University of Virginia Running Medicine Conference 2018 Takeaways

Despite the best attempts of March’s winter weather to block travel, I made my way to Charlottesville, VA a few days ago for the Running Medicine conference they have every spring. UVA consistently does a great job of recruiting well known, excellent speakers for this event.

Here was this year’s agenda for the Friday lectures:

• Knee Osteoarthritis: A Case Approach - Robert Wilder, MD, FACSM and Eric Magrum, DPT, OCS, FAAOMPT

• Clinical Decision Making for Footwear - Jay Dicharry, MPT, SCS

• An Update on Hydration Guidelines - David Hryvniak, MD

• Post-Operative Guidelines: Return to Running after Knee Surgery - Bryan Heiderscheidt, PhD, PT (Keynote)

• Gait Retraining: Finding the Right Balance - Bryan Heiderscheidt, PhD, PT (Keynote)

• Regenerative Therapies for Osteoarthritis of the Knee & Hip - Fran O’Connor MD, MPH, FACSM

• Nutrition: Controversies and Guidelines - Patti Deuster , PhD, MPH, FACSM

And the Saturday labs:

• Systematic Video Gait Analysis - Bryan Heiderscheidt, PhD, PT

• Rebuilding the Foot - Jay Dicharry, MPT, SCS

• Dynamic Pre- and Post-Run Exercise - Anne Dunn, MS, CPT & Jason Dunn, MEd

• Running Shoes 2018: Where are we now? - Mark Lorenzoni

Nobody messes with yoda

CPR for foot muscles with Jay Dicharry

There was so much great information presented, I could write for hours, but let’s just go with a few highlights.

1. Runners with known symptomatic knee osteoarthritis may benefit from a 3-4 month trial of one of the following: glucosamine/chondroitin, omega-3 fatty acids, fish oil, krill oil, or avocado/soybean unsaponifiables (ASU). There is a not an abundance of research to support each of these interventions but they do appear useful in some cases and have a low risk. It is not advised to start taking all of them simultaneously.

2. Once again, running does not cause osteoarthritis when performed at reasonable low to moderate mileage and intensity. There may be a potential relationship of higher mileage (>65 miles/week) and high intensities to developing knee OA. Overall though, runners tend to maintain a higher quality of life for more years without limiting knee pain than their non-running counterparts. That’s why running is actually believed to lead to protective cartilage changes, if anything. Let’s crush this myth.

3. Those darn medially posted motion control and stability running shoes (the ones with the harder inner sole material) can contribute to extra load at the medial (inner) knee joint, which is the side where most people with knee osteoarthritis acquire their degenerative issues. In other words, they probably aren’t going to help existing inner knee pain and may even exacerbate it.

4. Speaking of medially posted shoes, the location of the post continues to make no sense. The midfoot (navicular bone) drops maximally into pronation after the heel has lifted from the ground. How is the harder material that is no longer touching the ground going to stop this movement? It can’t. It won’t. Time to move on from your poor science, shoe industry. Let me take a moment to remind everyone that pronation is not necessarily an evil problem that even needs corrected with a shoe in the first place. But that’s not what sells shoes now is it? And one more thing, just because the inner foot arch appears to collapse while standing doesn’t mean that it does that same thing while running. Nor does it move any significantly extra amount beyond the amount every other foot type moves.

5. There are a couple new things coming along in shoe design. You will see a new trend of placing greater densities of foam across the forefoot region of a running shoe while the heel will have a slightly lower density. We need a stable surface to push off. Also, there are now straight lasted cushioned shoe models. The general shape of the shoe is based on the last and can be curved, semi-curved, or straight. Straight lasts were previously found only in the motion control and stability shoes, which, as I just mentioned, tend to further overload the the medial compartment of the knee. That overload is less likely in a cushioned model that doesn’t have the ridiculously hard inner heel material.

6. Following ACL reconstruction, runners and other athletes are returning to running before they have best function of their quadriceps muscle. These deficits, which are neurological in nature, are lingering for huge amounts of time, easily one year and even two years after surgery. While an athlete may demonstrate full strength of the quadriceps in a muscle test, and even good jumping technique, their ability to rapidly activate the quad muscle remains at a deficit, which leads to running gait changes, abnormal loading of knee joint, and potentially ongoing pain. Typical ACL protocols bring running back at 12 to 16 weeks post-surgery. Is that too early or are we just not appropriately getting the quad back online?

7. Though they are far from perfected and minimally researched, regenerative medicine methods such as platelet rich plasma injections and stem cell therapies are showing promise in helping athletes recover from long-standing tendon and joint injury. They aren’t going to create a brand new tissue for you but are probably a worthy treatment option to try prior to surgeries like joint replacement. Research will tell us more in the next few years.

8. Carbohydrate periodization may be beneficial in some runners to enhance fat oxidation and decrease carbohydrate dependence. With this method, which is actually how I personally train, you perform slower runs without any carbohydrate supplementation and maybe even do some of your shorter easy runs in a fasted state. That works great for early morning runs before breakfast. Your faster or harder runs would still have more carbohydrate intake prior and/or during.

9. There are three running gait factors that consistently show the best relationships to injury in the research: overstriding forward of the body’s center of mass, excessive bounce (vertical oscillation), and excessive compliance (body instability) at mid-stance of the running stride.

10. The gluteus medius muscle actually generates more force to stabilize the pelvis during mid-stance than the gluteus maximus when running on a flat surface at endurance speeds. Which is why it’s so important to get it functioning appropriately in endurance runners. The gluteus medius is notoriously weak and underactive in endurance athletes and that is reinforced by the repetition of moving in a single direction. You need to learn what it feels like to keep the pelvis level and stable while running and if you can’t do that, please come see me. I always prefer to teach people how to use their hip muscles in standing because the Jane Fonda leg raises lying on your side are typically performed incorrectly, and the leg raises don’t transfer into the actual way we use these muscles.

11. Any coach or clinician that thinks they are accurately measuring joint angles on a two dimensional video or image is doing their client or patient a disservice. The angle values they are measuring are likely incorrect, especially if they aren’t using body markers.

group run

7 Takeaways from the Healthy Running WV Conference

Recently, I had the opportunity to attend the Healthy Running WV Conference held in Ranson, WV on November 3rd and 4th. There were about 50 attendees from a variety of backgrounds: running coach, MD, PT, DPM, and general runners. I doubt many of them left without having their preconceptions of training, nutrition, or health challenged. And that’s because the two primary presenters, Drs. Mark Cucuzzella and Phil Maffetone, are well known for challenging the status quo. Although both have a long history in exercise performance, lately they are more interested in public health. And for good reason. I wanted to share just a little taste of the information presented.

1. Attempting to peak for endurance events can be unnecessary, injury causing, and downright unhealthy. Dr. Maffetone suggested that we may really only need 2-4 weeks of speedwork in the final preparation for a competition, and we can perform quite well with no speedwork at all if the aerobic metabolism has been well trained over time. This is quite a bit shorter than the 6-8 weeks recommended by coaches like Arthur Lydiard.

2. Runners unnecessarily run too fast most of the time. I tell runners this all the time (some believe me, some don’t), but let’s revisit it. Exercise does not have to be uncomfortable to result in health and fitness gains. Dr. Maffetone recounted working with multiple elite and Olympic level athletes that had measurably deficient levels of aerobic fitness who continued to make significant performance gains when he took away their anaerobic training and ultimately trained them at slower speeds.

3. Food quality is more important to overall health than a specific caloric intake. For everyone, athlete or not, poor quality carbohydrates do an extremely bad job of creating satiety. So guess what? You eat more of them. I’ve hammered my fair share of Oreos and still didn’t feel satisfied. The carbs lead to a dramatic insulin response that can change in magnitude over time. High-quality proteins and fats do a great job of making us feel full sooner and longer after a meal without the dramatic insulin spike. Unprocessed vegetables can even provide a worthy source of carbohydrate. This is not new information to me or many others, but it’s worth repeating for those that are unaware of how prepackaged food, which emphasizes carbs, have made so many things easier to prepare but far less nutritionally valuable.

4. There are performance and health benefits to emphasizing greater protein and fat macronutrient intake over carbohydrate. Commonly accepted information encourages 60-70% daily carbohydrate intake for endurance athletes. We could get away with 30-40% or even less. Routinely de-emphasizing carbohydrate reliance in training forces the body to rely more on stored fat, which is pretty awesome if you want to run in a marathon or ultramarathon. Then you won’t require as much additional fueling during these longer events, delaying or ultimately preventing the dreaded bonk. Dr. Cucuzzella, who recently maintains a low carb intake, but has run for decades, has the physiology lab data to prove his increase of peak fat burning efficiency from 1.18 grams/minute to 1.9 grams/minute in just a year. These same kinds of beneficial metabolic changes were suspected many years ago by Dr. Tim Noakes in his famous text “Lore of Running.” I’m anxious to see where the research is on this in another 5-10 years.

5. Sprinting hard at the end of a long event, like a marathon, is more likely to trigger a cardiac event (heart attack) in someone predisposed to having such a cardiac issue. Don’t know if you are at risk? Talk to your physician about finding out your coronary artery calcium score.

