Running Postpartum: Getting in Shape to Run

Whether you’ve had a child in the last year or 10 years ago, this article pertains to you. This isn’t article really isn’t meant to segregate new moms. It can influence any woman who has given birth. Ever.

Although I’m not a postpartum mother looking to run, I certainly understand the obstacles between the delivery room and the road. Truthfully, I see a fair share of moms in the clinic who attempted to return to running but found it more difficult than planned. There’s no lack of motivation, either. Who wouldn’t be chomping at the bit? Most running moms will trade their running shoes for other various forms of exercise leading up to the birth of their child, while some will forego most forms altogether. Let’s say you take the last two months off. Tack that onto what will likely be a minimum two months postpartum and we’re already looking at four months without impact. A cocktail of one part stir-crazy and three parts wanting to get back in “pre-baby” shape becomes a disastrous recipe for injury. A relative sedentary lifestyle is necessary as you accommodate a growing fetus, but nearly equally important to allow for ample time to recover postpartum. As we stated in our previous article on postpartum running, research has measured both thinning and weakening of the abdominal wall one full year postpartum.

Sciatica, SI dysfunction, and low back pain are large obstacles when looking to not only return to running, but life (and if you have to look any of those terms up it’s likely a good thing—meaning you haven’t dealt with them). Although what I’ll call ‘the big three’ (sciatica, SI dysfunction, and low back pain) represent a large percentage of postpartum impairment, moms looking to hit the pavement again will also likely flirt with an assortment of lower body injuries.

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Here’s a perfect example. This recent mom (delivery within six months of injury) suffered from nagging knee pain when she began her comeback. Treatment emphasized management of symptoms and swelling early and progressed to a variety of core stabilization and hip strengthening exercises. She returned to running within a few weeks. Other than managing the swelling (on the bone I might add), we did very little to address her knee. Treatment was focused on restoring spine and pelvic stability.

A common theme arises in my evaluation for moms looking to run: “I wanted to run to get back in shape. I wanted to run because it’s months since I last did.” If you’re reading this blog then there’s a fair chance that you run. Whether you’re a man or woman we all know the quickest way to burn calories: lace em’ up and start logging some miles. Sure. That may be true, but the changes that occur throughout pregnancy and delivery have something different in mind. You may, in fact, need to get back in shape to run.

I can’t recall how many times this has been written in my articles, but running is a highly loaded, repetitive activity. Without the stability and structural support to withstand impact your body breaks. With the literature being established that chronic weakness is overly prevalent in postpartum moms, it’s obvious that achieving prior strength and stability through the abdominals, hips, and pelvic floor is extremely important. It’s likely event required before beginning to run. Yeah. You may need to get back into ‘shape’ to run.

Our upcoming video series aims to teach you just that: restoring core strength while safely returning to running through a progressive, gradual return to running. As we continue to fine tune the video, literature, and program, we need your help. The feedback from article #1 was great and we are already incorporating your feedback. Through commenting below, on our Facebook wall, tweeting us, or filling out this form, we can continue to expand and perfect the program.

Are You Interested?

If this article would help a fellow mom, sister, friend, or co-worker, we ask you connect us with them through the social tools below… we want their feedback, too! The upcoming video series outlines training principles and strengthening programs tailored to postpartum moms. Before we finish shooting we want to hear from you to ensure a complete program. Help us out below, please!

Posted in Prevention | 2 Comments

Maximizing Push Off While Running

With growing evaluation of anatomy and function the more we can appreciate the designed (or adapted) system. From our head to our shoulders, knees, and toes (knees and toes) there’s an interesting progression that our body navigates from rigidity to flexibility and again back to rigidity. It should make sense at the most basic level, too. At the point of impact you’ll want a rigid system, designed to withstand the instantaneous forces of the foot meeting the ground. Almost immediately your entire body becomes flexible–from your foot pronating to your knee and hip flexing. This flexibility allows us to absorb high rates of loading and store energy for our preemptive explosion at push off.

Deviation from ‘the norm’, whether it’s due to weakness, tightness, sloppiness, or your bony structure, will affect the entire system. Of the previous reasons listed all but one (bony structure) is under your control. We all want to be faster, which usually equates to more miles, more speed workouts, more everything… more everything but refining the system. Yet, most of us slack on the items that can procreate speed without increasing run volume, frequency, etc. In fact, refining the system can not only improve speed, but also reduce your risk for injury–particularly for master runners. Think about it. You can move BETTER to waste less injury and maximize efficiency without having increase training stress. Win-win.

The goal of push off phase is simple: provide your body a rigid leg to transfer energy into the ground. Deviation between your spine and foot can all compromise the rigidity of your leg. Without a properly aligned leg at push off you’ll leak energy through unintended movements. A foot that fails to supinate or a knee / hip that fails to full extends are all deviations from ideal position. This all happens simultaneously, but let’s break it down into pieces.

Here’s a video explaining the push off phase:

maximizing, push, off, hip, running

The Hip

Starting proximally, the hip moves into extension at push off. Moving into full extension the hip moves closer to its “closed pack position” or most stable position. As our hips extend giant ligaments on the front draw taut. The tautness of the ligaments approximates the ball (femoral head) and socket (acetabulum) of the hip joint providing added stability. Limitations in hip flexor or anterior hip extensibility will limit your hip extension and your ability to achieve maximum stability. Tightness will draw range from your lumbar spine and further decrease stability proximally. A total mess!

