Reach Your Goals in 2012!

Let's talk about how to reach your goals in 2012!

 

 

Happy New Year! More in 2012!

Video Blog: First Aid For Tendonitis

Here is another video blog from Dr Marybeth Crane.
Today's topic for RunDoc is first aid for tendonitis.



Thank you for watching.

Video Blog: Does Running in the Rain Make You Sick?

You asked for more video blogs, so here is the beginning of a new series :)



So enjoy running in the rain! Jump in puddles!! Have fun!

Does Running in The Rain Make You Sick?

It’s one week after the cold, wet rain permeated the White Rock Marathon. Lots of people, including my mother, have asked me if I caught pneumonia from running “The Rock”?

So, does running in the rain make you sick? This is one of those questions that seems to be doomed to getting inconclusive answers forever. Especially when it comes to the opinion of Mom!

People usually do get sick more when the weather is rainy. That's because they stay indoors more, and indoors is where cold and flu viruses spread because of increased contact between individuals. On a sunny warm day, everybody goes outdoors, where there is (obviously) more space, better ventilation, and less physical contact with large numbers of other individuals.

Catching an infectious disease such as the common cold requires direct exposure to the pathogen (virus). Exposure comes in the form of close contact with an infected individual. Going into cold and rainy weather will not make you sick unless you also get colonized by the pathogen while you're out there.

There have been reports that cold temperature itself reduces the effectiveness of our immune system, but even that's not sufficient alone - you'd still need exposure to the virus.

Bottom Line:

"I'll get sick if I stand out in the rain or go out into the cold without a hat on" - Fiction

"Cold and rainy weather causes virus infections to spread more rapidly than usual" - Fact, due to people staying indoors more

Prevention:

Wash your hands, stay away from people who are sick, and feel free to run and play in the rain, just like we did last Sunday at the White Rock Marathon. Run Happy....and remember to jump in puddles after the 6th mile when your feet are already soaked!

Do NSAIDs Inpair Fracture Healing?

Do NSAIDs Impair Fracture Healing?

There has been a theory that comes from looking at animal studies that NSAIDs like ibuprofen or Naproxen inhibit bone healing and may cause delayed unions or non-unions in fracture patients. Some doctors even go so far to say that you shouldn’t use NSAIDs in postoperative orthopedic case; but what is the truth?

A recent article in the Journal of Family Practice by Yates, Shah and Blackwell, showed NO, ALTHOUGH THE EVIDENCE VARIES. Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t appear to impair clinical fracture healing. Even though animal studies show delayed healing and nonunion with NSAID use, evidence in humans doesn’t merit avoiding NSAIDs in patients with fractures who need the drugs’ analgesic and anti-inflammatory benefits.

Evidence summaryNSAIDs are commonly prescribed to control pain in patients with fractures. Laboratory studies have found that their antiprostaglandin properties delay callus formation and subsequent healing.1 However, human studies evaluating the effects of NSAIDs on fracture healing have found variable results.

BOTTOM LINE
The majority of physicians agree and recommend using NSAIDs temporarily along with other measures—such as rest, ice, and a steady return to the aggravating exercise—to relieve the pain of stress fractures until the patient is pain-free.

For more info on this retrospective analysis, click here.

Is it OK to Race White Rock Marathon Two Weeks After Ironman Arizona?

Yesterday, in my Grapevine, Texas office, I had a patient who asked me this very question. He raced Ironman Arizona, which was November 20th and wanted to know if I thought it was OK for him to "jump in and run with a friend" the White Rock Marathon? Really? When I started laughing, he then asked if I thought perhaps a relay leg was OK?

So, after I composed myself I said, "It depends....." So I thought I would give a better, more scientific answer than "Are You Nuts?"

What he really was asking is: How long does it take to recover from a marathon? How long does it take to recover from an Ironman triathlon? How much racing is bad for my body? These are all good questions posed in my office on a regular basis. The problem is that the answer is always, "It depends". Everyone recovers at a different rate. Age, experience and current fitness level are large variables in the equation. I know a marathon runner in town who ran 100 marathons in a less than 10 years; and of course, we have all heard of Dane Rauschenberg who ran 52 marathons in one year for charity and then wrote a book about it! The flip side is that I know runners who can only do one marathon a year without getting hurt and most triathletes only train for one Ironman a year. So what is the magic formula? How much is too much? I think the first thing to think about is what is your goal? If you are just talking about finishing the marathons and not really having a time crunch, then feel free to do up to six a year but realize that having more than two quality runs in a year is very difficult. The Ironman distance should not be attempted more than 2 or 3 times a year regardless of time goals! Now, for those of us who are addicted to the watch, "racing" a marathon is something that should not be done more than twice a year. "Racing" an Ironman triathlon should only be attempted one a year.

