NSCA Endurance Clinic Summary: Day 2 (I forgot to summarize the final presentation.)

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Maybe I was in a rush to post the Day 2 summary, I’m not sure.  I forgot to summarize the final presentation of the day.

Dr. Jeff Matthews: Running Injuries – The Big Picture

  •  DC, CCSP, CCEP, 1996 USAT National Team, high school track coach
  • Primary shock absorber of the body: FOOT PRONATION
    • Pronation isn’t a bad thing–it’s supposed to happen.
    • Posterior tibialis controls pronation via eccentric contraction
  • Secondary shock absorber: knee flexion
  • Aches & pains of the leg, foot and toes
    • Metatarsalgia
      • Pain at the metatarsal phalangeal joint as the heel leaves the ground too early.
        • Causes
        • limited ankle dorsiflexion
        • tight gastrocnemius
        • weak digital plantar flexors
      • Treatment
        • stretch gastroc with straight leg
        • increase distal plantar flexor strength
        • rigid forefoot in shoes
        • decrease stride length & employ heel strike
      • I have off and on metatarsalgia.  I’m going to work the toe flexors, particularly the flexor hallucis brevis.  I’ll use a band.
    • Hallux limitus and rigidus (aka Turf Toe)
      • Dancers and defensive backs get this as a result of doing a lot of stuff on their toes.
      • Loaded dorsiflexion of the big toe should be 42 degrees at toe off.
      • To check: Sit with knees bent at 90 degrees.  Lift toe with finger while foot is flat on the ground.  If it’s less than 30 degrees then you’ve got a problem.
      • Stretch toe flexors: Pull toe back 20-30x/day.
      • Restore joint motion to big toe.  I’ve been playing with this stuff quite a bit lately.  I’ve got a constantly tight left calf.  I’m wondering if restricted toe dorsiflexion is part of the problem.
      • I’m not only working to stretch the FHB, but also to strengthen it so my big toe can grip the ground.
      • Here’s a good big-toe mobility video:

    • Insertional Achilles tendonitis
      • occurs near the base of the AI
      • common in high-arched, stiff feet
      • common with Haglund’s Deformity.
      • Seems I have a bit of this; more along the lines of a bursitis from what I cant tell.
      • Strengthen with eccentrics.
      • He says “Work on the front of the tendon,” as that’s where the blood flow comes from.
    • Achilles Paratendonitis
      • He describes this as occurring with an audible squeak or creak–I’ve had that!
      • An inflammation of the sheath around the tendon
      • Work on the front of the tendon to increase blood flow.
    • Achilles non-insertional tendonosis
      • degenerative non-inflammatory condition from repeated trauma
      • treatment
        • rest
        • muscle work to stimulate fibrolasts to remodel
        • when appropriate, strengthen posterior tibialis and flexor digitorum longus
        • How do we strengthen the FDL?  Here’s one way:

    • Patellofemoral Pain Syndrome aka runner’s knee
      • comes from abnormal femoral movement
      • hip muscle weakness is the cause; increases with fatigue
      • Testing for PFS: 1-leg squat & check for 3 things:
        • leaning toward stance leg to maintain balance
        • knee caving in
        • falling
      • Treatment
        • retro patellar pain: recruit/strengthen the vastus medialis oblique (VMO)
        • stretch hips, foam roll quads, increase hip flexor strength
    • IT Band Syndrome (ITBS)
      • strengthen hip abductors
      • decrease tension on the tendon with soft tissue therapies
      • stretch glute max and TFL
      • may take 6 weeks (Didn’t take me that long to overcome mine.)
      • Check out my post on IT Band issues for more help.
    • Popliteus tendonitis
      • The popliteous unlocks the knee from the extended position.
      • inserts under the IT band and can cause lateral knee pain
      • if weak then knee may stay locked and send shock to the back
    • Treatment
      • Strengthen the popliteous
      • soft tissue therapy
      • control pronation (probably with foot strengthening drills and more importantly, HIP ABDUCTOR exercises)
      • Here’s a video on recruiting and strengthening the popliteous

  • Hamstrings
    • Hamstring strains have the highest recurrence rate and can take 4 months to resolve
    • Semimembranosus protects the medial meniscus during knee flexion
    • long head of biceps femoris helps stabilize SI joint and is most frequently injured in runners because of the long lever arm decelerates knee extension
    • more proximal the injury the harder to treat
    • Treatment
      • increase length, strength and flexibility
      • evaluate pelvis
      • strengthening abs/stabilizing pelvis can position pelvis correctly thus putting hamstrings at proper length
  • Low back pain
    • Pain causes weakness/looseness
    • Internal or external femoral rotation may become problematic.
    • Treat hips
    • A TFL problem = a glute medius problem.  This is huuuuge to me!
    • Seems to me that sitting too much is maybe the main problem here.

 

 

Summary of the NSCA Endurance Clinic: Day 2

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Day 2:

  • Dr. Carwyn Sharp – Role of Strength Training & the Endurance Athlete
    • Factors determining successful endurance performance
      • VO2Max – Not nearly as important as we’ve thought for years
      • Lactate/Anaerobic Threshold
      • Economy of Movement
      • Velocity at onset of blood lactate accumulation (vOBLA) – This may be the most important.
      • We need to think of ways to increase performance, not just measurements like VO2Max.
    • Improving Running Economy (RE)/Economy of Movement (EM):
      • strength
      • speed
      • power
      • More force into the ground/pedals/water = speed
      • More force comes from more strength
      • Heavy strength training and plyometrics are best
      • Both are shown to improve vOBLA
      • Plyometrics need to look like running: 1-leg hops, bounds, skipping.  This is SPORT SPECIFIC TRAINING.
    • Good idea to cut strength training during a taper.
    • Strength training guidelines
      • heavy weight training:
      • 3-5 sets of 3-6 RM
      • with 3-5 minutes rest between sets
    • Plyometrics: most convincing performance results.
      • varies depending on training status, mode and intensity
      • work: rest of 1:5 to 1:10
      • 80-140 foot contacts per session; fewer for beginners
        • 2-foot landing counts as 2 contacts
        • 1-foot landing is 1 contact
      • FIRST THERE MUST BE A SOLID STRENGTH BASE!
      • Donald Chu, Jumping Into Plyometrics
  • Coach Jay Johnson, MS – The Strength & Conditioning Coach Meets the Running Coach
    • former collegiate runner and running coach at CU Boulder
    • coached 3 U.S. Track & Field champions
    • 6 main points
      • Athleticism
      • Runners (and everyone else) need to first have a base of athleticism
      • good movement in 3 planes of movement
      • full ROM at the joints
      • strength
      • He builds aerobic metabolism on top of this foundation of athleticism.
      • The idea of athleticism is massively important!
    • Why did your athlete/client get better?
      • Did they simply go from being sedentary to being active?
      • Or did they get better because of the program you designed?
    • Understand the role of glycogen
      • The body must be trained to use lipids as fuel
      • This syncs with Seebohar’s discussion on glycogen.
    • Development of the aerobic metabolism is the most important factor for peak running performance.
    • Runners must  do non-running work to stay healthy.
      • GSM (General Strength & Mobility Work)
      • Gary Gray’s 3D lunge matrix.  I’ve played with this in the past.  I’ve returned to it.  Here’s a video

