No Pain, No Gain?

Overuse injuries in competitive and recreational athletes are some of the most common conditions I treat.  These include muscle strains, tendonitis, and stress fractures.  The athletes at risk for these injuries are those who compete year-round with little or no break in between sports or seasons, and those athletes who increase the intensity of their training too quickly.  A rule of thumb for distance runners, for example, is to not increase weekly mileage more than 10% per week.

When evaluating these athletes, I try to determine the underlying cause of the injury and decide whether or not continuing to play or train will result in harm or disability.  The prescription usually involves a period of rest, activity and training modification, therapy, and occasionally a period of immobilization.  I try to keep the athlete as active as possible while recovering, including low impact cross training activities whenever possible.  Swimming and stationary biking are ways to maintain aerobic fitness, while letting injuries heal.

Unfortunately, sometimes the prescription will prevent the athlete from competing for a while.  This can be difficult for young athletes, in particular, to come to terms with.  Sports are fun and offer many great life lessons--team work, hard work, dedication, and commitment to name just a few.  Sports can also teach us how to deal with disappointment and adversity, including injuries.  The true test of an athlete's character isn't how he or she handles success, but how the athlete deals with that adversity.

#3--San Diego Rock 'n' Roll Marathon

June 4, 2000.  3:27:55

After the Dallas White Rock Marathon, I just wasn't sure that my knees would hold up for another marathon.  I took several weeks off to rest.  I worked on some strength training (an area most runners, myself included, neglect) and did some biking.  My passion was now running, however, and I couldn't wait to get back on the roads.  I competed in more weekend road races, and even managed to place in my division a few times, winning a watch in the Mike Doucy Stars of Texas 10K.  It remains one of my proudest possessions!

I wasn't doing any speed work per se, but the road races were even better.  I was in "marathon shape," already, and just kept getting faster.  A friend of mine in Dallas mentioned that he was going to be running the San Diego Rock 'n' Roll Marathon in June.  The RnR series were relatively new at the time, and the idea of being supported by 30 some bands on the course was appealing in the days before iPods were common or even allowed at races.  I had an old college friend in SD whom I had not seen in a long time.  I'd never been there, so it seemed like a great excuse to go.

The trip was great.  I went to the Zoo and Sea World, and my friend took me sailing the day before the race.  Race day was hot for San Diego, and the course was hilly in places.  There were nowhere near 30 bands as advertised, but the entertainment was fun.  I ran a very strong race from beginning to end, running the second half faster than the first.  Training all year in the Texas heat and running all of those road races had really paid dividends.  I felt like I had plenty of gas left in the tank at the end of the race.  Also, I had no pain anywhere in my body!  I looked down at my watch--3 hrs, 27 minutes, 55 seconds.  In just my 3rd marathon, I had cut nearly an hour off of my debut time.  I was starting to feel like a real marathoner!  

I celebrated that afternoon by eating fish tacos on Pacific Beach (PB for those who live there).  I had always heard people talking about qualifying for the Boston Marathon.  I began to wonder, what would that take?

Speed Work, Vol. I: Yasso 800s

As I began to do more road races I would hear people talking about "speed work."  I was a novice on the subject, but quickly educated myself.  Speed work can take many shapes and forms.  One of the most effective workouts is the so-called "Yasso 800's" named after Bart Yasso.  The workout is simple and effective, and can help you reach any marathon goal.

The workout is done on a track and starts with an easy mile warm up.  This is followed by a series of 800 meter intervals.  The pace of the interval depends on your goal marathon time.  Let's say, for instance, that your goal marathon time is 3 hrs 30 minutes.  You should run the 800 meter interval at 3 minutes and 30 seconds.  Recovery between repeats consists of an easy 400 meter jog.  Start with 2 or 3 intervals and work up to 4-6 intervals.  Finish the workout with an easy mile jog.

The workout is tough and should be done no more than once a week.  It should be preceded and followed by a relatively easy run.  If you are able to consistently hit your target pace during the intervals, you should be very close to nailing your marathon pace on race day.

Here is a link to read more about Yasso 800s.
http://www.bartyasso.com/800s

Father's Day Thoughts

I started out the day with a nice 9 mile run on the MoPac trail.  After a couple of light weeks, I'm building my mileage base back up.  I spent the rest of the day relaxing and being spoiled by my wife and son.  

My job keeps me away from my family more than I would like, so I feel guilty leaving them to go on a long training run on the weekends.  I'm lucky to have a wife who understands my compulsion.   She knows that running makes me a better person--a better husband, dad, surgeon, and friend.