Learn More About Hip Flexibility and Running

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The Knee

Your closed pack position at the knee is terminal extension, or when your knee is locked into extension. With your knee fully extended or straight, you great a very rigid lever for transmitting force down the leg and into the ground. A straight knee is terrible for shock absorption (ie heel striking), but is great at push off. Generally, the inability to achieve full extension is reserved for those with extreme tightness or prior surgery’s that didn’t result in fully recovery; however, we can still see runners failing to achieve full knee extension for another reason. Simply put—if you’re unable to achieve full hip extension it’s likely that your knee will follow suit. This is a general reminder that your whole body moves together and you’ll rely on your weakest link.

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The Foot and Ankle

Although your true ankle joint achieves maximum stability will full dorsiflexion (flexing the foot upwards), the intricacies of the 26 bones in your foot achieve maximum stability from supination, or when your foot turns inward, and when the big toe extends. The final piece of push off is ever reliant on what happens above at the knee and hip, but also the control through the front 2/3rds of the gait cycle. For example, achieving supination at push off will prove difficult if the muscles responsible for getting you there are unable. Collapsed arches and high, rigid arches can also play a larger role as your anatomy may limit your ability to achieve proper position.

Learn more about big toe extension here

In all, you’re dealing the cards your dealt. Luckily, most of us fall into a grey area that allows us to dictate our anatomy through selective stretching and strengthening. The take home message is simple. In a sport with extraordinarily high injury rates you’ll need to find a better means for improving speed and durability. Historically, runners seek speed through harder, longer, and more frequent workouts. And although you may reap benefits, you’re certainly opening the door for injury. Dedicate yourself to better movement and a weekly minimum of 60 minutes to improve upon deficiency’s.

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Prolonging Running Injuries with Strict Rest

You need to understand that you will be hurt. It’s nearly impossible to run, improve, and not develop an overuse injury. Your response to pending injury makes all the difference between spending two weeks out of commission or six plus. The response to injury for most runners is nearly the same. First, complete denial and one too many runs results in widespread tissue damage. It’s that one single run where in retrospect you knew you shouldn’t have stepped out the door. Once the widespread damage occurs the second major mistake occurs.

I can’t begin to emphasize the magnitude of the second mistake. This all too common mistake is a Hail Mary pass to recovery. Not only will it prolong your recovery, but it will completely zap will earned fitness. You’ll say, “I’ll just take a week or two off from running completely. That should do it.” Sound familiar? A week or two ticks by and you become infuriated with the realization that your symptoms are simply waiting for you to start running again. Too often runners use a physical therapist as a last resort. After all, you don’t want someone telling you to not run, right? All of sudden we’re the bad guy because we’ll tell you not to run, but you’ll do it yourself without any specific direction or program?

Extended rest without a progressive loading program is injury suicide. I’m not talking about the first few days post-injury, either. Sure, you may need rest in days 1-3, but I’m talking about the days that follow, the grey area where you can walk and negotiate steps without symptoms. You can literally do everything but run. Your body’s false advertisement of being “healed” is a huge problem–mainly for your psyche. I’m guessing you’ll bounce around the house, bound around up steps, and lunge onto your injured leg and brag how you dodged the injury bullet. The absence of symptoms leads you out the door smiling. With every minute (note: not mile) that ticks by your symptoms slowly emerge and within minutes you go from cloud nine to six feet under. I’ve seen this scenario play out countless times. It happens whether you’ve rested for a few days or even a few weeks. How can you rest for two weeks, feel nothing, and have your injury suddenly reemerge? The answer lies in tissue resilience to load and subsequent breakdown with time off.

Breakdown is inevitable without load. Think of an astronaut and how their bones significantly weaken while in space. Without the effect of gravity, which causes load and resistance with movement, your bones, muscles, and other tissues essentially atrophy and disappear. The same is said for those who are bedridden. Compared to non-runners, those who run have a built their tolerance to load through training. Injured tissue takes a hit to this tolerance.

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It sounds self-explanatory when I say it, but injured tissue requires a progressive gradual load that slowly builds you back to running. The length of this loading program is usually related to how severe the injury and how long you wait after onset. Loading tissue (muscles, joints, ligaments) is always warranted. The feedback provided through a progressive loading program will relay the required info to determine when it’s safe to return to running. No more heading out the door “hoping it will hold up.” The program will help rebuild injured tissue while preventing breakdown of healthy tissue.

With frequent running you’re building your body’s tolerance to the associated impact. You’re building a base for both legs. Rest for say an injured Achilles will not only lower the tolerance for the Achilles, but for both legs that have adapted to the stresses of training. You’ll need to refocus following an injury. Come to terms with it and stop acting as if treating clinicians are the bad guys. Find yourself a gradual load program that doesn’t reproduce symptoms. An injury offers a few opportunities to rebuild overall strength, balance, and flexibility–areas that have likely taken a back seat during training. A gradual loading program is more than riding a bike, too. Find what you can do successfully and repeat it until the program needs to be adjusted. Plenty of research exists on the loads associated with certain activities (lunges, step ups, etc.). You just need someone to lay the blueprint. Suck it up and ask for help. PT’s are not the bad guys.