  • Keep the easy days easy and the hard days hard.
    • Do the intense strength/plyometric work on the hard running days.
    • Take it easy on the off days.
    • This is a key part of the periodized plan
    • His discussion on periodization was very helpful to me
    • Macrocycle
      • When it’s time to progress the runs, do so on the hard days.
      • Run easy or rest on the easy days.  Never up the intensity of easy days.
      • A complete day off every 14 days is a good idea
      • Take an active rest week after every 5k, 10k, and half-marathon
      • He takes three weeks after a marathon.
    • Microcycle
      • 4 days/week running
      • Monday – recovery day: Do strides on Monday; 4-5 x 20-30 seconds at 5k pace with 1 minute easy jogging between reps.
      • Tuesday – workout: High level aerobic workout or race pace workout.  Can include:
        • Threshold/tempo run or
        • Fartlek run or
        • Progression run or
        • Long repetitions or
        • Alternate the above with race pace workouts week to week
      • Wednesday – aerobic cross-training
      • Thursday – off or cross-training
      • Friday – easy run day w/strides
      • Saturday – long run
      • Sunday – brisk walk
    • The lunge matrix is done before every run
    • Runs follow with general strength and mobility work and Active Isolated Stretching
    • Here’s a link to Johnson’s 8-week strength progression.
    • This may have been my favorite lecture.  Johnson did a fantastic job of taking academic information (physiology, periodization, race pace training) and telling us in simple terms how he implements these things.  His point on athleticism was HUGE to me. I plan to contact him for coaching this coming season.
  • Nick Clayton, MS, MBA, CSCS,*D, RSCC – Functional Training for the Endurance Athlete
    • This was an active demonstration in the performance center, not a lecture.
    • Sport specific movement that mimics body position, speed of contraction contraction type of said sport
    • trains the body as an integrated unit
    • Primal movement patterns
      • squat
      • lunge
      • lift
      • push
      • pull
      • twist
      • Squat progression
        • 1-leg balance
        • 1-leg squat
        • 1-leg squat in multiple planes and with other body movement
        • 1-leg squat jump to deceleration
      • Lunge progression
        • stationary with narrow base
        • multi-planar
        • multi-planar with reaching
        • split squat jumps with focus on quiet deceleration
      • Lift (deadlift related movements)
        • hip hinge and balance progression
        • 1-leg Romanian deadlift/deadlift
        • kettlebell swings
      • Push/Press: Discussed mainly addressing the postural and scapular considerations of safe and effective pushing in sport training
      • Pull:
        • Shoulder stability patterns:
        • Y, T, I, W, stability ball roll-out
        • I liked these patterns.  I’m using them now as part of the warm-up or as correctives as needed.
      • split stance dumbbell row
      • cable “lawnmower”
        • It’s a single-leg cable row with a hip hinge.
        • This is a running pattern. Here’s a demo

Prior to the strength and plyo demos, we went through a really cool walking/lunging mobility process. Nick said he was going to email out videos of the warm-up and when/if he does, I’ll post them here.  I may video it myself.

Getting out on the floor to play with these exercises was a lot of fun.  I really liked the 1-leg plyo work.  I definitely got some valuable ideas that I’ll implement in my own training and with my clients. I also liked the shoulder patterns a lot.  I’ve seen the Y, T, I, W patterns before but I understand them better now.  I think it’s key to KEEP THE SHOULDERS AWAY FROM THE EARS WHILE YOU DO THESE.

  • Randall Wilber – Training and Competing in a Hot and Humid Environment
    • Dr. Wilber discussed in great detail how he helped Deena Castor (bronze) and Meb Keflezighi (silver)  prepare for the Athens Olympic marathons in 2004.
    • While not terribly important to my goals, some of this information was new and very interesting.
    • 2 ways to prepare for heat/humidity:
      • Natural acclimatization
      • Arrive 10 days to two weeks out
      • Gradually adjust timing of high-intensity and low-intensity workouts (two-a-days)
      • Gradually creep the workouts towards the heat of the day such that the final day has a HI workout near noon and a LI intensity workout in the evening.
      • Pre-acclimatization (Deena and Meb both did this prior to Athens.)
        • Very simple: Train in more clothing to make the body hot and thus approximate the hot conditions in which you’re to compete.
        • Arrive a few days ahead of the event and do your final workouts.
      • Cooling strategies
      • clothing
        • no cotton
        • lightweight and light color
      • sunscreen: avoid it as much as possible as it clogs pores and inhibits sweating
      • ice packs/towels
      • ice vest
      • Apply cold/ice to hands and feet: I’ve noticed on my own how  in cold weather, I can put on gloves or take off gloves and experience a significant change in my overall temperature.
      • whole body immersion: showers, tubs
      • ice drinks (like Slurpees)
      • Stay as cool as possible right up to the event.
      • Consume more sodium while training in the heat.
  • David Bertrand – Managing the Endurance Athlete
    • MS, USA Triathlon Level II Coach, lectures at SMU in the Applied Physiology Dept, head of DFI Tri Club, Dallas
    • Athlete selection:
      • Very important to coach people with whom you mesh
      • You may not be the best coach for everyone
      • Curiosity: He needs to feel curious about his clients and their goals.
      • “Training with David” document: This was very insightful
        • What does training with David bring…
        • coaching philosophy
        • requirements
        • rates
        • weekly training availability
        • how training is delivered
        • training jargon and abbreviations
        • I need to develop a document like this w/my name in place of David’s
    • Coaching styles and methodologies
      • autocratic: best for groups with both high and low cohesion
      • democratic: best for groups with moderate cohesion
      • Display a vision.  Express belief in the athlete
      • Buy-in: “Here’s how were going to do it.”
    • Communication
      • How am I most effective?  1-on-1?  Small groups?  Big groups?  Ask my clients.
      • LISTENING IS VITAL!
    • Training intensities
      • Most people go too hard.
      • This is in sync with Wilber’s advice that a little undertrained is far better than a little overtrained.
      • HR monitor can help keep athletes in check.
    • Writing and adjusting the plan
      • Adjusting the plan: This is your greatest value to them.  This separates you from the cookie cutter programs.
      • Most people need MORE RECOVERY, not more work.
    • Best practices
      • Don’t over-coach: Take 1 or 2 things and ask, “What did we focus on today?”  Less is more
      • Strive to learn.  Stay curious.  He told a great story about Jon Wooden.
      • Select days of the week for specific tasks.  Get organized.
      • Help athletes with something beyond just training.  Can you inspire them?
    • David gave a really superb lecture on what I call “filling in the cracks.”  That is, he spoke to issues beyond just physiology, heart rate, strength programs and other science. He talked about his time in the trade and how to actually work with human beings. I got a lot out of the lecture even though I’m not a tri coach nor do I plan on becoming one.

 

Summary of the NSCA Endurance Clinic: Day 1

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Part of what I love about the Denver area is that it’s home to numerous very good athletes and coaches–particularly of the endurance variety. We’re also not far from Colorado Springs which is home to both the Olympic Training Center and the headquarters for the National Strength & Conditioning Association (NSCA), one of the top certification bodies in the world of health, fitness and sports conditioning.

I was at the NSCA from last Friday to Sunday attending an endurance clinic. It was SUPERB! It far exceeded my already high expectations. All the speakers had volumes of valuable information. Not only did they present valuable academic information, they also told us how they applied this information in the trenches with their athletes. These guys weren’t just born as successful coaches. They’ve gone through a lot of trial, error and very hard work to get where they are. It’s very helpful to hear that type of information.

We didn’t just sit and listen though. Saturday and Sunday had us getting out on the field and into the performance center to learn about strength exercises, mobility drills, and plyometric drills. I got to meet a lot of my very capable peers and I got to work out in what is likely one of the top lifting facilities on earth. It was a fantastic weekend.