6. A simple glucometer can be an excellent, affordable self-monitoring tool for detecting carbohydrate intolerance and the early onset of insulin resistance that leads to type 2 diabetes. Cucuzzella and Maffetone suggest that people don’t just wake up one day with type 2 diabetes. The changes occur over time because of poor nutritional quality. By the way, a few years back we called type 2 diabetes “adult onset” to differentiate it from the type 1 diabetes that people can have at birth. Unfortunately, that has become a misnomer because young children have begun to acquire type 2 diabetes as the American diet has emphasized low-quality processed carbohydrates since the 1980s.

7. Insulin resistance is a common factor to a variety of diseases. There is growing evidence that issues such as cardiovascular disease follow long term metabolic changes associated with a high carbohydrate diet. Older research focused on cholesterol but the tide is shifting.

If you are interested in attending a future Healthy Running Conference, check out www.healthyrunning.org for more information. 

You can read more about each of this particular conference's primary presenters at the following sites:

• Mark: https://www.drmarksdesk.com
• Phil: https://www.philmaffetone.com

20 Cold weather running tips and tricks

The warm weather of spring will be here before you know it...or not. I don’t love the cold, but I’ve learned to appreciate the unique challenges of snow, wind, rain, ice, and that abominable snowman from Rudolph the Red Nosed Reindeer (hot cocoa!). Here are some thoughts on surviving this less pleasant time of year.

First off, it’s about mindset. If you keep telling yourself it’s going to suck to be in the cold, no surprise, it will suck. Have the attitude that you are adaptable and that the conditions are fun or unique in order to shift your perspective. If you have the guts to commit to consistent exercise, you have the guts to tolerate the cold for a bit.

If you struggle with the initial shock of cold when heading outside, try getting your core temperature up indoors first with 2-10 minutes of indoor biking, treadmill running, push-ups, air squats, running in place, butt kicks, or high knees.

It’s never as cold as you think it’s going to be - as long as you are consistently moving. Pretend you are dressing for a temperature that is 10-15 degrees warmer than the actual thermometer reading.

However, if you would happen to become injured by the aforementioned abominable snowman and had to stop moving, how long do you think you would stay warm? Probably not as long as you think. This is where it is smart to carry an emergency item or two, especially if you plan to be far from civilization, home, and other people. We’ve all heard about dressing in layers, but I like to dress with the intention to pack away the outer layer. A tightly packable, waterproof jacket is a great addition, especially on those damp 40-degree days. It’s there if you need it but not a hindrance if you never use it. In a pinch, a simple kitchen trash bag with a hole ripped in the bottom for your head can be used as a rain, cold, and wind barrier. Cheap, simple, and effective, but don’t expect it to be breathable. Space blankets are a great compact option. On long, adventurous trail runs, my ultimate choice would be a bivy sack, especially for going out into a more risky environment that would be less accessible in an emergency. Of course, this is overkill for running roads in a city. Consider that even if you had to stop moving for 60 minutes while waiting for help, a bivy sack or space blanket would be a welcome and potentially lifesaving item that weighs very little. Though it’s a little larger and heavier, the bivy is more ideal than a space blanket because you can actually get inside of it.

It’s not just the temperature that you have to consider. Wind and water will make the temperature feel at least an extra 5-10 degrees cooler. But if the sun is out, it can easily feel an extra 5-10 degrees warmer. The hardest conditions to dress for are when it is raining at 35 to 48 degrees. That’s perfect hypothermia weather. There’s a definite need for a breathable, waterproof jacket in that instance if you plan to stay out for 30 minutes or more.

Wool is an awesome material to layer, especially for socks. Many people love wool for the heat retention it maintains while wet, which can easily happen if you sink a foot in a puddle of slush. The Smartwool socks I’ve had have been amazingly durable and are my favorites so far. Anything but cotton, please!

In full-on cold muck, around 34-48 degrees, consider a waterproof/windproof sock, like this one from Sugoi. I’ve used these intermittently over the past five years. They definitely weren’t manufactured as a hiking and running product as they do slip around in the shoes a little. And they have external seams that might annoy some people. But they are flexible and my feet would only get a bit damp from sweat. (Keep in mind the dampness from sweat can cause chilling though.) They are useless if you dunk your foot deeper than ankle depth.

Check out some running gaiters if the snow is getting deep or if it’s slushy and muddy. Even a thin gaiter can keep debris from accumulating in your shoe. And if the weather is really poor, you might have a hard time untying the shoe to get that debris out in the middle of a run. Prevent it in the first place.

A single, thin layer can go a long way toward improving comfort. You don’t always have to use heavy, thick layers to get the job done. And the nice thing about a single layer is that it is still very breathable. This is why I hang onto a 15 year-old, super worn pair of tights that my wife would like to throw away. They are perfect for the 30-40 degree days. I’ve found that some areas are more sensitive to cold than others. My shins don’t need much coverage so one layer there is often plenty. My hands are super sensitive though and I’ll need to layer up a liner gloves and possibly mittens.

Carry a Buff or other similar multi-purpose garment. Options are nice. This can cover and protect your neck, face, ears, and head in one fell swoop, in any combination.

Cover your hands in a thick moisturizing and protective barrier like Bag Balm, beeswax, Aquaphor, or petroleum jelly. I have pretty poor blood flow in my hands and this, at the very least, buys me some additional time before my hands start to ache and lose blood supply. And it seems like the act of massaging these products onto the skin is helpful to increase blood flow even before going outside. If it was super cold out, I would put this same protective barrier on my face as well. I’ll carry a little tube of this stuff on a long run for reapplication and chaffing problems.

Sheet metal screws tightened into the bottom of your shoes make for cheap, light, and effective studs on slick surfaces. Just three to five of them can go a long way towards enhancing your stability if they are thoughtfully placed.

Cross train on snowshoes, cross country skis, or just go for a hike. Nobody feels their most fit when exercising in the cold. The clothing is restrictive, breathing is difficult, everything feels stiff, and the footing is horrible. These other activities are more than acceptable to provide an aerobic workout. As a bonus, they break up monotony and train your body in ways you might not normally. Were you going to PR today anyway?

Keep in mind any food you take will become more firm, perhaps more… chewy as it gets colder. Which means you will probably have a desire to drink more while eating. If you tuck the food close to your body prior to eating, it won’t be so darn hard to chew.

Similarly, if you use a hydration pack, tuck the tubing into your jacket so that it doesn’t freeze up. Depending on the size of pack, you may be able to place it under an outer layer of clothing. Drink small amounts from the pack often to keep the water moving. The real hard-assess of winter running mix a little vodka or whiskey into their water to help prevent freezing. It doesn’t take much to lower the freezing point.

Warm liquids are amazing in the middle of a long, cold bout. My dad always brought a small thermos of hot cocoa for me when I was a little kid hunting in the cold. I promise you, in the middle of a cold long run there is nothing better than hot tea or chicken broth. I haven’t found a thermos that works better than a Zojirushi. 

Carry back up charcoal hand warmers. Just don’t expect them to heat up quickly. For that, there are more instant hand warmers. Or make your own out of these inexpensive flexible heating pads.

Make loops that include public buildings where you could warm up for a few minutes if necessary.

Don’t tie your car or house key to your shoe in wintery conditions. Your hands might be too cold to untie the knot or the knot might just be completely frozen. There is no worse feeling than standing outside a locked warm car or house when you are super cold.

Find someone to hold you accountable to getting your run done. A consistent training partner can be a great motivator who won’t let you slack off and make excuses. Training groups can provide that same motivation. Plus it’s safer for everybody involved.

Bonus: Make a game out of it. A Hash House Harrier run is the best example of this game atmosphere. You will be so busy wondering where you are on the random course and where you are supposed to be going that you just might forget about the cold.

Bonus: Cellphone batteries die very quickly when exposed to the cold. Keep your phone closer to your body to keep it warm. If it does die, getting it warm next to your body may breathe some life back into it again.

Let me know if you have questions: derek@mountainridgept.com

Patapsco Valley 50K Race Report

As the weather cools off each year, my desire for a longer trail event grows. It’s a remnant of running cross country every fall. The Patapsco Valley 50K provided a perfect opportunity to race on new trails and enjoy some nice fall scenery. Although I favor more technical trails and longer climbs, the timing and location was hard to beat.

We arrived to the venue at Patapsco Valley State Park near Baltimore, MD a little prematurely, at 5:30 a.m. Although the prime parking spot did make the walk from the finish line to the car afterward much shorter. Packets included a sweet long-sleeve Brooks shirt and a toboggan. For those of unfamiliar with that term, it’s a winter beanie hat.

The wind was picking up as daylight approached. Although it was around 50 degrees, the wind made it so much more chilly. The start was at 7:00, slightly before sunrise, so we all began with headlamps. It was a novel touch but perhaps a little silly because the lights were no longer necessary within 25 minutes of the start.

I could tell from the elevation profiles and old race reports that the course began with a climb. What I didn't expect is how steep it was, which skyrocketed my effort way too early. My plan was to stay near the front, but I couldn't believe how hard these guys were going in the first mile. Especially for this climb being loose rock that was also covered in leaves.