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4 Training Lessons for Marathoners

You’d be amazed how many times during the week I talk training plans: how to stay injury free, train through injury, and peak for race day. The whole conversation revolves around a few main points that are overlooked in nearly every training plan. These concepts are widely used by the great running coaches are touted in countless books by the legends. The concepts and ideas, paired with my individual research, have served me well. I’ve PR’d in my last four marathons (all under 3). Three of the four courses are by no means fast (Pittsburgh, NYC, and Boston). Instead of writing about my training, why not open the book altogether and give you a glimpse into my 2014 Boston Marathon Training Log?

For some, the rules I discuss below will leave you overflowing with self-doubt during your training, particularly for those who seemingly do the opposite. As you’ll see below, most of my time was spent running much slower than race pace (nearly 30-40 seconds slower than marathon pace). Track workouts didn’t evolve until I was deep into training. You’ll also see how I approach strength training and injury, which happened twice while training for Boston.

The majority of plan is based on heart rate. Heart rate is a great gauge for training, but not so much or racing. Think of heart rate as a governor, keeping your pace in check based on the demands of temperature, elevation, and fatigue. My heart rate is broken into five zones, 1 being easy recovery and five being “I hate myself this hurts.” I was tested by Doug Bush of Endurance Factor using a sub-threshold test. If you’re not local to Buffalo, NY ask around. You’ll want to get this done.

Without further ado, here are my lessons (with training log support) for marathoners.

Lesson 1: Slow Down

Training Log: 27 of 30 Runs were in Zone 2 at the Beginning of Training

Speed kills (your legs). Zone two heart rate is your golden zone. You’ll spend the majority of your time in Zone two, particularly early in training. I’m fairly certain that most coaches will agree that runners tend to run too hard too often. Most runners train a bit harder–at or around zone three. Think of zone three as the ‘just hard enough to feel like you’re working, but not hard enough to be uncomfortable.’ Zone three invites breakdown early and often docks training time later as you struggle with injury. Take a peek at my training log. You’ll notice roughly 95+ percent of runs for the first nine weeks (18-9) were in zone two or below. Nearly all those runs were 30+ seconds slower than marathon pace.

Lesson 2: Long Run Pacing

Training Log: Every 18 Mile Training Run was in Zone 2 Heart Rate and up to 40 Seconds Slower than Goal Marathon Pace

Does anyone really care how fast your performing on your training runs? I can’t tell you how many athletes walk through my doors and reveal that their long runs are performed at marathon pace. Are you crazy? Race pace will inevitably cause breakdown–even at marathon pace. Running your long runs at a pace at or faster than marathon pace is a sure fire way to become my patient. Don’t give me your excuses about “building confidence,” either. You don’t have to “see if you can do it.” The long run is an endurance builder and your primary focus is to avoid breakdown. If you’re outside zone two heart rate you’re running too hard. This is especially true early on. Take a peek at my training log. You’ll notice that all of my long runs were in zone two with the exception of one 18 miler that was performed in god awful conditions. Slow Down! Please?

Lesson 3: Speed Work

Training Log: Only Two Speed Workouts Performed in First 10 Weeks (To Get Ready for C-Race)

There’s not entirely too much research on the concept of speed development, peaking, and maintaining maximum fitness, but it should make sense that you can only stay maximally fit for so long before you either become injured or overtrain. We like to think there’s a shelf life on speed and since you’re likely not running for a paycheck, you’ll want that maximum peak performance for race day. You can’t expect to visit the track once a week throughout training. There’s a time and a place for the track. Take a peek at my training log. You’ll notice that I don’t start any ‘faster’ running until week eight. Weeks eight through four build on long tempo intervals of roughly two miles and are faster than race pace. Normally, the four week mark begins adding speed to all the long “slower” workouts performed in zone two. Frequent bouts at the track are deemed difficult, but not damaging. This training plan offered a long B Race at Around the Bay, which served as Boston walk through. Normally, you would see 1-2 track workouts a week focusing on intervals at 800m or less.

Lesson 4: Upkeep Training

“I don’t have time to strength train.” What you’re really telling me is that you don’t think it’s valuable. You need to find time. You’ll find more value in losing 10 minutes of three runs and adding a 30 minute strength workout than doing the opposite. You’ll notice a few things here.

1:

I didn’t do a RunSmart Strength Workout every week. Life does get in the way, but doing no work in this realm is out right crazy. You’re sending an invitation to an injury.

2:

When I was injured I spent an excessive amount of time fighting my way back with strength workouts. An injury signals breakdown. Your body is hurt. Instead of sulking, take the time to rebuild and fix deficits.

3:

Yes, I too get injured.

Be smart with your training. The four lessons above outline common cause for for not only injury, but blowing up on race day. The fact is–most of them are factors within your control. And listen, stuff happens. Running is a tough gig and can take its toll. Listen to your body and rest when it begs you to. In running, there are no medals for those who ran fastest in training. Leave your “should have” and “could have’s” at the door.