I’m going to give a rundown of some of the pearls of wisdom I collected on Day 1. I can’t do each presentation thorough justice, but I’ll try to highlight some of the most important things that I heard.  I’ll follow up with days 2 and 3 as soon as I can.

Day 1:
Dr. Carwyn Sharp – Intro to Endurance Training

  • Exercise scientist, triathlete and ultra-runner who’s worked with NASA and has 14 years coaching experience.
  • Endurance athletes are often averse to resistance training thinking it will bulk them up.
  • He presented several studies which demonstrate that strength training enhances speed and endurance performance.
  • Sand, snow, wind, and hills can all contribute to the athlete’s resistance training.
  • On recovery from intervals: if you feel the effects of previous interval → you didn’t recover sufficiently.
  • The basis of speed is strength. Several studies demonstrate that heavy resistance training and explosive training improves performance.
  • 1-leg training is very important.
  • Progression
    • Move well on 2 legs (squat, deadlift) and get strong.
    • transition to split squat
    • then to 1 leg stability
    • 1 leg squat and deadlift
    • 2 leg plyos
    • 1 leg plyos

Bob Seebohar: – Nutrition for the Endurance Athlete

  • Registered Dietitian and USAT coach who has coached and advised Olympic triathletes
  • Metabolic efficiency – use more lipids/less carb/preserve glycogen
  • Nutrition periodization – “Eat to train. Don’t train to eat.”
  • Food First – Don’t use supplements to make up for poor eating.
  • moderate supplement use; only part of the season
  • prevent weight gain in off-season – no sport supplements during
  • He supports the lower-carb/higher-fat approach. I was very happy to see that.
  • Food log
    • Doesn’t as about amount of food eaten but rather…
    • What?
    • When?
    • Why? I love that he asks “why” someone ate something.

Dr. Randall Wilber – Overtraining: Causes, Recognition, Prevention & Illness

  • Physiologist to the US Olympic team.
  • Overtraining–or “underperformance” as he calls it–often isn’t due to too much training.
  • nutrition
  • blood work
    • Iron is often low in women.
    • Vitamin D deficiency is common
  • endocrine panel
  • urinalysis
  • Physiological and psychological metrics for tracking fatigue/recovery
    • overnight heart rate
    • blood chemistry
    • sleep quality
    • Salimetrics – He said look for the price to come down on this.
  • Take the athlete back to active recovery. Progress very gradually back to regular workouts.
  • If they perform well and feel good at their first LT workout then they’re on the right road back.
  • Coach Bobby McGee: “More performances are spoiled by slight overtraining than by slight lack of fitness. An athlete who is 90% conditioned for an event will do better than an athlete who is 0.5% overtrained.”

Good Information: Flexion Inspection (Sitting Is The New Smoking), When to Stop Strength Training (Part of Tapering for a Race), Running Technique

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There are so many knowledgable people out there putting out good information. Here’s a little bit that I’ve found recently.

Kinetic Revolution: Better hip flexion for better running plus overcoming our sitting habit

If you’re a runner or triathlete then you should definitely check out Kinetic Revolution. The author is James Dunne and he’s a rehab and biomechanics expert. His recent post is Flexion Inspection: How Long Do You Sit Down Each Day? He discusses the perils of setting, namely tight hip flexors that inhibit the glutes and thus limit your hip extension. He makes two suggestions:

1. Record Your Time Spent Sitting For 1 Week

This is Claire’s brilliant idea… I had to share it!

Keep a simple diary. Much like a food diary, but recording the time you spend sitting down every day. Every single form of seated activity, from working at a desk to cycling.

If you’re anything like me, the results will be ALARMING.

2. Offset Time Spent In Flexion With Specific Extension Exercises

I’m a realist. I get that much of 21st century living requires sitting – not to mention the leisure activities we engage in. Cycling for instance.

I usually suggest for every two hours spent in a flexion pattern, athletes should get up, and spend 5mins working on extension exercises such as hip flexor stretches and glute activations.

And he explains a hip flexor stretch progression here

I can’t really resist posting this video so we’ll meander away from running technique for a moment. Nilofer Merchant gives a TED talk on this dreadful sitting habit we have. She even suggests that perhaps walking while talking may drive creative thinking:

Sweat Science: When is the ideal time to cease strength training?

If you’re a runner who strength trains (And if you’re a runner, you should strength train.) then this piece from Alex Hutchinson’s Sweat Science column at Runner’s World is very much up your alley. It’s titled When to Stop Strength Training. He discusses research from the Scandinavian Journal of Medicine & Science in Sports, Here’s the big rock you should know (emphasis is mine):

What you’re looking at is the change in muscular power after resistance training was halted, based on meta-analysis of 103 studies. Note that power is different from absolute strength — power is your ability to deliver large amounts of force in a short period of time, which is often more relevant to athletic performance than plain strength is. And the interesting thing to note is that, 8 to 14 days after stopping, power appears to be a little higher than it was during training, though it’s not statistically significant. (The graph for strength, which I didn’t show, starts declining immediately.)

Speculation aside, if you’re an endurance athlete who includes resistance training in your regimen, you have to eliminate or reduce it at some point before race day. The graph above suggests that one to two weeks in advance might be an interesting time to stop.

 Running technique & mirror neurons: Watch and learn

Humans are visually-oritented people. We primarily learn by watching and imitating others around us. (Why did you ever decide to walk?  Did someone propose the idea to you? Did you come upon the idea of walking from a book you read? No. You decided to give walking a shot because you looked around and saw a bunch of other people doing it.) Mirror neurons are the specialized structures in our nervous system that enable our learn-by-watching process.

The cool thing is that we can improve our skills by watching other people do things. I’ve watched skiing videos to improve my turns and I’ve watched mountain biking videos to improve my switchback riding. We can improve our running technique the same way.

There are a lot of youtube videos out there on running technique and I’ve found a couple that are fairly informative and somewhat entertaining. These videos are a slightly funny compliation of 80s instructional video, current running analysis and in one clip we see vintage black & white footage of the great Roger Bannister, the man who first broke the 4-minute-mile barrier.

Stuart McGill, Born to Run & Ketogenic Eating

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Here’s what I’m into right now:

Stuart McGill

I recently finished Stuart McGill’s Ultimate Back Fitness & Performance.  It has definitely contributed to how I view conditioning and care of the spine.  For instance:

  • I’m very careful to avoid much if any bending or twisting at the lumbar spine.
  • According to McGill, the core musculature responds best to endurance-type training, so I now go for time rather than out-and-out strength.
  • McGill makes the observation that excellent athletes tend to have a very rigid core–but very mobile hips and shoulders.
  • Here are two videos with McGill.  The first has McGill discussing several myths regarding low back pain and core strength.  In the second video we see demonstrations of three exercises often prescribed by McGill.  These are often called the Big 3: the curl up, side plank and bird dog.?

Born to Run

I’m a little late to the party but I recently finished Chris McDougal’s Born to Run. This book has done more than almost anything to push the popularity of minimalist running.

Born to Run is more than a book about running.  Much of the book concerns the history and culture of the Tarahumara people who live in the isolated Copper Canyon region of Mexico.  Non-runners with any interest in other cultures will find this book very interesting.

The book and author have generated some controversy. Any runner knows about the hot debate over minimalist/barefoot-type running.  I won’t go into all that.  (For just about the most thorough discussion on minimalist running, you can’t do better than the Sports Scientists dissection of the subject.)