When my son is old enough to understand what it means to run a marathon in all 50 states, I hope he will be proud of me.  I also hope that he learns to dream big, set lofty goals, and to work hard to make his dreams a reality.

#2--Dallas White Rock Marathon

December 5, 1999. 3:41:06

I spent a year doing research between my second and third years of medical school.  I worked in a lab in Dallas, TX.  I enjoyed my time there and learned a lot (mostly that I didn't want to do research for a living--too slow).  I was still running 4-5 days a week, mostly for fitness and fun.  I joined the Cross Country Club of Dallas.  The Club was very active and sponsored races nearly every weekend.  I had nothing better to do, so I ran most of them.  I wasn't focusing on it, but I got a LOT faster.  One of my recommendations if you are trying to run a faster marathon is to compete in as many road races as you can.  You'll be doing speed work and not even realize it.  You almost can't help but get faster.

After Chicago, I really didn't think I'd ever do another marathon.  I had done it, right?  What's the point?  Well, the thought occurred to me, I wonder if I could break 4 hours?  With all the road races I was doing I was running sub 9 minute miles easily and my IT band issues seemed to be behind me.  I signed up for the local marathon, the Dallas White Rock Marathon.

Race day was very cool for Dallas, but ideal conditions for a marathon.  The course included a loop around White Rock Lake, my favorite training spot in town, so I felt like I had the home court advantage.  My pace was quick, and for the first 17 miles I was on pace for a 3:30 marathon!  Then, out of nowhere at mile 17, sharp pain on the outside part of my knee.  I knew exactly what it was--IT band syndrome again!

I didn't stop or even walk.  I just endured 9 miles of sharp, intense pain.  I finished in 3:41:06.  I was a little disappointed that I had to slow down, but mostly I was overwhelmed with a feeling of satisfaction.  I couldn't possibly have run even one second faster that day.  I gave it my all and was totally spent.

I really enjoyed both of the marathons I did and was proud of the accomplishments.  Unfortunately, it seemed that my old nemesis (IT band syndrome) would prevent me from doing any more.

Run 4 the Homeless, Pt. II

Run 4 the Homeless 5K was a big success today.  Over 600 runners and $26,000 raised for the People's City Mission.  Thanks to those who donated.  Good job, Lincoln!

I was towards the back of the pack, coming in just under 30 minutes.

You can still donate to the cause.  Follow the links from the post about the race last week.

Injury Prevention 101

I love taking care of runners, because we are dedicated and passionate.  It is gratifying to help somebody return to or continue doing something that I know means so much to them.  With that being said, I'd be glad if I never saw another runner with an injury in clinic, because that would mean they were out doing what they love instead of trying to recover.  Unfortunately, injuries do happen.

Some of the more common ailments I see are patellar tendonitis, achilles tendonitis, and plantar fasciitis.  Without going into boring details, a great number of these "-itises" can be treated with some simple stretching exercises, or better yet, prevented all together.

I've included a link to our patient education page that demonstrates proper hamstring and calf stretching exercises.  Try to make time to incorporate these stretches before and after your daily run.

Happy Running!

http://nebraskaortho.com/patient_education.shtml

Barefoot Running

This is something I get asked about ALL the time.  Throughout human history most running was done barefoot or at least done in shoes with very little support compared to what we see today.  Even today, billions of people in many parts of the world still wear sandals or go barefoot, much as our ancient ancestors did.  So, which is the right way?  The answer is not so simple.  People who run barefoot do so in a way that is very different than people who wear cushioned, supportive shoes.  Simply, barefoot runners tend to be mid and forefoot strikers, while shod runners tend to be heel strikers.  In general, barefoot running probably does cause less "shock" to the body.

The problem is when somebody goes from one extreme to the other too quickly.  I recently saw a guy in clinic who was training for the Lincoln Marathon.  He trained for months in cushioned shoes without any problem, but 2 weeks before the race switched to a minimalist, barefoot style shoe.  Needless to say, he ended up in my clinic for a host of foot aches and pains.

If you are going to switch to barefoot running, you need to do so gradually, because your form will change completely.  Your body is very adaptive, but it needs time.  Remember, the Tarahumara of Born to Run fame have spent their entire existence on the planet running long distances in sandals.

Moreover, I think you need to have a good reason to switch.  I am very curious about barefoot running and I've heard all the propaganda, and a lot of it makes sound scientific sense.  I haven't done it because I really haven't needed to.  If it ain't broke, don't fix it.  I've run thousands and thousands of miles relatively pain and injury free, so I can't see a good reason to switch.  On the other hand, if your running is constantly hampered by nagging injuries, barefoot or minimalist shoe running may be something to consider.