Posted in Performance, Personal, Prevention | 4 Comments

How Long Does it Take to Recover from A Marathon

There seems to be growing trend of under valuing recovery. Runners fear days spent not running equates to a fitness vacuum, sucking weeks of training gains. First, you need to come to terms that you can’t be at peak fitness year round. It’s impossible. You’ll break. Your fitness graph should roll upwards with ascents and descents. The forever present plague of under, or in some instances–non existent, recovery in the running population boggles me. As runners, we’re great at justifying more. “I already signed up to race,” “I’m not sore anymore,” and “I didn’t race that hard” are verbal diarrhea that litter my clinic. Justifying a quick recovery with a poor performance is dumb. A race that went less than ideal isn’t a valid excuse to slack on recovery. You’re not only recovering from race day, but all the time spent training.

“I’m not sore anymore.”

For whatever reason, runners correlate the absence of soreness with being recovered. I don’t have to cite the fact that muscle soreness peaks at 48 hours and dissipates thereafter. At this point it’s fact. Going down the stairs post-marathon normally isn’t an open invitation for a race the following weekend. Hell, it’s not even an invitation to start running again. Unless you’re running for a paycheck, pushing your recovery is simply a death sentence to sustaining a healthy running career. I’m not saying you can’t get away with it, but trust me… it will catch up with you. Justifying a quick return with “I feel pretty good,” feeling “recovered,” or “I won’t race hard” isn’t a green light to lace up. Chances are… there’s zero chance you can sign up and not go all competitive on a race.

Research conducted in 2007 by Petersen et. al. found significant muscle weakness both at two and five days post marathon. Using a counter-movement jump researchers found 18 and 12% decrease in performance two and five days post marathon. Maximum voluntary contraction, a measure of maximum muscle force, for both the knee extensors (quadriceps) and plantarflexors (calfs) found 22 and 17% respective dive in performance 2 and 5 days post marathon. The moral of this story? Running within the first week is really out of the question. That includes you–person attempting to justify a ‘shake-out run’. This study fails to account for the fatigue proximally. Fatigued and strained core muscles will likely cause excessive motion distally at the knee and ankle and invite injury into your life. Without a properly functioning set of butt and core muscles you can kiss healthy knees and ankles goodbye. Leetun et al found that hip external rotation and abduction (think glutes) weakness are significant predictors for injuries in basketball players and track athletes. The majority of injuries were found at the ankle (65%) and knee (23%) respectively.

Said weakness arises when muscular tearing occurs at a microscopic level. The ratcheting system responsible for generating force is destroyed. Luckily, your body responds by repairing the system to a stronger state, that is if you let it. Muscle breakdown is measurable. An enzyme called Creatine kinase (CK) is released post injury. It circulates through the blood and can be measured. Elevated CK measures were found up to one week post marathon in a study conducted by Kobayashi et. al., reflecting signals of damaged tissue leaking contents into the surrounding fluid.

Further extending the damage timeframe, a 1985 study by Warhol et. al. found structural repair at the cellular level to under electron microscopy to take three to four weeks. Continued tissue regeneration was also found at 12 weeks. Yes. That means that three months later structural repair is still occurring.

This article isn’t suggesting that you wait 12+ weeks prior to running, but to timeframe the accrued damage that occurs with long distance racing/running. At the very least you should wait a week before running again. You should also weigh the danger of racing or running too hard too soon. Easy running is one thing, racing or running hard is completely different. Personally, I follow the “one day of recovery for every mile raced” rule. Post-Boston Marathon I waited roughly seven days before running. Even then, I felt like garbage. I’ve been slowly reintroducing miles while shifting my focus to strength and balance.


Post race is time to rebuild and recovery. Shift back to regaining balance and strength that were neglected as training increased and time was pinched. Easily spending one hour a week with RunSmart Yoga and RunSmart BaseSix can effectively (and efficiently) assist you in regaining core and hip strength before your next round of training. Be smart. Don’t freak out. Let yourself decondition, recover, and rebuild. Remember, you can’t be at peak fitness year round.

References

Peterson K, Bugge Hansen C, Aagaard P, Madsen K. Muscle mechanical characteristics in fatigue and recovery from a marathon race in highly trained runners. Eur J Appl Physiol (2007) 101:385–396.

Leetun D, Ireland ML, Willson J, Ballantyne B, Davis IM. Core Stability Measures as Risk Factors for Lower Extremity Injury in Athletes. Med Sci Sports Exerc. 36(6):926-934, 2004.

Kobayashi Y1, Takeuchi T, Hosoi T, Yoshizaki H, Loeppky JA. Effect of a marathon run on serum lipoproteins, creatine kinase, and lactate dehydrogenase in recreational runners. Res Q Exerc Sport. 2005 Dec;76(4):450-5.

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2014 Boston Marathon Race Report

Truth be told, I wasn’t exactly sure of my capabilities before Sunday night. I was caught up writing plans for some different athletes and studied the course based on their capabilities. Sitting down Sunday night, a mere 14 hours before the gun set us off, I decided to write a best and probable case scenario.