Here are some thoughts on both the book and discussions that have followed:

  • The story is quite entertaining.  It’s possible that the entertainment value of the book and a subsequent New York Times article from McDougal have somewhat overshadowed some facts.
  • Alex Hutchinson who writes the Sweat Science blog for runner’s world describes an interview with McDougal that clashes with later statements from McDougal.
  • Hutchinson brings up several points in his response to McDougal’s article titled The Once and Future Way to Run.  One is this:

“4. The one part of the article that made me kind of angry was this passage, about McDougall’s visit to the Copper Canyon in Mexico that led to Born to Run:

I was a broken-down, middle-aged, ex-runner when I arrived. Nine months later, I was transformed. After getting rid of my cushioned shoes and adopting the Tarahumaras’ whisper-soft stride, I was able to join them for a 50-mile race through the canyons. I haven’t lost a day of running to injury since.

I actually interviewed McDougall back in 2009, shortly before Born to Run came out. And that’s not the story he told me. Here’s what I wrote then:

Long plagued by an endless series of running injuries, he set out to remake his running form under the guidance of expert mentors, doctors and gurus. He adjusted to flimsier and flimsier shoes, learning to avoid crashing down on his heel with each stride and landing more gently on his midfoot. It was initially successful, and after nine months of blissful training, he achieved the once-unthinkable goal of completing a 50-mile race with the Tarahumara. But soon afterwards, he was felled by a persistent case of plantar fasciitis that lingered for two years. “I thought my technique was Tarahumara pure,” he recalls ruefully, “but I had regressed to my old form.” Now, having re-corrected the “errors” in his running form, he is once again running pain-free.

I’m in New York right now, and won’t be back home until Monday night, otherwise I’d see if I can dig up my actual notes from the interview. But I remember McDougall telling how stressed out he’d been, because he’d spent all this time working on a book about the “right” way to run — but as the publication date loomed ever nearer, he’d been chronically injured for two years. It was only shortly before publication that he was able to get over the injuries and start running again.”

McDougal responds to Hutchinson’s post here and Hutchinson replies back.

Personally this doesn’t do much to bother me or take away from a) a great story that’s told in Born to Run or b) the value and importance of minimalist running. I think it does suggest that McDougal is not a scientist and that the need to create a compelling story may persuade a writer to drift towards a bit of exaggeration.

What’s your take on this back-and-forth?

Ketogenic Diet (high-fat/low-carb/moderate protein intake)

Here’s another party to which I’m a bit late: the high-fat ketogenic diet.  In fact, most people who’ve tried it probably abandoned it back in the early 2000s. (I think they should’ve have.) You’ve heard of the Atkins diet.  That’s largely what I’m doing now.

In reality, I’m becoming more focused and precise with this type of eating.  I switched to a higher-fat diet when I became familiar with the Perfect Health Diet.My current efforts are informed by the Art & Science of Low-Carbohydrate PerformanceJeff Volek, PhD, RD & Stephen Phinney, MD, PhD are the authors. I like their credentials and their experience. To me, it lends weight to their words. Here’s a rundown of the main points of the book:

  • Their book is well-referenced and fairly easy to understand.
  • They present convincing evidence (to me) in favor of a) greatly reducing carbohydrate and b) greatly increasing fat intake and c) why this strategy can be very effective for athletes.
  • How?
    • Burning fat for fuel (aka ketogenesis) is a cleaner process.
    • Inflammatory stress is lower compared to using carbs for fuel
    • You’ll be less damaged from exercise and you’ll recover faster
    • You have a nearly limitless supply of fat for fuel compared to a limited supply of glycogen.
    • By shifting your metabolism to prefer fat, you’ll avoid bonking.
    • Also, by shifting your metabolism to prefer fat you’ll improve your body composition.  Besides the aesthetic appeal of a lean physique, if you’re lighter then you’ll have a better ability to produce power.  If you’re lighter then you should be able to run and bike faster.
    • Endurance athletes who experience GI distress may do very well on the high-fat diet.

I was motivated to dig into this type of eating after I spoke with my former client and friend Mike Piet.  He’s moved in the low-carb direction after his friend and accomplished ultra-distance runner  Jon Rutherford.  Jon’s experience as an athlete who’s increased his performance is described in  the Art & Science of Low-Carbohydrate Performance. Thus far, I like the results. I’ll talk more about them as this experiment continues.

Look for Mike Piet’s guest blog post as he describes his very interesting low-carb/high-fat experience during the Savage Man Olympic and half-Iron distance triathlons–done on consecutive  days.

Park-to-Park 10 Miler & The IT Band is Fixed!

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I ran the  Park-to-Park 10 Miler on Labor Day and here’s a brief rundown.  Here are the facts:

  • Time: 1:24:27.

  • 8:21/mile pace

  • 174th out of 534 participants.

  • 16th out of 44 men in my age bracket.  (I tried to calculate how I did among all men and it was hard to figure out.  Looks like I was in about the top ⅓ of the group.)

Nothing spectacular but not too terrible either.  I improved on my 2009 time by about a minute-and-a-half.  I like that.  Other than that, it was very warm and for Denver it was humid.  Denver is a hilly town.  You may not notice it if you’re driving it but try running 10 miles through town and rarely do you encounter level ground.  What follows is more important than any of this.

I first ran this race back in 2009.  That was with the beginnings of an Achilles problem that would plague me for about two years.  (And I believe the Achilles problem was a symptom of a much bigger collection of issues that had affected me since about 2002.)  Since overcoming the Achilles trouble, I’ve run several races including my first marathon last year.

This summer a new problem cropped up in the form of some knee/IT band pain.  Would this derail my race?  Discussion boards are filled with people bemoaning the fact that they’ve spent years battling IT band pain.  What did this mean for me???

I recently discussed the etiology of IT band syndrome and how to address it.  (Work on the hip abductors!!) I’ve been a religious ultra-zealot about addressing my hip abductor deficiencies. With much relief and joy, I didn’t feel a bit of pain during the run.  IT band pain often strikes during downhill descents.  I didn’t feel anything.  Nor did I notice anything near the end when I was tired and pushing hard.  I’m thrilled to have figured out this issue and to have defeated it in fairly short order.

 

IT Band Syndrome: We Have A Weak Link

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“The single most important factor in predicting and possibly treating IT band problems is hip abductor strength.” John Davis, Running Writings

A weak link is found

My last post discussed finding and fixing our weak links. Well, during a trail run I found a weak link and the quest is on to bring it up to a respectable level. At this point I’ve boiled it down to poorly functioning glutes–the glute medius to be specific. Glute dysfunction is fairly common and I’m realizing more and more that I’ve had a good dose of it for quite some time. It’s gotten better but I’ve got to make it better yet. Right now this weak point is causing me some knee pain.

Inside IT band syndrome

Lateral epicondyle; where IT Band pain is typically felt

Lateral epicondyle; where IT Band pain is typically felt

Recently, while finishing a long trail run, I began to feel the dreaded symptoms of IT band syndrome (ITBS). Chances are, if you’re a runner then you either have or you will experience this issue too. If you look at the Wikipedia entry on ITBS you realize this is a mysterious ailment that might be caused by a myriad of issues from the feet to the hips, from the muscles to the bones, from too much running or cycling or rowing or dancing or whatever else you might do on one or two legs. Conventional treatment ranges from ice to ultrasound to stretching to orthotics and various pain drugs like ibuprofen.  (Do we really think that ITBS was caused by a lack of ibuprofen or an absence ice sitting on our knee?) I want to fix this issue and clarify what’s at work here. Let’s see if I can make some sense.