The trails at the top of the climb were smooth but so leaf covered that I lost the path a couple times since the daylight hadn’t shown up yet. The thick cloud cover wasn’t helping.

As the first three to four miles passed, I tried, half-heartedly, to back off a bit, but it still wasn't slow enough to recover and it wasn’t fast enough to stay higher in the rankings. That intensity might have been fine for a mile or two, but the guys showing up this year were clearly maintaining a pace faster than the average in the prior two years. It was around this time that I somehow stopped my GPS recording for a couple minutes. Data lost to the wind. 

After working my way into a small group with two others, we stayed within view of each other for at least 10 miles. At one point we crossed a small field as the rain spit and a huge gust of wind blew a large, 4-inch diameter, 8-foot long tree branch down to the ground just five yards to my left. Up until that point I had been distracted from the danger of the winds. Adrenaline spike.

Nonetheless, I pushed on, because at that point we are in the middle of the woods and there are no other options. It was strange how much the trail conditions would fluctuate. You could go one or two miles on twisty, super smooth singletrack and then be suddenly bombarded with nasty rock-strewn river edges and crossings for a half-mile. Despite a little recent rain, the trails were largely dry.

My favorite section of the course was along what I assume was the Patapsco River. Perhaps it was the Ilchester Trail, but I am not certain. It was bizarre. It was as if someone had taken a paved, single lane road along the river, flooded it, rolled in a bunch of boulders, threw in a couple mud slides, and cut several trees down across it. The edge dropped straight off into the river yet there was pavement here at one time. Kind of post-apocalyptic.

I felt like I was flying through the technical sections after mile 10 until I rolled my left ankle a bit. Not quite as bad as in my recent trail 10k but I definitely had to hold back for a couple minutes.

And to make things worse, I began to have occasional calf cramps around mile 13. The crazy speed up until this point was way too fast for me and started to cause negative effects even sooner than I would have hoped. I particularly use the balls of my feet on the technical areas so my calves were getting hammered. With two guys behind me, my first thought was “don't change your technique or they will know something is wrong.”

The cramps would improve for 20-30 minutes right after a little pickle juice that I had packed but I eventually ran out by mile 22. No surprise the two guys passed me around that time, the three-hour mark. That and I was prematurely getting a bit of bonky tunnel vision. Again, the result of starting too hard in the first 10 miles.

It also didn’t help that I inadvertently blew right past the mile 20 aid station, not realizing it was grouped together with the drop bags at the start/finish area.

After climbing the initial climb yet again, all I could think about was cola. I knew it could save me. I wanted nothing more than cola for about 5-6 miles. We had run this same section in the dark and early daylight so it seemed familiar, but I actually think that made it worse. The problem was that I was no longer running 7:45-8:30 pace, instead it was a 10:00-11:00 pace. This makes the miles go by much slower. Math can shove it.

At a lonely water cooler in the woods around mile 24, I tried to take a few swigs, only to squirt water up my nose and cause a cycle of coughing that ultimately cramped my pelvic floor muscles. Who cramps their pelvic floor muscles? Apparently I have not done enough kegels lately. I have never experienced this before, nor would I like to experience it again. So if you are going to drink fluid in a long run, don’t get it up your nose.

The aid station around mile 27 came about 45 minutes later than I had hoped, but three cups of cola and two ginger ales helped tremendously to resolve the bonk once I arrived. I don’t recommend running in a state of bonk for 5 miles. I had been trying to eat energy chews but the temperatures were so cold that they were like gnawing on cold taffy and I had run out of water. Also, that is not recommended, but on the bright side my stomach felt great because I was hydrated.

I ended up walking more than I would have ever planned. Of course my body had to throw out another weird cramp of my outer lower leg muscles before we could call it a day. This time it was my extensor hallucis longus and peroneus longus muscles. So my right foot wanted to twist outward and my big toe wouldn’t come down. Can I just take a nap or something? Much to my disappointment, the leg muscles were not trustworthy enough to bomb the final miles of the course despite the overall elevation loss.

All of this foolishness was obviously happening because of the early hard pushing. I was prepared to run in the 4:20 range but who would have ever guessed that the winning time (3:57) this year was going to be over 32 minutes faster than last year! There is no doubt that by chasing for so long I buried myself further than I have in a long time. Therein lies the problem of trying to keep up with these young guns that train an extra 30-40 miles more per week than I do!

On a good day (running smarter) this course has the potential to be a very fast 50K. The only silver-lining was that I did have a 50K PR by 5 minutes. I muffled my whimpering at the finish line with a nice bowl of warm chili and a Poor Righteous IPA from local brewery Jailbreak. Happy I didn’t knock out yet another tooth like I heard one of the other runners did.

Overall, I would definitely recommend the race to any mid-Atlantic region trail and ultra runner. Part of Blair Witch Project was filmed at the park, which makes it automatically creepy, yet perfect for your Halloween time. Perhaps I will check it out again in another year or two to go after a faster 50K PR.

How to keep muscle cramps from ruining your workouts and competitions

A CASE STUDY

The scene: It’s a hot, 75 degree Saturday in June, humidity 85%, birds singing. Maybe the most hot and humid day so far this month.

The athlete: Is 6 miles into what is expected to be a 15-mile long run. Last night they enjoyed a couple beers with dinner after completing a 4-mile easy run. Work was pretty hectic, so they drank coffee all day to keep focused. They didn’t consume much water or other fluids.

The cramp: Comes quickly into one calf during the long run, rendering the leg nearly useless and painful, despite the individual believing they weren’t putting out much effort. This has happened before. The runner stretches the muscle for 10 seconds, decreasing the pain and begins to run again. Four minutes later it happens again so they repeat the process until 8 miles, when they finally quit the run out of frustration.

Talk about a wasted training day. Did this runner do something wrong in their preparation for this run? Yes. No. Maybe. Perhaps I’m trying to trick you a little because the truth is we don’t have enough information about the entire situation. What is their maintenance routine like outside of running? Do they strength train? Have they eaten during the initial part of the run?

SO MUCH TO THINK ABOUT

You should see that there are a variety of factors to consider regarding the onset of muscle cramps. Here are some you’ve heard of and maybe some you haven’t:

• Prior training experience regarding intensities and durations

• History of muscle cramping

• Current hydration status, particularly related to level of sweat loss

• Electrolyte levels of magnesium, calcium, sodium, and potassium in the blood and muscles

• Muscle tone, which is controlled by the nervous system and reinforced by day-to-day use patterns (and also changed with routine soft-tissue maintenance)

• Central nervous system status, as in higher anxiety and stress levels

• Peripheral nervous system status

• Stimulant intake, such as caffeine, which impacts nervous system function

• Recent physical activity and fatigue levels

• Environmental conditions regarding temperature, humidity, and terrain

• Muscular demands at that moment, as in the force of muscle contraction required

• Direct muscle trauma

There is likely an interplay of these factors and you therefore need to consider them all in muscle cramp prevention. How are you going to do that? Partly with good regular maintenance and training habits. Partly with a little trial-and-error testing.

Muscle cramps have been a thorn in the side of many athletes for decades, and what fixes them in one athlete may not work for another. Some athletes just seem more prone to cramping while others have minimal issues. I would be surprised if the crowd that is prone to cramping didn’t have at least one or two of these areas to address though.

Available research indicates three main theories exist in the cause of exercise-induced muscle cramping:

1. “Skeletal muscle overload and fatigue from overuse or insufficient conditioning can prompt muscle cramping locally in the overworked muscle fibers.” (Bergeron, 2008)

2. “Extensive sweating and a consequent significant whole-body exchangeable sodium deficit can lead to more widespread muscle cramping, even when there is minimal or no muscle overload and fatigue.” (Bergeron, 2008)

3. “Either neural activity in the spinal cord or in the peripheral could be the cause of the cramps.” (Nakagawa, 2013)

WHAT WE'VE GOT HERE IS A FAILURE TO COMMUNICATE

Lately, the neurological cause has been winning research arguments, so it would make sense to try the solutions that have the most bearing in that area. I frequently tell athletes that the muscles only know what they are told by the nervous system. Without a motor nerve supply, muscles are useless masses of floppy meat. Which means that if the communication between the motor nerves and the muscles goes wrong, you will have a failure of the muscle’s normal function.

This nerve-muscle communication is as much about sending signals to a muscle as much as it is about stopping those signals. It is possible that, with repetitive use and fatigue, the signal from the motor nerve to the muscle isn’t stopped as efficiently as it should be and then the muscle insists on maintaining a contracted state, otherwise known as a cramp.

