So I am more aware of what I eat throughout the day.

I do miss running! Especially the racing, although this is gratefully the off-season. I have no doubt that when I return, the fire will burn again. However, I think this pause has shown me I’ve been “chained” (I had to run!) to running, and I feel those shackles have been loosed. As with gaining a new friend while old ones are away, running will now compete with swimming for my time. It’s a dilemma I never expected but welcome.

So what I thought was going to be a hardship has turned out to be a gift. It answered the question of what life would be without running. As for all you injured runners, maybe I’ll see you at the pool!

Running Times – Gone!

, ,

Running Times started in 1977, the year I took up distance running. There really weren’t good running books back then so the magazine became my go-to source. I devoured every issue, usually reading it cover to cover the day received. Without fail, there was something, usually many somethings that could be incorporated immediately into one’s training and racing. I kept piles of RT around, only discarding them when making long distance moves. 

There were regular features. I loved the Shoe Guy, J.D. Denton, who owed a Fleet Feet store in Davis CA. His offbeat articles on life in a running store were funny, refreshing, and educational. The Owner’s Manual, written by various authors but often Pete Pfitzinger and Owen Anderson, provided a plethora of training advice. I lost count the number of times I had developed an injury or training impasse that the current issue addressed, as if the writers had been talking to my training partners! Nutrition, coaching, shoe reviews, performance tips, race results, and the latest discoveries in sports medicine and psychology were regular topics. Generally an accomplished masters runner was profiled along with their training regimen, providing many good ideas to try. Every year they ranked the top masters (about 10 deep) by age group. Alternately, it showcased high school and collegiate runners. Without Running Times, I probably would not have been aware of others in my cohort around the country or the juggernaut college programs.

What made Running Times unique was both the quality and depth of its articles. RT was not glossy, like Runner’s World, but was full of substance. Many articles were four to six pages long, with illustrations to break up text. Every issue had a nice balance. Even the ads were good – I bought a number of books and gear from the Marketplace section. For many years the last page was reserved for “By The Numbers”, a list of obscure running factoids. 

About 15 years ago I stopped discarding. The pile grew. There was no way to mine the gold in those pages. So last year I started going through the pile, from oldest forward, cut out articles and pasted them in notebooks by topic. Typically about half of each issue was worth saving. This process took several months, because I invariably read the articles while cataloging. Gems galore! I left room in the binders for many more years of Running Times.

Then in the December 2015 issue, a bombshell. Rodale Press, the publisher of Runner’s World, which had acquired Running Times in 2007, would discontinue it in January. I had passively wondered if/when the ax would fall when the magazine was sold. Rodale said they would maintain the tradition and focus on more serious running. And for many years they did. Maybe the 115,000 circulation, compared to Runner’s World 800,000, wasn’t enough to justify RT. The public statement was that Rodale wanted to stay “focused and aligned for continued growth as a company.” Another way of saying Running Times wasn’t paying off. They said they would incorporate aspects of RT into Runner’s World. But after four issues, it’s clear Running Times is gone, solid gone. Remnants of RT in Runner’s World are hard to find.

We live in a world of change. And in business consolidation rules. The small guy gets squeezed out. Maybe it’s a faint hope that some enterprising, idealistic folks will buy the rights to Running Times and recreate the magic that leapt off the pages for 38 years. Meanwhile, I have three filled notebooks to leaf through. Not all is lost!

Eccentric Heel Dips – The Magic Elixir!

,

We runners have some predictable issues and injuries. Starting from the bottom the most prevalent are plantar fasciitis (PF), Achilles tendinitis, calf strains, sore knees, tight hamstrings, hip and groin strains, and lower back pain. If you’ve been running very long, you’ve probably had bouts with all of these. I certainly have!

What to do? Could there be a one-size-fits-all solution to these multiple maladies up and down the kinetic chain? Well, no. But I have found one rather simple exercise that both directly and indirectly addresses these issues – eccentric heel dips. I think some of my clients consider me eccentric and obsessive when I impress upon them the importance of doing them – day in and day out. Perhaps they are right. Meanwhile I take my own medicine and perform them multiple times each day.

Here’s the basic description: Stand on the edge of a stair or any kind of a riser that allows you to dip your heels to a comfortable stretch. Supported only by the front of your foot, allow your body weight to stretch the heel downward, allowing one foot to take the majority of the weight. When you hit bottom, and just after a second or two, push back up onto your toes with both feet and then repeat the downward stretch with the other foot. Remember this is a dynamic, not static stretch – keep moving! Do some while bending the knee and some with straight legs. Repeat for one to two minutes if you have the time – 15 seconds if you’re going up an escalator. Any amount of time is beneficial. Find excuses to do these throughout the day, and certainly before and after you run. Focus on where you feel the stretch. Do not be surprised if you feel it all the way up your back. There are neuromuscular connections all through the kinetic chain.

Now that I’ve described these, let’s explore what’s going on. First, with eccentric exercises, there is negative resistance applied to the muscle, which lengthens it. Muscles resist force rather than produce it. An illustration is the basic bicep curl. When we lift the weight towards us we are concentrically shortening the muscle. When we let the weight down it is eccentrically lengthening. While we might think of concentric exercises as more strengthening and eccentric as stretching, eccentric action also strengthens muscles. In fact, about 30-40% more weight can be handled eccentrically. Not surprising, eccentric exercise helps build concentric capacity. For example, if we lower the weight slowly when doing bench presses, over time that helps increase the amount of weight we can press back up. As it relates to running, heel dips not only ward off debilitating injuries but also enhance spring in our step and improve balance.

Give heel dips a try! But do not expect an overnight miracle. You have to be willing to do them regularly to see the benefits. Heel dips are most helpful with calf, heel, and foot issues. But if your hamstrings are tight (and what runner’s are not!), you should feel a slight stretch there too. If there is pain, don’t overdo it. While this stretch will improve circulation and help healing, it can also increase irritation and inflammation. As with all things, too much of something good can be detrimental. Once you get the hang of this, start holding a 10-pound weight while doing your dips.

So maybe it’s not magic. But it sure is effective! I’ve been doing these consistently for over six months and have not had the recurring hamstring and calf issues I had been plagued by. Maybe they will work for you too!

Load More