IT Band insertion

IT Band insertion

ITBS symptoms

The most typical symptom of ITBS is lateral knee pain, somewhere in the neighborhood of what you see on these two pictures. That’s where the IT or iliotibial band inserts. As is typical, I felt a sudden onset of pain at this site while running downhill. It’s a fairly sharp pain. Knee flexion while stepping down off a step often brings it on. Apparently, ITBS can be felt elsewhere along the IT band.

  The research: It’s all about the hip abductors.

I found some superb articles with some very valuable information regarding the root cause(s) of ITBS and how to address the issue. Biomechanical solutions for iliotibial band (IT band) syndrome / ITBS comes from RunningWritings.com.  Glutes rehab – recent research and Gluteus medius – evidence based rehab come from Running-physio.com. There is some overlap between these articles and they all refer to quite a bit of important research.  If you’re a trainer who’s working with someone who has ITBS or if you’re suffering from ITBS, I strongly suggest you read these articles. I’ve summarized some things but definitely go to the sources for a thorough rundown.

Both sources cite a study from Stanford, and here’s what you need to know:

“Long-distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners. Additionally, symptom improvement with a successful return to the pre-injury training program parallels improvement in hip abductor strength.”

Some sources suggest that foot/ankle dysfunction–specifically over-pronation–is at the cause of ITBS rather than hip dysfunction. Irene Davis and others of the University of Delaware studied both the hips and feet/ankles. They stated:

“However, aside from this variable [an increase in rearfoot inversion moment], these results begin to suggest that lower extremity gait mechanics [i.e. foot and ankle] do not change as a result of ITBS. Moreover, the similar results of the current study […] suggest that the aetiology of ITBS is more related to atypical hip and knee mechanics as compared to foot mechanics. Therefore, the current retrospective study provides further evidence linking atypical lower extremity kinematics and ITBS. (Ferber et al.)”

The Running Writings article discusses several other studies that had similar findings to the Stanford study. The writer reached this conclusion:

“At this point, the evidence overwhelmingly points to a biomechanical fault in the abductor muscles of the hip as the root cause for IT band syndrome.  Weak or misfiring gluteus medius, gluteus minimus, or tensor fasciae latae muscles are unable to control the adduction of the hip and internal rotation of the knee, leading to abnormal stress and compression on the IT band.  This muscular dysfunction manifests as excessive hip adduction and knee internal rotation, both of which increase strain on the iliotibial band and compress it against the fatty tissue between the lateral femoral epicondyle and the IT band proper, causing abnormal stress and damage. But although the pain is coming from the lateral knee, the root of the problem is coming from the hip muscles.”

(By the way, the hip abductors of which I speak consist of the gluteus maximus, gluteus medius, gluteus minimus and the tensor fascia latae or TFL.  See below.

Here’s something important: Very often the glute medius doesn’t do its share of the work and the TFL does too much work. Therefore it becomes important to condition the glute medius while de-emphasizing TFL activity. The side-lying hip abduction exercise (described below) works particularly well for activating the glute med while minimizing TFL activation.)

Hip abductors. If they're weak, your knees will probably hurt.

Hip abductors. If they’re weak, your knees will probably hurt.

The Running Writings piece also says, “a doctoral thesis by Alison Brown at Temple University also investigated (hip abductor) muscle strength in runners with and without ITBS; interestingly, she found no difference in maximal strength, but a significant difference in endurance.”

On a slightly different note, a recent study in Medicine and Science in Sports and Exercise indicates excessive hip adduction (adduction is the opposite of abduction; If you adduct too much then you’re not abducting enough.) is a precursor to patellofemoral pain or PFP. So again, we see abnormal hip mechanics playing a role in knee pain in runners.

Finally, the Running Writings article does a nice job of dispelling some myths about ITBS, among them the idea of foam rolling and/or stretching the IT Band. I won’t go into all of it but the bottom line is: Don’t bother. The IT band isn’t the problem–it’s the hip abductors! Work on them.

Tredelenburg gait

What happens when those hip abductors fail to do their job? We get what’s called Trendelenburg gait. Here’s a picture of it.  Notice the right

Trendelenburg gait

Trendelenburg gait

hip drops. When that happens the hip muscles on the left are stretched which puts prolonged tension on the IT band. That excess tension may cause pain at the IT band insertion located on the knee. There’s your pain.

Testing the abuductors

Heeding the observation that hip abductor endurance is key to ITBS, I tested that endurance using the old-fashioned, Jane Fonda-style side-lying hip abduction. (I elected to forgo leg warmers.) I got to almost 30 reps on my right leg (the affected side) and the hip was dying. I got to 30 reps on the left leg and with only moderate fatigue. I’ve seen similar performances in several other clients and my wife who also has some ITBS. This all fits in line with what this research found.

The exercises

The two articles from RunningPhysio do a great job of discussing a wide variety of exercises that engage the glutes. In Glutes rehab: recent research we see research on the exercises that elicit the most contraction from both glute medius and glute max. Look at the tables below to see which exercises get the most out of these muscles. (I’m not sure exactly how all of these exercises were performed.)

wpid-Photo-5-Nov-2012-1944 wpid-Photo-5-Nov-2012-2022

 

 

 

 

Here’s RuningPhysio’s take on how to apply this information:

Practical application

From the research findings a good programme for runners wanting to target GMed would be starting with single leg mini-squat, side-lying abduction and pelvic drops and progressing to single leg dead lift, single leg squat and side-lying bridge to neutral. For advanced work you could add leg weight to side-lying abduction or combine side plank with upper leg abduction. This set of exercises would start with at least moderate GMed activation and progress to in excess of 70% MVIC. It would contain both functional weight-bearing exercises that are a closer fit to the activity of running, and non-weight bearing activities like side-lying abduction which has been shown to activate GMed without increasing unwanted activity in TFL and anterior hip flexors (McBeth et al. 2012) and has been used successfully to rehab runners with ITBS (Fredericson et al. 2000).

Runners wanting to improve GMax could start with single leg bridge, lunge with neutral trunk and single leg mini-squat and progress to single leg squat, single leg dead lift and forward step up. All of these exercises are ‘closed chain’ single leg activities where the GMax provides power to extend the hip but also works to help stabilise the hip and pelvis. As a result they are fairly functional for runners as GMax has a similar role during running.

In Gluteus Medius: Evidence-based rehab, the writer very wisely discusses differences in what we might call “functional” vs “non-functional” exercises. (This article also describes most of the exercises you’ll want to employ.) Generally, we might say a functional exercise would look like something we do in real life. A 1-leg squat or 1-leg deadlift is an example. These exercises have us standing (weight bearing) and using the whole body in concert. We don’t isolate a muscle in a functional exercise but rather we train a movement pattern and integrate lots of muscles together. In contrast, a non-functional exercise tends to isolate a muscle. The side-lying abduction or side plank are examples of non-functional exercises. These exercises don’t much resemble anything we do during most of our daily activities or sports. That doesn’t mean they don’t have value though, and the article does a nice job of discussing this issue.  The article states:

“Closing thought, from the research I’ve read and patients I’ve seen, a combination of both functional weight bearing and less functional (sidelying) exercises is most likely to be effective in glutes rehab.”

My process

Like I said, my right glute med is indeed easier to exhaust than my left. I figure though that I should work both sides with a little extra work on the right. I’ve been doing lots of the side leg raises and side planks.  I can’t yet do a good side plank while abducting the top leg. That’s a tough one. It’s one to shoot for in the future. I’m also doing a lot of band walks.  I don’t loop the band around my ankles though, I loop it around my feet. This study determined that placing the band around the feet recruits more glutes and less TFL. These are sort of the non-functional exercises that I do pre-workout or first thing in the morning.  