There is a great article in the New York Times about this.  I've included the link.  Special thanks to Eric and Melanie for sending it to me.


http://well.blogs.nytimes.com/2011/06/08/are-we-built-to-run-barefoot/

Post Marathon Blues

This is week 2 of recovery from the Vermont City Marathon.  I ran a 10K last weekend, have a 3K this weekend, and will start my first "Boot Camp" in 2 weeks.  I've kept busy and avoided the post marathon let down.

I was very well prepared for my first marathon.  I had trained intensively for the race, and there were no surprises or challenges that I wasn't up for.  I broke through the wall at mile 20 without any problem.  The one thing I wasn't prepared for was the feeling afterwards.  I was very proud of my accomplishment, but I felt like something was missing.  You spend 18 weeks training for something and obsessing over every detail and then one day, poof, it's gone.  I wasn't prepared for the void that was present after the first marathon.

I've never really read about this phenomenon anywhere, but it makes sense I suppose.  There are many ways to deal with it.  If you know you are going to be running another race, sign up for it so you have another goal to work towards.  If not, change something up in your training.  Work more on strength and cross training, run a new course, or try running with a different group.  Your goal can also be to take some time off, spend time and do something special with your family.  They deserve it!

Run 4 the Homeless

I'm still in recovery mode from the Vermont City Marathon last weekend.  I ran the 33rd Annual Havelock Run today.  Our team from Nebraska Orthopaedics raised money for the Arthritis Foundation, as we did last year.  We had full teams for both the 3K and 10K races.  The turnout and support was amazing.  The running community in Lincoln is as good as there is anywhere.

While on the course I saw signs advertising a Run 4 the Homeless next weekend.  The race benefits the People's City Mission of Lincoln and goes to help support those in our community much less fortunate.  I've included a link to the Mission's website, and have created a page where you can donate to the Mission.  Please consider joining me in donating to the People's City Mission.

http://www.firstgiving.com/fundraiser/scottswanson/Run4theHomeless

http://www.peoplescitymission.org/

#1--Chicago Marathon

October 11, 1998.
4:23:59

My first marathon (& last without body glide!)  I had only been running for a year and a half.  I had done a few local 5Ks and the Bolder Boulder 10K up to this point, but I knew next to nothing about distance running.  I was amazed that people actually could run 26.2 miles.  It seemed almost super human to me at the time.  I researched marathons some more and discovered that if you were in reasonably good shape and had a "base mileage" of 15-20 miles/week, the marathon was within your grasp.  With enough time and training (4 months on average) you can go from running 3-5 miles per day to completing the marathon.

I've always enjoyed testing myself and this seemed like the ultimate test.  I was a second year medical student at the time.  I would often have to run at 5 in the morning or 11 at night, but I don't think I missed a single training run.  The marathon consumed me.  In my limited free time, I read everything I could about running.  I've mentioned Hal Higdon's programs before.  His weekly novice program became my bible.  

Chicago was a great choice for a first marathon.  It's truly one of the great cities of the world, and was cheap and easy for a med student with limited time and money to get to.  I stayed with a friend from college who couldn't understand why the guy who used to go to Leavenworth Cafe every night after the bars closed was now running marathons.

Marathon day was perfect.  Mid 50's, sunny.  Chicago is a flat, fast, well organized and supported race.  My running had always been hampered by IT Band Syndrome, and this race was no different.  I held back for the first half of the race, running very cautiously.  If you've suffered from IT band syndrome, you know that the pain can come on very suddenly, and can bring your run to a screeching halt.  By mile 11, however, the endorphins started to kick in, my pace quickened, and my knee pain melted with the miles.

My time was slow, 4:23:59, but I finished.  That was my only goal.  I was sure I would never run another marathon. 

The Heat is On

With Memorial Day behind us, summer has pretty much begun.  In southeast Nebraska, that means heat and humidity.  I actually really enjoy running in the heat and working up a good sweat because, to paraphrase Dr. George Sheehan, "sweat cleanses places a shower can never reach."

One must be smart about summer running, however.  At the Vermont marathon, two runners had to be pulled off the course because of heat stroke.  Both runners had temperatures greater than 105 degrees F.  Several years ago at the same race, a runner was in a coma for 12 hours after the race.  He returned to finish the marathon this year!

I've posted links to a Mayo Clinic article on heat stroke, and some helpful tips from Jeff Galloway of Runner's World related to summer running.

http://www.active.com/running/Articles/20_Tips_to_Stay_Cool_on_a_Summer_Run.htm
http://www.mayoclinic.com/health/heat-stroke/DS01025