I’m not one to get caught up in hype. It’s weird. I’m an anxious and often impatient person. It encompasses nearly 95% of my life, but racing seems to relinquish any and all uncertainty. I sit down and look at my data from all the training I accomplished and set up realistic expectations. I simply stick to my plan and trust in my training. It’s funny. I toe a starting line every year encompassed with uncertainty of my capability. I look at previous races and think, “wow, can I really run faster than that?” Regardless, I set a plan and gave it my best go.

Our weather report couldn’t have been better. Cooler temps paired with a tail wind called for a fast day. Working my way through athletes village, which resembled that of a refugee camp, I made my way to the start. One thing was clear: it was going to warmer than anticipated. I met up with a running friend, Matt Kellman, and we decided to run together (again). Overheating was my primary concern consider winter spent more time below freezing than above. None the less, I broke down the race into five segments and went to work.

Segment 1: Start to Mile 4

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Plan: 6:30/mile

Actual: 6:30/mile

Mile 1: 6:38 Mile 2: 6:25 Mile 3: 6:29 Mile 4: 6:31

The first four miles are a mess of bodies and rolling downhill. With zero wiggle room, you were pretty much held to the pace of the pack. Runners were being tripped left and right, while some were pushing through for position. It was comparable to jumping lanes in traffic only to be stopped in another lane. The plan here was to bank some time without blowing the quads up early. Overall, I knew I was paced within a few seconds of the plan, but I wasn’t feeling overly confident. A crowded, narrow road left you at mercy of the pack.

With my lack of internal “hype” I’ve been known to be a rather slow starter. Inadvertently, this allows me to often run fairly even across long races. My last three marathons: Boston, New York and Pittsburgh have nearly all been even split.

Segment 2: Mile 4 to Mile 15

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Plan: 6:35/mile

Actual: 6:35/mile

Mile 5: 6:36 Mile 6: 6:34 Mile 7: 6:39 Mile 8: 6:34 Mile 9: 6:32 Mile 10: 6:41
Mile 11: 6:40 Mile 12: 6:41 Mile 13: 6:25 Mile 14: 6:35 Mile 15: 6:40  

After coming in hot from the downhill I knew it would be tough to dial in to a slower pace. I was still feeling sluggish coming through the 10K mark, but again, I think it helped me dial it in and prevented me from over reaching. The crowds began to grow as you ran through Ashland, Framingham, and Natick. A swell in crowds was coupled with growing adrenaline. Mile four to 15 were sandwiched between defining changes in terrain, it was easy to segment this nine miles. The entire segment was laced with rolling hills. A mile slow was followed by a mile fast, eventually averaging them to goal pace. Each passing town came out in full force and provided crazy noise. Fun fact: slapping outstretched hands of toddlers provides a significant boost in energy. I used it throughout my day at Boston. Shouts of ‘Thank You Runners’ and an outpouring of support from the crowd, volunteers, and law enforcement ticked these miles away faster than ever. The first twenty miles felt easily half of that. At the tail end of this segment came Wellesley. Wellesley is home to an all-female college who are notorious for offering up smooches and noise to fuel runners through mile 15. Signs of “Stamina Turns Me On” to a rolling tally of total kisses kept you smiling and running. The noise through Wellesley was unreal. Deafening is an understatement. I imagine it’s the closest you could feel to being a professional athlete. I ticked through miles and felt fantastic. After a quick self-assessment I thought about pushing. I can honestly say I felt zero fatigue moving through mile 15. I decided to hold back, which was the right decision.

Segment 3: Mile 15 to Mile 16

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Plan: 6:30

Actual: 6:30

This short, fast downhill segment came before the notorious hills of Newton. The plan was to bank some time in anticipation. I did just that. Felt great and ready to tackle some hills!

Segment 4: Mile 16 to Mile 21

2014, boston, marathon, race, report

Plan: 6:41

Actual: 6:53

Mile 17: 6:54 Mile 18: 6:54

Mile 19: 6:39

Mile 20: 6:52 Mile 21: 7:07  

I hit the hills with a high cadence and the goal of being able to push over the top. Again, the crowd was fantastic. Fueled on spilled Gatorade, high fives, and adrenaline, I took my time on the climbs. The sun began to roast and I continued my plan that I instituted from mile five. Hit up the water station and just start dumping. I felt terrible for anyone in tow, but I know what I needed to do. I averaged 3-4 cups of water at every station: one for my mouth and the rest for my body. As I lapped each mile I knew I was off considerably and even saw a single 7:05 on Heartbreak Hill. Still feeling great I calmed my nerves coming through mile 21 and looked forward to the descent into Boston—ready for a strong finish.

Segment 5: Mile 21 to 26.2

2014, boston, marathon, race, report

Plan: Whatever I Have Left

Actual: 6:37/mile

Mile 22: 6:32 Mile 23: 6:41 Mile 24: 6:34
Mile 25: 6:44 Mile 26: 6:42 Finish: 5:49

The downhill into Boston was awesome. What a fast way to end the course, that is, unless you pounded the downhill early. I felt fantastic cresting Heartbreak Hill. The plan here was to go with whatever was left in the tank. Truthfully I felt great. I took in all Boston had to offer. I settled into a groove and kept it there. “MEB WON” was shout from the crowds and for the first time I saw an entire pack of exhausted runners began to cheer. It was amazing. The downhill into Boston began to wear on my quads and the last three miles easily compensated for how easy the first 20 felt. I hit aid station repeat button, a simple sip of Gatorade paired with 5+ cups of water over my head. I kept reflecting back to all the support I had for this race. That, paired with an awful winter, urged me to continue my push. There’s a lot of pressure when you know so many onlookers are tracking you!