If cramps occur intermittently for you during exercise, the most likely scenario is one or a combination of these factors:

1. Poor self-maintenance habits of the muscles

2. Poor nutritional choices

3. Subpar preparation of the muscles and nervous system for the task at hand

4. Neglecting to account for environmental demands

YOUR HOMEWORK

Prevent the cramp with proper preparation and regular maintenance:

• First and foremost, if you always cramp in the same muscles, I would not be surprised to find that the resting tension in that muscle was elevated compared to muscles where you don’t ever cramp. Cramping muscles are likely to be more tender to firm pressure. Plus, you may be able to tell that those muscles are physically more taut than your other muscles. Your focus needs to be on getting that resting activity to decrease at all times. For that, you are going to routinely and specifically massage that muscle 1-2 minutes every other day with a massage stick, lacrosse ball, or your hands. It should be uncomfortable to work on the irritable tissue. And it’s going to take a month or two of consistent work to keep that muscle more relaxed. If you want it quicker, then my suggestion is to have dry needling to “reset” the nerve-muscle communication.

• Strength train the muscles that routinely cramp to increase their fatigue resistance while simultaneously strengthening any other muscles that can assist with the same motion. For example, the calf muscles are effective pushing muscles so be sure to address any strength loss in the other rearward pushing muscles like the gluteus maximus and hamstrings.

• Consider the psychological aspect. Cramping has a lot to do with nervous system function. You aren’t going to make the situation any better by increasing anxiety and stress levels. Athletes that struggle with this need to practice techniques that can lower their stress through deep breathing, meditation, yoga, or sports psychology. It’s no surprise that you could train for weeks without cramps but on race day the anxiety increases at your main event, contributing to the mystery cramps.

• Expose yourself consistently to any triggering environmental stimuli, like higher heat and increased humidity.

• If you are expecting to be in a competition that requires minimal or significant terrain changes then try to duplicate those changes or lack of changes in your training.

• Progress gradually and consistently in durations and intensities of prolonged exercise.

• It’s easy to suggest staying hydrated. Typical advice. Just keep your urine on the clearer side consistently. Not just the day of or day before longer exercise bouts. Don’t overhydrate because that can carry health consequences as well.

• Consistently eat a well-rounded diet. If you start restricting specific foods that carry important nutrients, then you need to ensure you are obtaining a suitable replacement. For instance, by restricting meat you may cut out a large magnesium source. Do your research on what micronutrient requirements frequent exercisers have and adjust accordingly.

Prevent the cramp during activity:

• Vary the range of motion and demand on the muscle as much as you can before you have any sense of cramping. For instance, to change the motion and demands of the calf while running switch from your usual forefoot strike to a heel strike for 20-30 seconds every 1-2 miles. Research indicates that the muscle fibers must achieve a shortened state in order to cramp (Bertolasi, 1993). For instance, if you are constantly running on your forefoot, the calf muscle fibers don’t get a chance to elongate, keeping them in a shorter, and riskier, position at all times.

• Eat something containing carbohydrates during the exercise. It stands to reason that if muscle fatigue is delayed by eating to supplement energy stores, then you may not cramp as soon or maybe even at all if a few calories are always coming in (Jung, 2005). Nerves must have a supply of energy to function, too. They like glucose. It never ceases to amaze me how many people think they can go harder and faster in an event than they do in training with fewer or worse yet, no calories. Multiple systems change function without normal blood sugar levels.

• Stick to a reasonable plan. Just because you feel good physically and mentally from resting a couple extra days prior to competition doesn’t mean you should suddenly decide to pursue higher intensities than you have trained for. Even if you don’t cramp, you will probably bonk in a long event, or blow up in a short event.

If the cramp happens:

• Attempt to stretch the muscle. Do not stretch it rapidly and do not stretch it as hard as you can. A gentle but prolonged stretch is the best option at this point. Hold the stretch for at least 30 seconds. Now is not the time to bounce to the end point of the stretch because you have special structures in place to cause muscle contraction when that bounce hits its end point.

• Massage the muscle with firm pressure. Even a single, prolonged pressure of 30-60 seconds to the muscle may break its cycle of cramping.   

• Eat. Didn’t I just go over this?

• Try my personal favorite solution, dill pickle juice, as the muscle threatens to cramp. It’s not the salt that is effective but the noxious stimuli from the vinegar. A new sports drink named Hot Shot relies on a similar mechanism but it has more of a spicy flavor. Either way, the potent oral stimulation effects nervous system input.

• Try a couple electrolyte tablets or maybe a sports drink containing electrolytes. This isn’t supported by research, but a placebo effect is still a possible effect. But will you still have the placebo effect now that I’ve told you it shouldn’t work? Please let me know how that goes. I personally stopped using them.

• Overall, you must adjust according to the variety of factors at hand. If you know you are under-hydrated, aren’t eating enough, haven’t maintained your frequently cramping muscles, undertrained, stressed out, and it’s really humid outside, then your best option is to slow down a little, learn a lesson, and work on the flaws before your next event.

There are instances where cramping with great frequency can be a sign of diseases and serious neurological issues so do not hesitate to contact a medical professional if muscle cramping is occurring outside the realm of exercise. Even a history of sciatic nerve problems can predispose a person to cramping during exercise.

Take care of the muscles and the nervous system with planning and preparation and they will take care of you.

Please let me know if you have any questions at derek@mountainridgept.com. And definitely let me know if you find some of these ideas helpful in muscle cramp management by liking the Mountain Ridge Physical Therapy Facebook page. Or buy me some dill pickles. 

For those who would like to geek out on some related material:

1. http://journals.lww.com/acsm-csmr/Abstract/2008/07001/Muscle_Cramps_during_Exercise_Is_It_Fatigue_or.9.aspx

2. http://link.springer.com/article/10.2165/00007256-199621060-00003#page-1

3. https://www.researchgate.net/publication/299960193_Neural_Mechanisms_of_Muscle_Cramp

4. http://home.trainingpeaks.com/blog/article/controlling-neuromuscular-performance-to-prevent-muscle-cramps?utm_source=tpr&utm_medium=email&utm_campaign=07-16-anl

Sunday Q and A: Marathon Leg Pain

Question of the week:

Last year during marathon training, when I ran more than 15 miles, my legs would begin to have a lot of pain. Is there anything I can try to help lessen my leg pain when running high miles?

As far as the leg pain goes, I’m going to answer this question specifically about training and the muscles themselves. Hopefully it’s not the joints causing pain and I especially hope it’s not generated from nerve structures. Without seeing an individual’s running technique or knowing anything about their training history, some things I expect to help would include:

1. Strength training the quads, hamstrings, calves, and gluteals. A period of higher reps with light to moderate resistance and a period of lower reps against a high resistance are both useful. Performing higher reps against a moderate resistance to the point of failure can be very helpful in improving the resilience of a beginner or intermediate marathoner’s muscles. Hammer the quads with lunges, the hamstrings with dead lifts, and the calves with bent and straight knee calf raises. Performing enough reps to cause failure can promote great changes.

2. Self-massage the quads, hamstrings, calves and gluteals. A supple muscle is better at absorbing loads. This also helps relax the more irritable areas in the muscle that some people call “knots” or trigger points. In my personal experience, it prevents cramping that is associated with fatigue. Rolling with a foam roller, tennis ball, lacrosse ball and a massage stick are all common and useful depending on the location.

3. Address any running technique issues. Over-striding, for instance, can kill your quads early. It is also common for newer runners to lack the understanding of how their bodies should absorb impact. A few (4-8) strides of 25-50 yards in your bare feet one to two times weekly can help most runners gain a little insight into proper force absorption. Grass and turf are nice for this. You shouldn’t sound like a herd of cattle when your foot hits the ground. Speedwork can improve running technique as well, so….

4. Increase your speedwork. For a beginning marathoner, one speed workout per week is sufficient. Part of the leg discomfort may simply be from the byproducts of rapid glycogen breakdown in the muscle. The best way to become used to cleaning up those byproducts is to train at a higher speed on a frequent basis. That means you should purposely make the muscles hurt in short, hard runs so they find the pace of a longer run easier to sustain.

5. Continue to emphasize longer runs every one to two weeks. If you have a three-month training block before the marathon, that’s at least six critical long runs, maybe even up to twelve. There is a huge and important adaptation time that must be considered when you are planning to run longer distances.

6. Don’t go out too hard. Better to start slow and prevent your body from quickly depleting the stored glycogen sugars. If you feel well at mile 12 and you are going 15 miles, then by all means pick it up a bit at that point. Make note of what you felt like throughout and adjust the pace accordingly in the next run. Long runs are all about aerobic base training, not speed or pace records, so there’s no shame in going super slow and even walking frequently to keep the stress lower.

7. Eat during the long runs. If you only have a few years of running experience, it is unlikely that you are burning your energy stores at the most efficient rate no matter your pace. So your best option is to eat during the longer training runs to insure a constant supply of energy. Even consuming 50 calories an hour can help tremendously, though you should experiment with taking in more, as long as your stomach tolerates it. Most people can consume at least 100 calories in an hour without distress if they are moving at a pace that is hard but sustainable for at least 90 minutes. Some do better with liquid calories, some with solids. Some people can only eat unprocessed foods while others can eat sugary gels until the cows come home. Experiment in training, not on race day. And start eating early in the run, by 30 minutes.

Let me know if you have any training and injury questions at derek@mountainridgept.com. 

Are you bonking?

Anyone who exercises for an extended period is at the mercy of their stored energy and blood sugar levels. Glucose is the basic sugar circulating in the bloodstream and it is well controlled within a specific range for a healthy person. Stored sugar, glycogen, from your liver and muscles, can be used to keep the blood glucose regulated.