Why is this true? Well, simple math. It takes a minimum of 4 months to train effectively for a marathon and 6 months for an Ironman. Then you need at least one day for every mile you ran and three to five days for every hour your triathlon took. That means a month of recovery before you start to train again after a marathon and at least 6 weeks after a 12 hour Ironman. Last time I checked, there were only 12 months in a year; hence, the common recommendation of racing no more than 2 quality marathons or one quality Ironman triathlon a year.
Why do some people recover faster? Age. My feeling is that youth is wasted on the young. I remember being able to run a marathon and get up and go to work the next day. Now I have to take at least one day off and often take two! Experience does help. Your body has been there before, so it knows it will live. Veterans often have a post-race routine down that helps them recover. (Often this includes the anesthesia known as beer!) If your fitness level is high and your nutritional status is good, you will recover faster.

What can you do to hasten recovery? Walk a cool down after the race. Do not sit down immediately even though your legs are begging you to! Take a 15 to 20 minute walk and stretch gently. An ice bath is best, but very few people I know are that tough. A cool bath followed by stretching before you go to bed is helpful. A large amount of carbohydrates and water also helps. Hence the beer phenomenon! A massage a few days after the race will help you recover. More than anything, do not start training again until you are fully recovered. Many injuries occur due to too much, too soon, too fast and too fatigued syndrome!

So how much is too much? Again, the answer is always, "It depends." Listen to your body. Really listen and stop being stubborn or stupid! If you start training and you are exhausted, you are doing too much. If you are spending too much time in my office and less on your bike, you are doing too much. The answer is really simple stupid. Listen to your body and it will tell you how much is too much.

Bottom line: Let your body fully recover from your races and quality times will be recorded. Race only one to two marathons or one Ironman triathlon a year. As for other distances, keep in mind that you need one day for every mile of a running race and at least 3 days for every hour you raced in triathlon. Anything shorter, you better take off your watch and go for the finish instead of the time and prepare yourself to spend some quality time with your local sports medicine physician!

Run Happy! And Recover Well! See You at White Rock!

Can You Name 11 Things to Know About 11/11/11?

Do You Know 11 Things to Know About 11/11/11?

1. Did you know that tomorrow, November 11, 2011, happens only once every 100 years? Cool! And No, I don’t think anyone is predicting that the world is ending on that date!

2. It’s your lucky day! Brush it off as nothing more than a prime number, but some people look to the number 11 for good luck. What makes 11 more special than, say, 4, 15, or 3,856? Numerologists associate the number with balance and congruency, and math whizzes think it’s interesting because of little facts like this: If a number is divisible by 11, reverse its digits and that will create another multiple of 11 (for example, 1,056 is divisible by 11 — reverse it to 6,501, and that’s also divisible by 11).

3. Or is it your unlucky day? For every person on Team 11, there’s also someone who wants nothing to do with what they believe is actually an ill-fated digit. The 16th-century scholar Petrus Bungus said that 11 "has no connection with divine things, no ladder reaching up to things above, nor any merit" — and because of this, many numerologists of his time considered the number to represent pure evil.

4. Wedding bells will be ringing! You don’t need good luck to make a marriage last — you need love, respect, and hard work. But maybe it can’t hurt to get hitched on 11/11/11. In fact, more than 24,000 couples across the United States plan to wed this Friday, according to WeddingChannel.com — compared to about 1,500 couples who get married on an average Friday in November and 2,667 pairs who tied the knot last Valentine’s Day.

To prepare for the influx of marriage applications, the marriage license bureau in Las Vegas has even announced that it is increasing staffing on Nov. 11, according to USA Today.

5. There could be a baby boom, too. At Baylor Grapevine, there are already quite a few C-sections on the schedule for tomorrow! What’s even better than having an 11/11/11 anniversary date? An 11/11/11 birthday. And back in February, some parents-to-be did their darndest to conceive a child who would be born on the lucky day. Couples who enjoyed a Valentine’s Day romp could be in luck, as a baby who was conceived around February 18 could very well be born on Nov. 11.

6. Nov. 11 is also Veterans Day. It may be getting overshadowed this year by weddings and gambling, but Veterans Day is celebrated annually on Nov. 11. The United States honors its war veterans on this day to commemorate the signing of the armistice that ended World War I, which went into effect on the 11th hour of the 11th day of the 11th month. This 11/11/11, don’t forget to pay your respects to those who have served our country.

7. And it’s Corduroy Appreciation Day! It’s time to don your favorite pair of cords, since Nov. 11 is also National Corduroy Appreciation Day. It’s been celebrated annually on this date for the past few years, as 11/11 most resembles the lines of the fabric. And since this year there’s an extra 11 in the mix, corduroy fanatics everywhere will be celebrating in a big way: According to MSNBC, events include the Chicagoland Corduroy Appreciation Ball in Chicago and the Annual Grand 111111 Meeting in New York City.