Finish Time: 2:54:22 – 43 Second PR

Much like the previous 26 miles, rounding Boylston was amazing. This was by far the most amazing piece of running I’ve had to date. I dug deep and knew a PR was all but mine. It hurt and when I finished I looked down to see 2:54:22, a 43 second PR.

Throughout the course complete strangers acted as if you’re a rock star. Awestruck: the only way to describe this experience. As fatigue set in you would run up on an athlete with a prosthetic (or two). You would see a mother or father pushing their child through the run. How could you do anything but run harder? Every obstacle was greeted by the city. It didn’t matter if they knew you or not. “Let’s go, baby!” “You got this!” “Keep it up. Let’s go. Let’s Go.” launched me over these hills. Prior to running Boston I thought I would be a one and done, but honestly, I have no doubt I will be back.

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What Causes Tendon Injuries in Runners

Tendon injuries in runners are all different, yet may all have one defining similarity. It’s common knowledge amongst orthopedic professionals that eccentric activity increases the load to a tendon. For those who are unaware, our muscles can produce force as they shorten (raising a weight overhead) or as they lengthening (lowering the arm). Both activities fire the same muscle groups, but each motion causes specific muscles to either shorten or lengthen.

Common tendon injuries occur to the Achilles, patellar, and high hamstrings tendons.

Eccentric activity is always a lengthening contraction of a muscle and increases tendon tensile load. Injury can result to the tendon for a few reasons. For some, not enough rest or too much too soon can result decreased tolerance to load. For others, weakness or range of motion restrictions cause excessive eccentric activity and result in loads that are above tissue threshold. Some injuries are a result from your footwear. A simple change of shoes from high to low drop can cause excessive Achilles tendon load through midstance. If a single or repetitive load is applied above tissue threshold an injury results. At a tissue level we know what causes an overused tendon. The trick is to identify the source of excessive eccentric load and fix it.

The gait cycle revolves around two phases: deceleration and acceleration. Both are critical and each can cause various injuries. Deceleration occurs on the front half of the gait cycle. With every foot strike our body is required to control the interaction the ground. Instantaneous to foot contact our body loads downward, decelerating to the pavement. Our muscles lengthen eccentrically to not only shock absorb, but to also load for our acceleration phase–push off. For the sake of this article we are evaluating the front half of the gait cycle–the loading or deceleration phase. This phase is dominated by eccentric-rotational movement.

If we can’t control our spin to earth there are significant downstream costs.

If we can’t control our spin to earth there are significant downstream costs. Our joints, muscles, and tendons will be yanked through excessive, damaging movement as our foot progresses from initial contact to push off. A weak core, hip, knee, and ankle are all to blame, but it’s always nice to have a jumping off point. I’ll typically throw our proximal muscles under the bus and scold the core and hips. It’s not uncommon to see an Achilles Tendinitis patient develop symptoms due to their inability to control their collision with the ground. An uncontrolled landing literally wrings the Achilles like a rag. A weak chain of muscles allows for excessive eccentric movement. Remember, eccentric movement only happens in the front half of our stride. Also recall that eccentric movements increases tendon load.

For those suffering from tendon issues, begin pointing your finger at the front end of your stride and correlate with poor control during loading. It doesn’t matter if your pain is at the Achilles, knee, or in the butt (or for our train wrecks all three). Improving your ability to meet the demands of initial contact through midstance is crucial. There’s no substitute for rest, either. Tendons are notoriously slow healing and will likely require some finagling (yes, finagling) of your program. Unlike muscles, tendons are non-contractile tissue. They serve as anchors for your muscle to contract and produce force. Since muscles shorten and lengthen in a ratcheting fashion they require oxygen. Oxygen is transported via blood. My point? Blood is a good thing, that is, if it stays in your body. Your muscles are deeply routed streams and neighboring tributaries of blood vessels that transport blood. With increased vascularity comes faster healing. Tendons don’t contract though.. they’re just anchors–anchors with poor blood flow. Tendons get enough blood to survive and that’s it. Enter your frustration with slower healing.

Take a look at this video demonstrating how our body loads eccentrically at initial contact. With poor control comes increased load to joints, muscles, and tendons.

More of a visual person?? Take a look here:

If you’re suffering from a tendinitis or tendinosis you’ll need to look to the chains of muscles responsible for controlling landing forces. Start with proximal muscles that control for movement. Core and hip strengthening are always a great place to start and remember, BE PATIENT!

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First Run After Injury

The first run after injury is crucial but often butchered by most runners. Your first run sets the table for a full recovery or completely destroying a what you thought was healed injury. The internal dialogue starts to weigh the fact that you can walk and negotiate stairs without pain. Essentially every aspect of your life is pain free and seems to have resolved with a week (or two) of rest. Most of you have lived the story, some of us hear it everyday (me!). You think you’re healed–you’re fine. You lace up and head for the door. Confidence shortly begins to fill with self-doubt. Symptoms go from nonexistent to negligible climbing to ‘not that bad’. Continuing on that trajectory, your pain worsens until you’re at a perfect, yet damaging, distance from your car. You refuse to walk back and decide that running is your only option. Sound familiar?