If your blood sugar decreases to lower levels during prolonged activity and can’t be stabilized, your brain will prioritize itself over anything else because glucose is its primary fuel source. This means working muscles are not exactly high on the list. You are in the process of bonking, otherwise known as non-diabetic hypoglycemia or exercise-induced hypoglycemia.

Risk of bonking increases with the following:

1. Longer duration of exercise
2. Higher exercise intensity
3. Exercise in a hot environment
4. Insufficient calorie intake during the day of exercise
5. Chronically insufficient calorie intake over a period of days
6. Insufficient recovery time from a prior bout of exercise or multiple days of exercise as it takes nearly a day to restore glycogen after it has been used (in ideal conditions)
7. Another recent episode of bonking
8. Dehydration
9. Limited prior exposure to depleting exercise
10. Athlete inexperience

Athletes are not always aware of the signs and symptoms of bonking until they become more dramatic. Some symptoms of the blood sugar drop are mental and others are physical. The initial cues can be subtle but the symptoms can progress to more severe levels rapidly. Many marathoners know this as the feeling of “hitting a wall” around mile 18 to 20.

When bonking, pace per mile might initially change by something small, like 15 or 20 seconds. But if the effort continues and no calories are consumed, you could easily slow by 1-5 minutes per mile or even more.

I’ve known many hard-working, well-trained marathoners that train months for an “A” race, doing tons of distance and maybe even trained up to 23-26 miles. They feel strong but depleted at the end of those long training runs but they train more slowly than they race. So by running faster in the actual race they burn through their energy stores sooner and completely crash despite decreasing mileage for several days in advance of the marathon. That’s tons of training wasted because they refused to learn to eat a little something in the marathon.

Bonking happens around the same point for most people because we all store similar amounts of glycogen that are used up at similar rates. It’s possible that years of training could allow someone to burn a greater percentage of fat for energy, but harder efforts always require higher glycogen dependence. And having run for just a couple years isn’t long enough to perfect a fat burning metabolism.

The signs and symptoms of declining blood sugar, in a general classification order of increasing severity:

Your job is to detect symptoms as soon as possible in order to keep your state from declining further. Ignoring the symptoms and hoping for the best is never going to end well. If you have signs and symptoms consistent with the green items, there’s a good chance you can pull things back together if you take appropriate action, though it won’t be a day of personal best performances.

A few experienced and lucky athletes might be able to come back quickly from the yellow zone but nobody is bouncing back from the red zone. Only the more stubborn people will even push themselves far into the yellow zone. It’s a super dangerous, slippery slope. Don’t do it. You can’t win against physiology.

Many people don’t have the motivation to put themselves deep into the pain cave, so they just automatically slow down in order to feel better when they feel uncomfortable and have persistent negative thoughts. Kudos to you for not being a ridiculously stubborn fool like some of us!

Simply slowing down may be sufficient to finish out the workout or competition. If you don’t want to slow down, then you need to eat something containing carbohydrates as soon as possible. Ideally this would be something with simple and complex carbohydrates. There are receptors in your mouth that detect sugars and just the act of eating can immediately reduce the brain’s stronghold on protecting you… from you.

But there’s a good chance that you need to slow down AND eat something, depending on how long you are planning to exercise. If you are bonking after 90 minutes and planned to be active for 3-4 hours then it’s going to be unreasonable to sustain the same effort without eating many more calories.  

Three truths about bonking:

1. You have to learn to eat during prolonged activity, even though you often won’t feel like eating, or the bonk will occur.
2. If you don’t eat and your intention is to maintain both a high intensity and a prolonged duration of greater than 2 hours, the bonk will occur.
3. Bonking is completely preventable.

Thanks for reading! Please let me know if you have any questions at derek@mountainridgept.com.

Sunday Q and A

I recently had the pleasure of meeting with a few parents and students on the Mountaineer Middle School cross country team as they were getting ready to start their season. I wanted to touch upon a couple questions that were asked because I imagine multiple people, of any age, can gain value from the answers.

Question #1

One runner asked if there was anything he can do to change the fact that his legs become tired far before his breathing or heart feel fatigued during a race. This typically occurs for him halfway through, but then about 75% of the way in, he is able to overcome the leg fatigue to finish strong. This was especially problematic for him on flat courses.

First off, I expect this to occur to some extent, especially in a younger, less-trained, or less-experienced group of runners. It’s common to feel good and be excited, so you barrel off the line. It happens to everyone from ultra-marathoners all the way down to 400-meter runners. Let’s say we apply an old coaching philosophy: run the first one-third with your head (smarts), the second one-third with the legs (fitness), and the final one-third with your heart (desire).

Sounds like this young man has the final portion down but there’s a good chance his first one-third is faster than ideal. Young runners are notorious for going out too hard, which makes the later stages of the race more uncomfortable. One problem is that in a cross country race these kids almost always have to do this because the area available to run shrinks down to a narrow path where real estate is at a premium.

So let’s just leave the “going out too hard” concept alone for now, because it’s not a road race where you can easily pass people. This student has to go a little harder than ideal in order to be competitive in a 3K race. In order to get through that middle one-third, there will be discomfort, but it’s the point where the person with the most fitness will excel because he can recover on the move from the slightly too quick first third. Plus, there is research at the 5K distance to show that starting out 3-6% faster than average total race pace results in faster overall times. (http://www.ncbi.nlm.nih.gov/pubmed/17149992)

I suggested that this young man focus on his cadence just prior to the point where he feels the leg fatigue. As we fatigue, our cadence tends to slow down. There’s a good chance he ran the first one-quarter to one-half mile with a quicker cadence but then settles into a longer, more loping stride. At the same time, the pace drops a bit. To take some of the stress off of the painful quadriceps and calf muscles you can decrease your stride length and increase your turnover.

One good thing is that cross country around this region generally means terrain changes. Hill climbs are the perfect time to increase cadence. This is easily achieved by pumping the arms more quickly. The legs and arms will always be in sync. If you think about increasing speed of arm movement, the legs must follow. The steeper the incline, the shorter your stride should become. A single leg turnover of 96 per minute going up super steep hills wouldn’t be crazy. A gradual incline might demand something in the range of 88-94 foot strikes per minute.

Even on a flat course you can make the conscious choice to fluctuate your cadence. It’s a nice distraction, if nothing else. Hopefully it is done in a preventative manner prior to the leg muscles feeling highly fatigued, but better late than never. A flat cadence could be more like 84-90 per minute. On downhills it could easily drop into the upper 70s.

One key to all of this is to experiment and train with the cadence fluctuations. It’s not going to come naturally in a race if you’ve never done it before. Instead, it’s just another burden to add stress and you might just forget to do it. Plus you are more likely to waste energy if it’s extremely new. Your nervous system has to practice the quicker turnover in order to make it efficient.

The more recent GPS training watches, like the Garmin Forerunner series, have a cadence measure. It’s worth paying attention to this number while running. And if you upload the data onto the Garmin Connect website or other training sites, you can see where the cadence tended to slow down or speed up during training or racing. It wouldn’t be surprising to see the turnover slow just as the point of heavy leg muscle fatigue approached.

Here’s a fun little experiment. Go find your favorite hill for repeats. Something at least 100 yards long and hopefully more gradual. Run it hard once with your normal turnover rate. Run it again while trying to maintain the same pace but while really trying to stretch your stride out extra long with a slow turnover. Do it a third time while focusing on a super quick turnover, again maintaining the same pace. Now there’s going to be some fatigue by that point, no doubt, but can you feel the difference in the demands that it places on your body?

Question #2

One parent wanted to know if their child needed to drink a sports drink before their cross country meets. Not that I have a perfect diet, but I’m not a big fan of mainstream sports drinks in the first place because they are often loaded with tons of processed simple sugars.

In shorter races like the 3K or 5K, the runner is primarily relying on stored energy, glycogen, within the muscle fibers. For a short event there should be plenty of that stored glycogen available unless you haven’t eaten for several hours or maybe you exercised really hard in the 1-2 days prior.

Some sports drink sugars, like fructose, are known to cause stomach upset if consumed before, during, or after exercise. That’s not very conducive to performance (or a pleasant child, for that matter.)

A snack or lunch two to three hours prior to the event should be sufficient for topping off the calories needed to get through these shorter events. Drinking water after that point is plenty sufficient.

I’ve seen parents “grasping at straws” when their child has succeeded in the main season and is headed to a big event, like a state meet. Instead of sticking to the same nutritional plan that the runner had used all season, the well-meaning parent has their child drink some new mysterious sports drink 15 minutes before their race. Maybe the runner tolerates it. Maybe they don’t and fail miserably. That’s the equivalent of playing with fire in my mind. Go with what has worked in the past.

The one instance where I can think a sports drink might be appropriate is if the runner had missed their lunch or breakfast for some reason. And that should not be happening. Plus, the runner has hopefully tried the same sports drink on an earlier occasion. It might be smarter to have the individual carry an emergency “real food” snack. That’s a good idea anyway because you should avoid becoming hungry on race day.