Pre-workout or throughout the day:

  • side-lying hip abduction: 2-3 sets x 10-20 reps.  I go to exertion.
  • side planks: 2-3 sets x 10-20 seconds
  • band walks: I side shuffle as well as walk forwards and backwards. I go to exertion.
  • Hip hikes: Easy to do. This movement has you lifting the pelvis away from the Trendelenburg gait pattern.

Functional/main exercises:

  • 1-leg squat: 3 x 8-15 reps. I recently used a kettlebell in the arm opposite my stance leg.  I focus on keeping my pelvis level, knees somewhat apart and I don’t let my non-stance side hip drop which is very important. I also throw several reps in randomly throughout the day.

  • 1-leg deadlift 3 x 8-15 reps: I often hold one or two kettlebells, dumbbells or a barbell.

  • Off-set step up: 3 x 6-12 reps use a knee-high plyo box for this. I hold a dumbbell on the side opposite my stance leg. I drive up powerfully with the stance leg then do my best to control my descent back down. I don’t plummet back down uncontrolled.

  • ice skaters: 3 x 12-20 reps. This is a power exercise in which I drive side to side in an explosive manner. There’s no way to do this without using the glute medius.

  • 1-arm carries/farmer walks: I carry a kettlebell in one hand and walk. Very functional and simple to do.

These exercises do a great job of conditioning our movement sling system. Read here and here to learn more about these systems of muscles that work together as we move.

Using Exercise to Expose Weakness: Part I

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weak linkA general sort of concept is on my mind and it’s been expressed by several experts that I look up to. In his book Movement, Gray Cook says “True champions will spend more time bringing up weaknesses than demonstrating strength.” The great powerlifting coach Louie Simmons of Westside Barbell says, “The Westside program is all about finding where you are weak and making it strong.” Your weaknesses will hold you back.” Kelly Starrett discusses the idea of “making the invisible visible.” With this statement he suggests we can use exercise to expose movement problems. (He talks about this concept here,here and here.)  What does all this mean?

All these guys are telling us that rather than going to the gym and doing fun stuff that we’re already good at and simply making our strengths stronger (taking the easy route, really) rather we should find our weaknesses and work like hell to bring them up to speed.

A slightly different paradigm

I think most of us have an equation in our head regarding exercise.  It might look like this:

I exercise → I get stronger.

(BTW, the word “strong” doesn’t just mean muscular strength.  We can get stronger at swimming, biking, driving a golf ball, carrying bags of mulch, etc. “Stronger” means to improve an ability.)

There might be a few more dots to connect between those statements though. With regard to the earlier statements about weaknesses and making the invisible visible (i.e. make hidden weaknesses visible), we might see the equation thus:

I exercise → I expose weaknesses/pain/poor movement → I correct/improve my weaknesses and poor movement →I get stronger.

What often happens is that we find an exercise that we enjoy doing and at which we’re very strong. We really like that exercise! We do it and we demonstrate to ourselves (and let’s face it, others in the gym) how strong and able we are. Therefore our already well-developed ability gets stronger.

In contrast, I think a lot of us have discovered exercises that we don’t like. The movement pattern feels awkward, painful or somehow asymmetrical or unbalanced. We have a poor ability to execute the exercise. We may tack it on at the end of a workout if we feel like it–and we rarely feel like it. In other words, we’re weak at this particular movement. We don’t do it well and we know it so we avoid it. Thus we rarely if ever explore this particular exercise. What happens?  We probably get weaker and weaker at it.

So while something we’re already fairly good at gets better, a glaring weakness gets weaker.  And what do we know about chains and weak links? At some point that weak link (poor movement pattern) is going to cause us a problem if it isn’t already. We may not even know how strong we could be if we fixed our weakness.

My rule of thumb is: “If it’s really difficult to do and you don’t like doing it, then you probably need to do a whole lot of it.”

My experience

A lot of my clients have movement problems and various aches and pains. Their weaknesses are often rooted in a forgotten ability to move properly and maintain their joints in proper position. We frequently need to dial back the exercise intensity and simply work on slow, proper, mindful movement. Sometimes this requires a frustrating level of concentration. It gets difficult. It isn’t always fun. This frustration may lead a client to say ” I just want to work out!  I don’t want to think!” In other words, he or she want to revert to their hold habits, ignore their movement shortcomings and do what they’re already good at.

This is an important fork in the road. If a client chooses to continue to focus and do the hard work of correcting bad habits–to improve their true weaknesses–then he or she will almost certainly start to see lasting improvement in the near future. This client and I will likely have a long, productive and happy relationship. On the other hand, we have another type of client.  He or she balks at the first sign of difficulty, ignores and avoids weaknesses, and in essence chooses to tread water and only marginally strengthen their limited strengths.  He or she has picked an easy but limited route. In this case, our relationship is thankfully short.

The big picture

I’m going to go into some specifics in the next post, but for now I’d like you to consider the idea that the real way to get stronger is to seek out and wallow in your pathetic weaknesses. If you think you don’t have any, then add weight, reps, range of motion and/or speed to see if things start to come apart. Recognize where you start to fail and dedicate yourself to working on those weaknesses.

Interesting and Informative Information: Fat Isn’t So Bad, Skimpy Research on Injury Prevention in Runners

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Read this!  Learn things!

What if bad fat isn’t so bad?

“Ronald Krauss, M.D., won’t say saturated fats are good for you. ‘But,’ he concedes, ‘we don’t have convincing evidence that they’re bad, either.'”

I’ve written here that I’ve been persuaded that not only is fat good for us, that “bad” saturated fat is also at the very least not as bad for us as we’ve been led to believe.  I found another article to further support my thoughts.  What if fat isn’t so bad? is a 2007 article from NBC News.  In it, we get a good dissection of the various flawed studies by which we’ve arrived at the idea that fat–particularly saturated fat–is pure evil.

The article discusses among other things Ancel Keys’s landmark Seven-Countries Study from 1970. This study did more to advance the fat/cholesterol/heart disease link than anything else around. This study went on to frame our current low-fat guidelines. Seems the conclusions that were drawn were quite inaccurate.  From the article (emphasis is mine):

“The first scientific indictment of saturated fat came in 1953. That’s the year a physiologist named Ancel Keys, Ph.D., published a highly influential paper titled “Atherosclerosis, a Problem in Newer Public Health.” Keys wrote that while the total death rate in the United States was declining, the number of deaths due to heart disease was steadily climbing. And to explain why, he presented a comparison of fat intake and heart disease mortality in six countries: the United States, Canada, Australia, England, Italy, and Japan.

The Americans ate the most fat and had the greatest number of deaths from heart disease; the Japanese ate the least fat and had the fewest deaths from heart disease. The other countries fell neatly in between. The higher the fat intake, according to national diet surveys, the higher the rate of heart disease. And vice versa. Keys called this correlation a “remarkable relationship” and began to publicly hypothesize that consumption of fat causes heart disease. This became known as the diet-heart hypothesis.

At the time, plenty of scientists were skeptical of Keys’s assertions. One such critic was Jacob Yerushalmy, Ph.D., founder of the biostatistics graduate program at the University of California at Berkeley. In a 1957 paper, Yerushalmy pointed out that while data from the six countries Keys examined seemed to support the diet-heart hypothesis, statistics were actually available for 22 countries. And when all 22 were analyzed, the apparent link between fat consumption and heart disease disappeared. For example, the death rate from heart disease in Finland was 24 times that of Mexico, even though fat-consumption rates in the two nations were similar.”