Overdoing it seems to be hardwired into our DNA. It hinders healing, which eventually causes further damage to our confidence and psyche (oh yeah and body!). Remember, we all get hurt and injured. That’s not the point of this article. It’s more important to discuss the steps required to resume running. As stated, that first run is so crucial. Most athletes analyze runs comparatively. “Well I’m used to running 5-8 miles so 3 miles should be an easy gauge.” You’ll need to ditch the mindset if you want to fully recover. Often a first run will tolerate less than 10 minutes. Ten minutes you say? Who cares about 10 minutes? Well, for one, your injury certainly does. Were not looking to increase fitness with a short, simple run, but simply “feel it out.” You’ll want to grasp how your injury bodes before jumping off the deep end.

The All Important 10 Minute Feeler

Clinically speaking, I will always begin with what I like to a call a ‘10 Minute Feeler Run’. Ten minutes is an easy gauge that allows you to assess symptoms with minimal chance for aggravation. It’s set in stone, too. Ten minutes doesn’t mean 10:15, or 10:45. Ten is ten. I don’t care that you don’t feel anything or feel like you could run forever. Ten is ten.

Ten minutes allows us to assess your tissues immediate and latent response to load. Symptoms can be felt during the run or within minutes of stopping. For others, the effects might not be felt for 24 hours. I’ve had patients experience zero symptoms in their ‘10 minute feeler’ with symptoms drastically increasing the next day. Imagine if said individuals were to keep running. The effects of stretching a run longer could cause a setback measuring weeks to months.

Other Considerations:

Before making that crucial decision to start running you’ll need to be able to function in daily life without pain. That means walking, negotiating stairs, squatting, etc. If you can’t function at lower level activities how do you expect to fair at higher ones (running)? If you can’t do these activities then unfortunately your answer is rest. Rest can equate to 24 hours, 7 days, or even longer depending how much damaged occurred.

The key here is catching it early. You’ll know something is wrong. Burning or sharp pain is always a dead giveaway when it comes to injury identification. Symptoms may be experienced mid-run or once you stop. You know your body best. Don’t talk yourself out of an injury. The best thing is to start the rest cycle paired with ice immediately.

Progressing from 10 Minutes

No one wants to lace up for a 10 minute feeler, especially in the colder months. You’ll spend more time getting dressed than actually running. Warming up on an elliptical or bike can help get the blood flowing and transform the experience into a workout. Remember, motion is lotion and may actually help you complete 10 minutes successfully. Once you’ve completed 10 minutes without symptoms, it’s time to progress. Every other day is your best bet. I’m guessing less than 1% will listen to what I just wrote, so please don’t go three days in a row. Fill the in between days with spin classes, strengthening, and the elliptical. These activities can serve to minimize fitness loss, keep you sane, and not re-injure yourself. You’re looking for small gains early. Literally one run to the next might yield 90 seconds of gain but take it. Ninety seconds turns into tens of minutes fairly quick. You’ll see progression every few runs but you’ll need to patient.

It’s so important to avoid the mental trap. Going out for an ‘easy 3’ is no way to test an injury. Does it make sense to throw 20-30 minutes at a recently injured tissue? It shouldn’t. Ten minutes has served me well and quickly grows to tens of minutes. It allows a safe gauge and shows improvement in a short time. Work the process, remain patient, and stay in control. You will run again… why not make it sooner rather than later?

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How to Check for ITB Tightness

Checking for tightness has often been reserved as a passive, “I need to see someone” task. And although this is often the case, there are a few life hacks that allow you to self-assess and forego a copay.

In lieu of an Iliotibial Band (ITB) epidemic that has stricken Buffalo, NY, I thought I would offer a quick self-check that could foreshadow a nasty, often nagging problem in the next few weeks. I wish I could point my finger and one specific cause: transition to outdoor running, new shoes, or another glaring issue; however, I have yet to see a correlation in mechanism from one patient to the next. Sure, there are consistencies at an impairment level (weakness, tightness, or imbalance), but again, no explanation why 14 patients walk through in 10 days, while the usual number hovers around a few per month.

Without delving into the cause and symptoms of ITBS (for that same reiterated response throw a Google Search out there), I find it more beneficial for you to understand a few often overlooked aspects of this thick, fibrous band.

Function:

how, to, check, itb, for, tightness,The ITB is an extension of your glute maximius and tensor fasciae latae (TFL) muscle and runs laterally down the leg, reaching out to grab the patella before continuing onto the tibia. More importantly, you should understand that while your knee bends and straightens the ITB shifts back and forth over a bony projection on the femur (thigh bone). An interface known as a bursa sac separates your ITB from bone. In the presences of tightness, weakness, or spasm, the ITB will drag along the bony ledge and snap over the bursa sac. Imagine drawing your finger across a guitar string. As you pull across the string bends until it slides under your finger and snaps. With every snap comes friction and irritation. Eventually, you’re left limping through your run and unable descend a flight of stairs.