Do you have any questions about training, racing, recovery, or injuries? If you do, shoot me an email at derek@mountainridgept.com and you might get to see the answer in a future blog post.

Kanawha Trace 25K Race Report

Earlier this week, I was struggling to decide what race to do this weekend. There were several quality trail running events in the area, including: Lost Turkey Trail 50K and 50 Miler, Appalachian Front Trail 50K, Run with the Deer Flies 25K, and this race, the Kanawha Trace 50K, 25K, and 10K.

My wife and I argued throughout the week on how to appropriately pronounce “Kanawha” because she claims the “wh” is silent and I refuse to admit this is possible. What do you think? If you think the “wh” is silent then I don’t want to hear from you. Otherwise, please get in touch.

On Friday, I finally committed to entering the 25K at the Kanawha Trace. I knew I wouldn’t be able to push a 50K and be happy with the result. In the end, I’m glad that I decided to do the 25K. For a while now I’ve wanted to get into one of the southern WV trail races that WV Mountain Trail Runners has a hand in, so I was expecting a well-run event.

I wasn’t interested in staying overnight nearby so the 9:30 start time of the 25K allowed me to drive in on the same day. The 50K group had already started at 7:30. Packet pick-up was at the Arrowhead Boy Scout Camp. Even having signed up late the night before, the crew had my packet prepped. They’re on the ball. The race shirts were great quality and a nice shade of royal blue. No weird colors here!

The logistics were a little confusing, since I’m not from the area, in that there was a shuttle bus ride to the official start line about 4 miles down the road from the camp, so you still need to account for that extra time required. And mentally prepare yourself for a slightly muggy school bus ride. Being late July in these Appalachian hills, thunderstorms and humidity rule.

The start is in a residential area of Barboursville, WV and requires just over one mile of paved road running before getting to the real trails. When I finally arrived at those trails, I received a big punch in the face. The course immediately begins climbing over 300 feet in about three-fourths of a mile. The hillsides are steep in that region and require frequent switchbacks to the keep the task even somewhat reasonable.

Having started with the 10K runners, I had to make it a point to run my own controlled race and not get caught up in competing with the high school boys doing less than half of my distance. Even still, I watched several of them fade back to me in the first three miles because there is just so much climbing early on. And they probably aren’t accustomed to racing distances beyond their 5K cross country meets. I remember those days. The days before I was old and #dadstrong.

It was much easier to keep track of the people in each event because of the varied race number colors. The 10K folks had yellow while the 25K’ers had orange. The 50K racers had white numbers but the only time I encountered them they were heading the opposite direction from me. These colors coincided with the flagging and signs used along the course, minimizing possible confusion. Smart.

Apparently it had rained the night prior because much of the course was wet. At the bottom of one early descent, I watched a 10K racer bite it right in front of me when he stepped onto a chunk of wet, filmy sandstone. I nearly stepped on him. He didn’t stay down too long, but that had to hurt.

Just as I was arriving at the second aid station at mile five, I downed the banana I had been carrying, which the crew managed to catch in this photo. Intense, right?! Well, anyway, check out that sweet piece of singletrack. 

Mile 5 marks the split of the 25K and 10K races. Shortly thereafter I descended a steep and slick ravine on paths that resembled game trails. The trail was nothing less than challenging and ultimately resulted in my butt hitting the muddy ground. As I reached the next valley and wooden bridge crossing, I came upon two beagle dogs in the trail. They were apparently scared of me and started running away on the singletrack. They ran in front of me for what seemed like a mile, serving as an unexpected pace crew and welcome distraction. Thanks beagle dog crew! Hopefully they went back home, wherever that may be.  

It wasn’t too long after that where I encountered a less helpful dog. It was a sizable mutt somewhere along a gravel road. I thought I was going to have to defend myself as it was lunging, snarling, and displaying its white teeth. Crazily yelling at it must have worked. Good riddance.

There was rarely a time in this course that I felt like I was running in a valley or along a ridgeline for long - the terrain was frequently fluctuating. This race has a little of every possible scenario: long steep climbs and descents, short steep climbs and descents, long gradual climbs and descents, gravel road, paved road, wooden bridges, singletrack, off-camber, game paths, clay mud, sandy mud, doubletrack, switchbacks, freshly mown grass paths, gas line right-of-way, rock drops, giant rock overhangs, cliffs, large loose rocks, timber roads, several log jumps, and a couple of local residents’ yards.

I went off course slightly in two different locations but for the most part I found it to be very well marked. The color coding was super helpful and the signage at intersections plentiful.

As fatigue set in, I began catching myself wanting to hike on some of the climbs where I would normally trot slowly, so I knew I needed to bring in some calories soon. But I also realized I had only packed a banana and a gel, underestimating the toll of these crazy climbs. It became clear why the total elevation gain of the 50K and 25K are only 1000 feet different: there’s a ton of climbing in the beginning of the 25K course. Taking the gel too early would be just as disastrous as taking it too late.

It was during mile 9 that I ran under a really neat rock overhang where I was imagining a family of American Indians several hundred years ago seeking shelter from a summer thunderstorm. And eating. Mostly because that’s what I wanted to do. Good thing there’s an aid station at mile 10.

Taking my sweet time at the 10-mile aid station in favor of surviving what had clearly become a toughman challenge, I took a gel with several cups of water and put a cup of ice in my hat. That mix made me feel like running again for a couple miles but I was definitely feeling heavy fatigue by the time mile 13 came around. Thankful that the climbs at this point were brief as I rolled along a ridge, the focus became holding my technique together and trying to use the terrain advantage to negative split. I knew there should be a big descent not long before the finish.

As I finished that descent and the end of mile 15 approached, I must have let my guard down a little. There was a brief climb and a quick descent toward the Mud River where I stepped onto a large, wet, cambered rock, only to fall hard onto my right wrist and leg. Unlike the first fall, that one hurt and took some of my skin with it. I don’t usually fall in trail races and now this was number two for the day. Clearly it’s a bit of a technical course and the recent rain had made it more treacherous.

The low blood sugar bonk had kicked in by the time the last mile came along. My form had degraded as a result but I knew from the elevation profile that there were no more climbs or descents. Please, no more! Stubbornly focused on keeping my core stable and arms from flailing, I could finally make out the pond at the Boy Scout camp through the trees.

In the end it was 16 miles in 2:19:01 to win the 25K race and barely set a new course record. The new record was my ultimate goal, so I was very happy with that result. Plus, my wife won the women’s 10K! Congratulations to her! Maybe she will start saying the "wh" in Kanawha.

The volunteers greeted me at the line with this wild, wood finisher medal and custom crock.

As usual, the WVMTR folks put on a great event. Check it out next year if you can. I’m sure most of them will never read this but events like this are successful because of the volunteers and race directors. Thank you!

The art and science of exercising in the summer heat

Your body is finicky about its temperature, which means it will carry out whatever processes are necessary to stay within the best working range. And that includes slowing you down when you go outside to exercise.

In a hot environment, at rest and with activity, blood is diverted to the skin for cooling purposes via increased sweat production. The sweat on the surface of the skin leads to a loss of heat via convection and evaporation (hooray for science). It’s a pretty awesome and effective system - as long as you aren’t working at really high effort levels or in a really hot and humid environment.

Sustained exercise causes a shift of a portion of our blood volume to the working muscles. And the bigger the muscle used, the bigger the blood supply required to keep it going. Harder efforts will inevitably use more energy at a quicker rate and therefore increase your core temperature to even higher levels than easy efforts. That’s where the sweating mechanism gets a little more inefficient as you are generating more heat than you can get rid of. High humidity also affects the cooling mechanism because the evaporative efficiency of sweating is reduced.

And then we add a third concern: dehydration. Dehydration decreases overall blood volume which magnifies the blood distribution problem further. This means there’s less blood volume for cooling and less blood volume for working muscles. This does not mean you need to go overboard with drinking water, as you could end up in a dangerous state of hyponatremia where you have actually diluted your body’s electrolytes. This ultimately wreaks havoc on your brain function and can lead to death. Some level of dehydration is expected during hard exercise in hot conditions, you just don’t want it to get out of control. Drink to quench your thirst and do not try to drink excess amounts to “stay ahead” of water losses.

Unfortunately, when it’s hot, the body uses more of its stored carbohydrate, glycogen, for energy. This may not be much of a factor for a 30-minute run, but if you intend on racing a marathon you must consider it a factor because you are hoping for your glycogen stores to last as long as possible.

You might think you can compensate for that increased glycogen loss by eating more during longer runs, but there are still a couple problems. One problem is that when the core blood volume is reduced to maintain cooling and supply working muscle, there isn’t much blood left for the internal organs, particularly the intestines and stomach. The other problem is that any carbohydrate you take in while exercising in the heat is used at a slower rate.

With the loss of blood volume to the digestive organs, your stomach might feel like it has a brick in it after deciding (too late) to eat that first gel at mile 10 when you realize you are suddenly feeling woozy. Is it the heat? Are you dehydrated? Was it the pre-race pasta dinner? It’s just poor planning and underestimating Mother Nature.