The large-scale Women’s Health Initiative is discussed:

“We’ve spent billions of our tax dollars trying to prove the diet-heart hypothesis. Yet study after study has failed to provide definitive evidence that saturated-fat intake leads to heart disease. The most recent example is the Women’s Health Initiative, the government’s largest and most expensive ($725 million) diet study yet. The results, published last year, show that a diet low in total fat and saturated fat had no impact in reducing heart-disease and stroke rates in some 20,000 women who had adhered to the regimen for an average of 8 years.”

Several other studies are discussed.  The comment from the article on these studies is this:

“These four studies, even though they have serious flaws and are tiny compared with the Women’s Health Initiative, are often cited as definitive proof that saturated fats cause heart disease. Many other more recent trials cast doubt on the diet-heart hypothesis. These studies should be considered in the context of all the other research.”

The article goes on to discuss the subtle differences between the types of LDL or “bad” cholesterol.  Seems that all LDLs aren’t created equally:

“But there’s more to this story: In 1980, Dr. Krauss and his colleagues discovered that LDL cholesterol is far from the simple “bad” particle it’s commonly thought to be. It actually comes in a series of different sizes, known as subfractions. Some LDL subfractions are large and fluffy. Others are small and dense. This distinction is important.

A decade ago, Canadian researchers reported that men with the highest number of small, dense LDL subfractions had four times the risk of developing clogged arteries than those with the fewest. Yet they found no such association for the large, fluffy particles. These findings were confirmed in subsequent studies.

Link to heart disease
Now here’s the saturated-fat connection: Dr. Krauss found that when people replace the carbohydrates in their diet with fat — saturated or unsaturated — the number of small, dense LDL particles decreases. This leads to the highly counterintuitive notion that replacing your breakfast cereal with eggs and bacon could actually reduce your risk of heart disease.”

In much of the medical community, this talk of fat being healthy (or at least not un-healthy) is heresy. There seems to be a strong bias against openly discussing evidence to the contrary.:

“Take, for example, a 2004 Harvard University study of older women with heart disease. Researchers found that the more saturated fat these women consumed, the less likely it was their condition would worsen. Lead study author Dariush Mozaffarian, Ph.D., an assistant professor at Harvard’s school of public health, recalls that before the paper was published in the American Journal of Clinical Nutrition, he encountered formidable politics from other journals.

“‘In the nutrition field, it’s very difficult to get something published that goes against  established dogma,’ says Mozaffarian. ‘The dogma says that saturated fat is harmful, but that is not based, to me, on unequivocal evidence.’ Mozaffarian says he believes it’s critical that scientists remain open minded. ‘Our finding was surprising to us. And when there’s a discovery that goes against what’s established, it shouldn’t be suppressed but rather disseminated and explored as much as possible.'”

Go here to read the full article.

Injury prevention in runners – “skimpy research”

The smart people at Running-Physio have done a good job of summarizing a research review of studies looking into injury prevention in runners. In all, 32 studies involving 24,066 participants were examined. The relationship between injury and running frequency, volume, intensity and duration were examined. The results? I’ll let the writers tell you;

“Regular followers of RunningPhysio will know of the ongoing debate we have with those staunch supporters of research who insist we must be evidence based. Surely this shows us just how unhelpful research can be in reality – over 30 studies, involving 24,000 runners and no firm conclusions on injury prevention! No wonder Verhangen (2012) described it as “skimpy published research” and went on to conclude,

‘Specifically for novice runners knowledge on the prevention of running injuries is practically non-existent.’

Nielsen et al. isn’t the first review of its kind in this field – a Cochrane Review in 2001 reached a very similar outcome and was updated in 2011 with equally negative conclusions; Yeung, Yeung and Gillepsie (2011) completed a review of 25 studies, including over 30,000 particpants and concluded,

‘Overall, the evidence base for the effectiveness of interventions to reduce soft-tissue injury after intensive running is very weak.’

They go on to make the very wise observation that, “More attention should be paid to changes in training charactisitcs rather than the characteristics themselves.”  Based on their reading of the research review, Running-Physio makes the following suggestions:

Novice runners should be especially cautious with increasing volume or intensity of training.

Increase in weekly mileage should be done gradually. The higher the weekly mileage the more caution needs to be applied in increasing this distance. Running expert Hal Higdon talks about runners having a ‘breaking point’ – a weekly mileage above which they start to develop injuries. For every runner this is different but with experience you can find your breaking point and aim to work below it. A gradual increase in mileage helps avoid crossing this point and picking up an injury.

Changes in intensity of training should be added in isolation, rather than combined with increase in distance. Be cautious when adding interval training or hill work and use each training session for its specific goal (i.e.long slow runs at an appropriately slow pace).

Be aware of signs of injury – look out for persistent or severe pain, swelling, restricted movement or sensations of giving way.

Use rest sensibly – don’t be afraid to rest or replace running with cross training when your body needs it.

Seek help – the right GP, Physio or health care professional can make a real difference!

Something I observe here is that we’re often looking for the  (training variable) that causes the one thing (an injury).  In reality, it’s typically many variables (some of them unseen) that bring on an injury. Also, nowhere in the article or the research is the discussion of running technique. I would think that how someone runs probably has a big effect on whether or not he or she becomes injured. I’ve mentioned previously that where the foot lands in relation to one’s center of mass is quite important as it pertains to impact and running efficiency.  I’d be interested in an analysis of the foot placement (and stride length and cadence) in the role of injury.

 

Things to Read: Taking on Dr. Oz, Don’t Take Your Vitamins, Questions About Barefoot Running,

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There are several interesting things out there to check out.  Here are a few:

The New Yorker on Dr. Oz

Scientists often argue that, if alternative medicine proves effective through experimental research, it should no longer be considered alternative; at that point, it becomes medicine. By freely mixing alternatives with proven therapies, Dr. Oz makes it nearly impossible for the viewer of his show to assess the impact of either; the process just diminishes the value of science.
the New Yorker

Dr. Mehmet Oz is hugely popular.  I don’t know how many people watch his show but it’s a lot. We all know who he is. He’s a Harvard- and University of Pennsylvania-trained heart surgeon and he directs Columbia Hospital’s Cardiovascular Institute and Integrative Medicine Program. He knows a few things. An article in the New Yorker titled The Operator: Is the most trusted doctor in America doing more harm than good? takes Dr. Oz to task for perhaps crossing a line from science and good doctoring to entertainment.

I agree with a lot of what the article suggests. He seems to veer from scientific-based factual information into entertaining yet scientifically questionable material. He’s had psychics on his show and he often discusses “miracle cures,” and “breakthrough fat-burning this-and-that.” I haven’t seen much of him but what I do see and hear sounds very sensational. He seems to promise miracles to desperate people. Sounds a little kooky to me. From the article:

“The Dr. Oz Show” frequently focuses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Much of the advice Oz offers is sensible, and is rooted solidly in scientific literature. That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like “startling,” “breakthrough,” “radical,” “revolutionary,” and “miracle.” There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat. Last year, Oz broadcast a show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay-reparation therapy, had recanted. (Spitzer last year apologized to “any gay person who wasted time and energy” on what he conceded were “unproven claims.”) Oz introduced a show on the safety of genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.” He also broadcast an episode on whether the apple juice consumed daily by millions of American children contains dangerous levels of arsenic. “Some of the best-known brands in America have arsenic in their apple juice,” he said at the outset, “and today we are naming names.” In each of those instances, and in many others, Oz has been criticized by scientists for relying on flimsy or incomplete data, distorting the results, and wielding his vast influence in ways that threaten the health of anyone who watches the show. Last year, almost as soon as that G.M.O. report was published, in France, it was thoroughly discredited by scores of researchers on both sides of the Atlantic.