In a clinical setting we determine the length of the ITB via the ‘Ober’s Test.’ It’s a quick, easy way to assess length but unfortunately, you cannot perform it solo. While Ober’s Test has been researched and remains a clinical favorite during evaluation, my little test is simply based off anatomy and clinical experience. Best yet, you can do it from home. Bust out your foam roll and get crackin’.

Learn More & How to Self-Assess

If you’re looking for more information about foam rolling your ITB, TFL, Glutes, etc, take a look at our foam rolling section. First, remember that ITB may be tight and causing your symptoms, but it’s generally caused from weakness elsewhere. Foam rolling and restoring length to this tissue is important, but will likely be short lived if you don’t address the primary causes.

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Racing with Injury: When is it ok?

Knowing when to hold or fold em’ is a life lesson. We’re all walking the line of losing battles to win the war. It’s always easier looking in too. We all lend advice of ‘rest’ and ‘recovery’ when talking to a friend, but our own battle is force fed self-assurance and justification. We justify everything about an injury. Statements like “It’s not that bad,” “maybe I’ll just run easy today,” and “I just need a day or two of rest” lay the foundation for denial. We truly are our own worst enemy. Looking beyond the injury includes encompassing self-doubt. A mental war is forging on all fronts and you’re convinced that for every run missed offsets months of training. Chillllllllll.

Running is highly addictive. Don’t believe me? Spend a day in my office. Go ahead and talk to someone who has been sidelined for a few days, weeks, or months. I see it everyday. Mood disturbance quickly can quickly evolve into varying levels of depression. Observing behavior removes any doubt that the addiction is a catalyst to breakdown and further injury. It’s simply not sustainable. Sure, it’s healthy to be active, but where does the line become drawn? At what point do we suck it up and simply say, “Well, I have to bag this one.” I see runners limping themselves through miles with that “tougher than nails mentality.” Are you really tougher than nails or are you simply afraid–afraid of what others will think? Maybe you’re afraid of posting a DNF. “I’m weak.” “I’m a failure.” “Everyone will see that I DNF’d or DNS’d.” There’s a saying that a DNF trumps DNS. Really? Does it? Is it worth the weeks or possibly months required to offset DNF (did not finish) damage?

Here are a few certainties of being injured:

1. Anyone and everyone will be out running on your drive home
2. You will be bored
3. You will grow impatient
4. You will be difficult to live with

Although #1 will be beyond annoying, while #4 is annoying for your family, #2 and #3 is where the damage comes. Boredom breeds impatience and annoyance, which inevitably leads to rushing an injury. Find a way to fill the void. Find a way to sweat with some well needed cross training. Spend time with your family and friends, but please, stop freaking out and rushing the process.

I know the difficulty associated with skipping a planned event. I, like you, are not immune to injury. After a full week of minimal running I had to make the difficult decision of logging my first DNS (did not start). The entire week was a mixed bag of emotions. Early in the week I knew the right call. I convinced myself that I was out. Simple as that. Easy, right? Packet pick up with my wife and friends was a tough pill to swallow. That big race jive gets you itching, not to mention questioning your decision. A few trots down a hallway and some running in place opened inner dialogue. “I have no pain, maybe I can run.” The trots became progressively longer (yes I was that guy trotting down the sidewalk in jeans to “test it out”). I still knew I shouldn’t run, but the ‘what if’s’ circled the wagon. See! We’re all a little crazy. When push came to shove I stuck with my gut, which ended with the right decision. I toured DC on foot and began to feel my Achilles at mile 5, which most certainly would have been sooner and to a greater intensity if I was racing. At the time of this post, I’m nearly 95% recovered and most certain that I would have missed Boston if I raced at DC.

running, race, with, injury, when, is, it, ok
Bagging the race allowed me to run 7 uninterrupted miles through DC and soak in the National Mall. Picture Left: Capitol Building. Picture Right: Kickin’ it with Abe

Now, this all needs to be put into context. The DC race was a ‘B’ race with an overall goal of prepping for Boston. If it were Boston I would have run and dealt with the consequences. You’ll need to weigh the situation, too. Never let a B, C, or fun race jeopardize your A race. This is a frequent topic of conversation with my patients. Refrain from arguing the cost aspect, too. I don’t want to hear it. Eating a race fee is nickels compared to what you could possible spend in copays and deductibles when seeking treatment.

As runners we’re consistently pushing our upper limits, often stroking bad habits of training and racing. Worst yet, we get away with it when were younger and more resilient–it sets the expectation. As we age and healing slows, we fall back to said expectations. Athletes reminisce of better times: pairing hard workouts or two-a-days was all in a day’s work. Runners consistently log miles when they know it’s against their best judgment. Maybe it’s a fear of appearing weak or simply being afraid of losing fitness? We all have our own reasons and most of us live in denial. Eventually it will catch up with you.

Since when did seeking help become taboo? “I’m afraid to get treatment because they’re going to tell me to not run.” I hear this quite often, but when a knee, ankle, hip, whatever, has been beaten for weeks, what else can you expect? Be proactive and be attuned to your body’s signals. Most injuries begin minor and can be fixed quickly with minimal down time and treatment sessions. The longer you wait, the longer the process.

Remember, DNF does not trump DNS.

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