Those gels are meant to be consumed with large amounts of water: 6-10 ounces. Guess how much water is in one of those little aid station Dixie cups? Probably 1-2 ounces. Gels are a very concentrated source of calories, so the proper amount of water needs to be included to dilute them or it will often upset your stomach.

Once the woozy bonking has started, it’s usually too late to get those calories in quickly and maintain your pace, at least for a few minutes. So back off the pace, eat, and then reassess. You can keep the workout from being a complete disaster by making that choice to slow down for a mile and getting in some extra calories and fluids when you first notice a decline in performance and mental state. A slower than expected race finish is better than a DNF, and slowing down on a training day is better than needing your significant other to come pick you up in the car. Nobody needs to see your Road ID bracelet today.

Prevention is the optimal solution for feeling well and having a decent race or training day when the heat is brutal.

Most of us are capable of absorbing around a liter of water per hour but for prevention all you would need to do is drink 16-20 ounces of fluid per hour. I’m saying “fluid” because you may like energy drinks, but realize those don’t always work well in the heat for the same reason the gels can be a problem; too many calories and not enough pure water can slow the rate that fluids are absorbed in an already stressed digestive system.

You should also consume a small amount of calories early and often. Maybe you normally take in 100 calories per hour starting at 45 minutes in a 2- or 3-hour event. Well, you might start at 25-30 minutes instead and try to do it in smaller quantities and at more regular intervals. You might see if you can get in 110-130 calories in an hour instead. And preferably use something you have eaten in hot weather and at a high effort before. There’s nothing worse than experimenting on the day of a competition. Don’t blame me if you haven’t tried these things out before race day.

If you can pull it off, it is wise to use ice and cold water to help regulate your body temperature before and during exercise. During my most recent long run, which lasted 2.5 hours in the middle of a humid 90-degree day, I sat or stood in four creeks for 1-2 minutes each. I’m sure some purist runners would have a problem with mid-run stops, but I consider it a way to ensure success and consistency in pacing for the remainder of the run. You can also chew on ice, use wet sponges or clothing, and place ice within your hat and clothing. If nothing else, the cold is a nice distraction.

Proper pacing or effort dosing is critical in prevention. Expect the worst if you plan to start out at your PR pace on a humid 85-degree day. The calculator at this link can help guide pace adjustments. It’s probably not going to be a PR kind of day but finishing strong would be nice wouldn’t it? It’s also not the kind of day to do speedwork or long, hard pushes in a competition.

A huge part of prevention is regularly having heat exposure during exercise leading up to a particular event. This is the reason why you will experience a disaster day if you always train early in the cool mornings or only exercise indoors at a 65-degree gym. Your body is exceptionally good at adapting to the stressors consistently placed upon it. Try to have the heat exposure for at least two weeks prior to a hot competition or big training day.

Some other thoughts:

• Plan ahead by checking the weather forecast before you head outside.
• Try to exercise in shaded areas to avoid direct sun exposure that will heat you more.
• Figure out ahead of time if you are going to develop blisters from wet socks and shoes by going for multiple brief runs with the shoes and socks wet. Shoes that are well broken-in are less likely to be a problem.
• Wear light-colored clothing.

Clearly, exercising in a hot environment requires your body adjust to not one but many stressors: your working muscles, increased need for temperature regulation, and increased demand on glycogen energy stores. Training or competing in the heat doesn’t have to be dangerous if you are otherwise healthy, well prepared, and plan appropriately.

Seek medical attention if you have any of the signs and symptoms of heat illness:

• Headache
• Nausea
• Vomiting
• Pale, ashen, or flushed skin
• Loss of sweating
• Confusion
• Loss of or changes in consciousness
• Excessive fatigue
• Sudden onset of weakness
• Visual disturbances
• Chills
• Severe muscle cramping
• Severe stomach cramping

Stay safe out there. Share this article with all of your exercise buddies. If you have any training questions contact me at derek@mountainridgept.com.

Highlands Sky 40 Mile Trail Run: Best Race for Anyone with Achy Feet

Super tame section of Canaan singletrack

The neverending boulder fields, rock-strewn trails, endless bogs, and cold stream crossings will provide your feet with the nice, soothing care that they deserve. I wish I lived closer to the course so I could run it after work on days when my feet are a little achy.

Seriously though, this is a brutal course, at least through the beginning miles. For those of you unfamiliar with the event, the point-to-point course traverses the Canaan Valley and Dolly Sods areas in the Monongahela National Forest.

Despite doing my homework by asking prior competitors about the terrain, stalking Strava segments, and searching YouTube, I could have known so much more about the course. There is no substitute for experience and having never done the event it’s hard to know what to expect. But that’s also part of what makes the challenge more exciting.

Pre-race

The pre-race dinner at Canaan Valley Resort was great. There was a nice variety of carb-heavy food and local craft beer from Mountain State Brewing. Several high quality door prizes were given away. I won coffee from Sweet Bloom Coffee Roasters and as of this morning I've decided it's the best coffee I've ever made at home. 

Most racers stay at the resort but I ended up staying at the Timberline Ski Resort, which I would see around mile 35 in the following day’s run. I awoke at 4:00 AM and began the typical race morning preparation with the special hotel rendition of my classic breakfast sandwich: 1 everything bagel, 4 slices of bacon, and 1 egg. After a banana for dessert I was on my way out the door.

Bacon makes you faster not fatter

Start

My wife and I drove down to the starting area in Laneville, WV, arriving around 5:30 AM. It was a little chilly for standing (because I’m a wuss), but perfect for running. The forecast was calling for very nice sunny and slightly warmer weather. Wish I could duplicate that for every race. I’d heard rumors that the top competitors started out hard and fast to avoid a bottleneck at the trailhead. That was definitely true, as I was running around 7 minutes per mile on the paved road until we hit the trail around mile two and there were runners in front of me going even faster.

Almost go time

We then began the long ascent from Laneville, WV up the mountain toward the Dolly Sods area. We made our way through multiple mountain stream crossings and large, unforgiving patches of stinging nettles. A pack of five guys formed in front of me going up that 6-mile climb, and the current leader was well off of the front. The pack of five eventually became a pack of three, as two dropped off behind me. I had to make the decision early to let them run away from me as I was pushing my heart rate well into heart rate zone 5 and I don’t even do that in the early miles of a road marathon!

Frolic in the ferns

After getting to aid station #2 one runner caught me and I dug deep to stay near to him as we descended into another large ravine. It’s not always the climbs that are hard on your legs. If it hadn’t hurt me so much I would have liked that descent more because it was laden with ferns.

Entering Dolly Sods

I did eventually catch that group and was able to stay in front of them for the entirety of the race. But in my efforts, I mistakenly pushed myself a bit too much, too early. The upper portion of the mountain became quite steep in places, enough to require use of the arms and hands to climb. I quickly learned that these were some of the most true and unforgiving mountain trails that I have ever raced. I came into the halfway point in second place, wondering how rough I was really going to feel by mile 30, knowing the early course had taken a toll. As an aside, I’m voting aid station #4 the best on the course for their high level of enthusiasm!

Multitasking food, shoes, and socks with fantastic volunteers

Friend Daniel Hanks shaving his legs at the halfway point

Road Across the Sky

Running the stretch of gravel road known as the Road Across the Sky, I could gradually feel my efforts catching up to me. It was difficult to run under 9 minutes per mile on a section where I should have been able to do 8 minutes easily. As a result, two runners caught me.

By the time mile 30 was approaching, I was definitely depleted more than I expected. Nothing like making a beginner mistake. I began hiking uphill sections where I would normally run.  

Those couple miles up to mile 33 were not fun, as the terrain was exposed to full sun and at over 5 hours into the event I was becoming emotionally and physically drained and that allowed yet another runner to catch me. Very demotivating. He was doing what I usually strive to do: negative split!

I felt like my nutritional intake was lagging behind and that contributed to my suffering. Speaking of nutrition, here’s what I ate and drank during the race:

• 4 Gu gels
• 1 peanut butter and jelly sandwich
• 2.5 bananas, 2.5 liters of water
• 3 oz. pickle juice, 3 dill pickle spears
• 6 Oreo cookies
• handful of plain M & Ms
• handful of trail mix
• 2 salted boiled potato slices
• 12 oz. Coca Cola

Stupid knee

At mile 33 I started to have right lateral knee pain. I briefly forgot about it at aid station #7, but when I took off running again it reminded me of its presence less than 100 yards from the aid station. The intensity grew rapidly and substantially. I couldn’t even walk without pain and I was forced to limp. That was incredibly discouraging. I began to mentally prepare to walk the final 7 miles of the event, hoping to somehow hang on for a top 10 finish.

Butt Slide

But I actually didn’t have to walk that much as I began descending from the ridge. My inner Physical Therapist kicked in and told me to look for the fatigue-related running pattern changes. I noticed that I was disengaging my right quadriceps and allow my right knee to snap backward a little. The muscle just wanted to be lazy. And I know I have a history of landing with my right foot closer to centerline (i.e., crossing inward). I realized that if I just ran with the knee slightly more flexed and with a wider stance, the pain began to consistently subside.