Dr. Eric Rose was interviewed for the article.  Rose is a professor of surgery at the Mount Sinai medical school.  Rose and Oz worked together, most notably on Frank Torre’s 1996 heart transplant.  (Frank Torre is the brother of former Yankee manager Joe Torre.) He said this:

“I want to stress that Mehmet is a fine surgeon,” Rose said, as he did more than once during our conversation. “He is intellectually unbelievably gifted. But I think if there is any criticism you can apply to some of the stuff he talks about it is that there is no hierarchy of evidence. There rarely is with the alternatives. They have acquired a market, and that drives so much. At times, I think Mehmet does feed into that.”

I asked if he would place his confidence in a heart surgeon, no matter how gifted, who operated just once a week, as Oz does. “Well,” he replied, “in general you want a surgeon who lives and breathes his job, somebody who is above all devoted to that.” Again he mentioned Oz’s experience, but when I asked if he would send a patient to Oz for an operation, he looked uncomfortable. “No,” he said. “I wouldn’t. In many respects, Mehmet is now an entertainer. And he’s great at it. People learn a lot, and it can be meaningful in their lives. But that is a different job. In medicine, your baseline need has to be for a level of evidence that can lead to your conclusions. I don’t know how else you do it. Sometimes Mehmet will entertain wacky ideas—particularly if they are wacky and have entertainment value.”

And there is this observation from researcher Eric Topol:

“Mehmet is a kind of modern evangelist,” Eric Topol said when I called him at the Scripps Research Institute, where he is a professor of genomics and the director of the Translational Science Institute. Topol, one of the nation’s most prominent cardiologists, founded the medical school at the Cleveland Clinic and led its department of cardiovascular medicine. “He is keenly intelligent and charismatic,” Topol said. “Mehmet was always unique, but now he has morphed into a mega-brand. When he tells people the number of sexual encounters they need each year to improve their lives in a specific way, or how to lose weight in three days—this is simply lunacy. The problem is that he is eloquent and talented, and some of what he says clearly provides a service we need. But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.”

Dr. Oz seems like the latest in a long line of American snake-oil salesmen.  The best ones mix truth with fantasy and it sounds like Dr. Oz is doing just that.  On the positive side, the article tells us that Dr. Oz is pro-vaccine.  Read the full article on the cult doctor here.

The New York Times: Don’t Take Your Vitamins

The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders.
the New York Times

I’ve discussed various questions about supplements. Now, a recent opinion piece called Don’t Take Your Vitamins is in the New York Times and it goes into more information on the topic.  Here’s a bit:

“Antioxidation vs. oxidation has been billed as a contest between good and evil. It takes place in cellular organelles called mitochondria, where the body converts food to energy — a process that requires oxygen (oxidation). One consequence of oxidation is the generation of atomic scavengers called free radicals (evil). Free radicals can damage DNA, cell membranes and the lining of arteries; not surprisingly, they’ve been linked to aging, cancer and heart disease.

To neutralize free radicals, the body makes antioxidants (good). Antioxidants can also be found in fruits and vegetables, specifically in selenium, beta carotene and vitamins A, C and E. Some studies have shown that people who eat more fruits and vegetables have a lower incidence of cancer and heart disease and live longer. The logic is obvious. If fruits and vegetables contain antioxidants, and people who eat fruits and vegetables are healthier, then people who take supplemental antioxidants should also be healthier. It hasn’t worked out that way.

The likely explanation is that free radicals aren’t as evil as advertised. (In fact, people need them to kill bacteria and eliminate new cancer cells.) And when people take large doses of antioxidants in the form of supplemental vitamins, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state where the immune system is less able to kill harmful invaders. Researchers call this the antioxidant paradox.

Because studies of large doses of supplemental antioxidants haven’t clearly supported their use, respected organizations responsible for the public’s health do not recommend them for otherwise healthy people.

So why don’t we know about this? Why haven’t Food and Drug Administration officials made sure we are aware of the dangers? The answer is, they can’t.”

The article goes into how the supplement makers have tied the hands of the FDA.  Seems this sort of thing happens in many different arenas from food and drugs to environmental regulations.  It seems over and over again we’re shown that we should get our nutrition from real food, not pills and powders.

The New York Times: Is Barefoot-Style Running Best? New Studies Cast Doubt.

(Somehow all these article came from the great city of New York. Wasn’t really intentional but… there it is anyway.)  I’m a big fan of minimalist or barefoot-style running.  I believe in my case it has helped me regain proper mobility and strength, and has helped me overcome pain and regain my running ability.  That said, simply donning a pair of Vibram 5-Fingers and hitting the road WAS NOT a cure-all for me. A lot more work went into my efforts to fix my running.  The New York Times discusses things in this direction in this recent post in the Well Blog section.

The article discusses research from the Journal of Applied Physiology that looked at forefoot vs. heel striking in runners.  (Advocates of barefoot-style running suggest that barefoot running promotes forefoot striking which is suggested by some to reduce injuries.)  The pertinent findings are these:

In the end, this data showed that heel-striking was the more physiologically economical running form, by a considerable margin. Heel strikers used less oxygen to run at the same pace as forefoot strikers, and many of the forefoot strikers used less oxygen — meaning they were more economical — when they switched form to land first with their heels.

Most of the runners also burned fewer carbohydrates as a percentage of their energy expenditure when they struck first with their heels. Their bodies turned to fats and other fuel sources, “sparing” the more limited stores of carbohydrates, says Allison Gruber, a postdoctoral fellow at the University of Massachusetts Amherst, who led the study. Because depleting carbohydrates results in “hitting the wall,” or abruptly sagging with fatigue, “these results tell us that people will hit the wall faster if they are running with a forefoot pattern versus a rear-foot pattern,” Dr. Gruber says.

That covers running efficiency of two different foot-strike styles.  The article says this about injuries:

The news on injury prevention and barefoot-style running is likewise sobering. Although many barefoot-style runners believe that wearing lightweight shoes or none at all toughens foot muscles, lessening the likelihood of foot-related running injuries, researchers at Brigham Young University did not find evidence of that desirable change. If foot muscles become tauter and firmer, the scientists say, people’s arches should consequently grow higher. But in a study also presented at the sports medicine meeting, they found no changes in arch height among a group of runners who donned minimalist shoes for 10 weeks.

Other researchers who presented at the meeting had simply asked a group of 566 runners if they had tried barefoot-style shoes and, if so, whether they liked them. Almost a third of the runners said they had experimented with the minimalist shoes, but 32 percent of those said that they had suffered injuries that they attributed to the new footwear, and many had switched back to their previous shoes.

This isn’t terribly surprising considering that from a biomechanics standpoint, running is a complicated task. There are numerous joints and muscles involved in the kinetic chain. If any part of that chain isn’t functioning properly then we may get a problem. If we’re conditioned to running in one type of shoe then abruptly change to another shoe, then conditions are very different under our feet and thus the way we run will be altered.

Minmal shoes have been a component of my overcoming various chronic aches and pains–which I should say were acquired while running in conventional “good” running shoes. I initially simply running in my old, bad style in my new minimal shoes.  It didn’t work!  I had to regain competency in my feet, hips, and torso to fix my running issues.  Minimal shoes allowed me to become more aware of my feet and more aware of how I land on the ground. So again, I think minmal shoes can be a very good idea so long as they’re not looked to as a be-all-end-all cure to running injuries.