All of my consistent strength training paid off because I had reliable quads on the steep downhill section affectionately known as “Butt Slide.” However, just out of the fear of pain returning I remained timid on the downhills and technical sections through mile 35. At one point the trail became less obvious I was wandering aimlessly for about a minute on that hillside. Trusting my directional instinct fortunately brought me back to the red flags on trail.

Road Race

I had recovered very well from the 2 miles of easier running. The flat gravel and paved road from that point on gave me hope that I could run quickly without tweaking my knee. As I approached the final aid station I could see one of the runners who had passed me on the Road Across the Sky. I downed 2 cups of Coca-Cola at aid station #8 and took off with a new motivation. It became a road race from mile 37 to 40. I managed to move up a place at the start of mile 38.

Finish

I ultimately finished up 4th overall, which makes me happy having never raced there before. That was definitely slower than where I wanted to be but the reasons were very clear to me. That course is a true challenge and quite beautiful. It would be great to run parts of it again while taking more time to stop and appreciate the surroundings. When trying to run hard there is so much time spent staring at the ground, hoping not to fall or twist an ankle. I will be back. 

Happy to be done and excited to have run the final 7 miles

Thanks

Special thanks to Dan Lehman, Adam Casseday and the rest of the WV Mountain Trail Runners crew for putting on such an awesome event, really caring about the racers, and giving out some cool prizes. And a big thanks to my wife for driving my tired butt home and crewing for me. And thanks to Pearl Izumi for the sponsorship this season. 

6 Deckers Creek Trail Half-Marathon Recovery Tips

Hope you had fun in the race. That last mile is brutal, right? Here are a few considerations to improve your recovery.

1. Active recovery. At a minimum, go for a short walk. It can be slow and relaxed. If you are more experienced, going for a short run isn’t out of the question, of course. Going for a swim is a great choice too. Anyone with at least a couple months of training under their belt will feel better having performed active recovery - if it’s done correctly. It will take at least 10 minutes of activity to get to that point though.
2. Avoid anti-inflammatory drugs. Inflammation gets a bad reputation because it’s usually accompanied by discomfort. But you need those processes to heal properly! Let your body do what it is meant to do in recovering from muscle soreness. Besides, over-the-counter anti-inflammatories are actually not very effective at improving the discomfort associated with delayed onset muscle soreness.
3. Ice anything that seems like a new injury. Yes, inflammation has a good side. But a true new injury (besides muscle soreness) can have a little too much of that inflammation. Ice is nice to be able to spot treat anything that has flared up without having the systemic effects of medication. Ice now so these areas are not still an issue in three days.
4. Regain normal hydration levels. It was hot and humid, so there is no doubt that you lost more fluid than you took in. Your urine shouldn’t be dark in color. It should be more like the color of a light beer. Drink 6-8 ounces of plain water every hour until you have achieved that level of hydration. If you have gastrointestinal discomfort at this point, then there’s a really high chance that your hydration levels are off.
5. Gently perform muscle self-massage. Use a foam roller, massage stick, tennis ball, lacrosse ball, or even a rolling pin from your kitchen to roll up and down the full length of the thighs and lower legs. It doesn’t have to be highly uncomfortable but a little tenderness is fine. Try for 30 strokes on every side.
6. Take a nap. Sleep is a great recovery method. The weather stinks today anyway. If you feel fatigued or drained then take advantage of a quick nap to boost your endocrine system’s output of healing hormones.

Training errors in the athlete, part 4

Underestimating the importance of proper recovery. When it’s time to work hard in a workout or competition you need to have some gas in the tank. That tank doesn’t get filled up without good recovery techniques like full days off, active recovery days, consistent sleep, compression, nutrition quality and timing, proper hydration and muscle maintenance.

If you start every competition or workout on a half tank, guess what happens? You go half as far with half the intensity. Sometimes that's intentional and planned. But many times it's not. Then as injury and overtraining occur, you have to ask yourself, “What am I really getting out of this?” In order to feel your best, remain healthy, and perform at your best, recovery is a huge part of the equation. Don't dig yourself into a hole that you can't get out of. 

Not working hard enough to produce a strong stimulus that the body wants to adapt to. Athletes are supposed to be constantly pushing their bodies on many of their training days. That’s how you become better, right? Unfortunately it’s also how you become overtrained, injured, stale, and burned out.

This leads you to constant training at a moderate effort on “dead” muscles. Or running the same distance every day. Monotony is the straw that broke the camel’s back. For runners, yes, you need days to emphasize aerobic conditioning in easy efforts ranging from 30 minutes to 3 hours. Other days you can have interval training that emphasizes anaerobic work at a really high effort for anywhere from 30 seconds to 5 minutes. Sure there’s a place for a moderately paced tempo run of 15 to 60 minutes, but not every day.

Strength training athletes need to avoid constantly using a weight that causes failure at 10, 12 or 15 repetitions. Or always doing just one set. If you are really after a change in performance, there needs to be a training cycle where the weight is significant enough to cause failure at other points, like 8, 5, or even 3 repetitions. And other times it’s fine to do 20 repetition sets. The point is, change the stimulus.

Indoor general fitness athletes are often one of the most guilty of this mentality. Three and four times per week they bounce from one cardio machine to another, being sure to start breathing harder and break a sweat at each machine for 10 or 20 minutes. They occasionally check their heart rate and compare it to the machine’s chart. No surprise to see a heart rate of 70% of the predicted maximum. And they wonder why they never see significant fitness changes.

Then there are the athletes that push a little harder but it’s just to that 85% level, which definitely hurts more. But then they struggle to sustain it as one steady effort for longer than 10 minutes (because it hurts) at which point the effort drops a notch. Meanwhile, other people in the gym are barely working at all.

In any sport, the key is variety. Variety in intensity, duration, training surface, speed, force produced, and direction of movement. Yes, you want adaptation to a consistent stimulus for a while but then you have to change that stimulus to continue making gains. 

Ignoring injuries when you first begin to have symptoms. Some injuries classically only hurt at certain times in their formation. That doesn’t mean they aren’t a problem. It doesn’t have to hurt all of the time to be a problem. Don't ignore it. Never ignore it. Yes, you can try to treat it yourself for a little while. That really might work.

But please make your life and my life easier by just coming to Physical Therapy within a couple weeks of the problem onset, even if it’s just for a consultation. If you don’t like what I have to say about it then seek another opinion. Regardless, if you intervene early, and start the right treatments, your recovery time is going to be drastically different.

For instance, if I see someone with back pain from a sacroiliac joint sprain in the same week they are injured, then they often recover in well under a week. If the sacroiliac joint has been a problem for 2 months and had no proper treatment, then buckle up for at least a month of consistent work. #getPT1st

Training errors in the athlete, part 2

Poor hydration habits before, during, and after exercise. Our bodies are around 55-65% water. Humans can live for weeks without food but only days without water. We depend on good hydration for basic function of our systems. For athletic performance, the demand is even greater because athletes need to maintain a greater blood volume, sweat for temperature regulation, sustain tissue integrity, and repair exercise-induced damage and injuries.

Dehydration will decrease blood volume and with that decrease you won’t be able to cool yourself effectively or supply the working muscles with enough blood. If your core temperature reaches 103-104 degrees, the hypothalamus in the brain will just say “no.” Your movements will slow down and your entire nervous system will not function at its optimal level. And nobody loves that dizzy feeling of decreased blood pressure after you stand up from sitting or lying down when dehydrated.

As far as structure is concerned, hyaluronan molecules bind with water to keep your connective tissues, like cartilage and tendon, strong, supple and resilient. Keep the hyaluronan happy by staying hydrated! And we want the muscles to remain loosey-goosey!

Take in 5-10 ounces of fluid every 15 minutes in a warm to hot environment during exercise. Otherwise, try to keep your urine nearly clear. Don’t over drink though, as that can have negative consequences as well.

Avoiding strength training. People tend to gravitate toward what they enjoy most. For many athletes, they just want to do their sport and that’s it. Unfortunately, regardless of sport, some muscles and movements aren’t worked hard enough or frequently enough. We will become very good at using certain muscles, like the hip flexors, which slowly shuts down important muscles like the gluteus maximus.

Core strength is important regardless of sport because your trunk needs to be a stable base while the arms and legs move. As running guru and PT Jay Dicharry says, “You can’t fire a cannon from a canoe.”

A loss of muscle mass as we age can be counteracted (to some extent) with strength training. Overall, it comes down to being a healthy, well-rounded athlete -- and without strength training that’s not possible.

Being afraid to let go of a regimented training program. For those Type-A personalities this is difficult. Your long run doesn’t always have to be on Sunday. Some weeks, you might even need to skip that long run altogether. That twinge in your shoulder while swimming is trying to tell you something, so listen up.

Sticking to a “must do” mentality is a great way to dig yourself into a hole of over-training, injury, staleness, and boredom. That’s particularly true when you aren’t able to optimize the other aspects of training, like nutrition, soft-tissue work, compression, sleep, and so on.

I liken it to the “pay me now or pay me later” philosophy. Take an easier intensity day or a day off when you clearly need it or end up taking several of them in a row once your performance drops, you become ill, or you develop an injury.