8. Break out the origami and heavy metal. Okay, so it’s Veterans Day, Corduroy Appreciation Day, and thousands of couples’ wedding days. But Nov. 11 is also Origami Day in Japan (where the paper crane symbolizes peace), as well as National Metal Day, when VH1 will be honoring heavy metal music (rumor has it, the original lineup of the band Black Sabbath, including Ozzy Ozbourne himself, may reunite for the momentous occasion).

9. It’s a great day to jet set. Come Friday, Americans will be doing more than tying the knot and sporting cords — plenty of people are also going on vacation to take advantage of the once-in-a-lifetime 11/11/11 deals offered by travel Web sites to celebrate the day. Where is everyone headed? According to Viator.com, the Grand Canyon is one of the top destinations, as well as Paris, New York City, and Niagara Falls.

10. The last 11/11/11 made weather history. Though few people are old enough to remember the last 11/11/11, it was also famous for the Great Blue Norther, one of the biggest cold snaps — a dramatic temperature fluctuation — in U.S. history. For many Midwestern cities, this date in 1911 was only time when record-high and record-low temperatures were broken on the same day.

11. 11/11/11? There’s a Facebook group for that. If you’re feeling like the lone 11/11/11 reveler in your circle of friends, look no further than the 11:11 Facebook fan page. This group of more than 643,000 people from around the world is counting down to 11:11 a.m. on this momentous 11/11/11. Cheers!

Crazy, but I’m sure someone is having a special 11/11/11 race somewhere today! Maybe we should’ve planned that! 11 miles on 11/11/11!

Happy November 11, 2011!

Ps. Most of this was taken from a fun article on http://www.everydayhealth.com/ Thanks guys!

Getting Slower With Age? Sarcopenia is Preventable and Reversible!

So why is it so hard to keep muscle mass when we age? Turns out it is caused by sarcopenia. Really! I'm not making up the term. Sarcopenia is the progressive loss of muscle mass that results from the normal aging process. It has been felt, in the past, that the loss of one to two percent of your muscle mass each year after the age of 40 is inevitable.

Turns out there are lots of things we can do about sarcopenia. One of them is to stop trying to look like a cachectic Holocaust victim and actually build some upper body muscles!! Runners tend to feel like if they bulk up at all in their upper body that it will slow them down. Research actually has refuted this claim over and over, but it is still one of those long-standing running myths. Strength training actually helps preserve muscles and strengthen bones which often improves your running economy and hence makes you more efficient, reducing the amount of energy to run at a certain pace. Win-Win!

Many factors go into the onset of sarcopenia. Chronic disease and environmental factors can accelerate loss of muscle mass, but these are not really controllable. Factors under our control that affect the progression of sarcopenia are motor unit restructuring, protein deficiency, and changes in hormone concentrations. These combine to produce the age related loss of muscle coordination and mass.

Really, it is all about proteins. There are two kinds of proteins; non-essential (those your body can synthesize) and essential proteins (proteins we need to get from foods). Your body seeks a balance between protein production (synthesis) and usage (metabolism) for energy and cell structure. We don't usually lose our ability to metabolize proteins with age, but we do lose our ability to synthesize them. This is where hormone balance comes into play. Things like Insulin-like growth hormone (IGF-1), testosterone and growth hormone. As our bodies age, our hormone concentrations decline. This is why aging baseball players love growth hormone, they think it stops sarcopenia! (Hgh declines after age 40 but there is not good research that proves supplementation will actually help!) What's more, it appears that as we age, we actually require more protein but continue with a similar diet hence we are out of balance.

The hormone decline and protein deficiency one-two punch is largely responsible for sarcopenia, but when you add the most vital aspect - motor unit restructuring - they combine to form a cocktail that results in the physical manifestation of aging. Motor unit restructuring is the product of the inevitable death of neuron cells. Fast twitch neurons (those responsible for precise or quick movements) die off first. When the cell reaches its predetermined life span, it dies. When a motor neuron dies, the muscle fibers that are under its command can deteriorate or atrophy. To prevent atrophy, when a fast twitch neuron dies, a slow twitch neuron nearby attaches itself to the now abandoned muscle fibers, innervating and keeping them alive. This change is known as motor unit restructuring. This is why we become slower and less coordinated as we age.

So how can we thwart this process? Move! Often! Sitting on the couch and leading a sedentary lifestyle is a good way to ensure sarcopenia with age. The best way to cure or at lest slow down the onset of muscle mass loss is resistance training. We recommend our patients participate in daily exercise, but often this is not enough. It will help your cardiovascular system, but resistance training with weights is the only way to reverse muscle mass loss. Couple this with increases protein intake to have the building blocks to redevelop muscles.

So, you want to be able to beat the young pups when you are in your 50's and 60's? Talk to your doctor about any health issues like diabetes or hypertension. Change your diet to higher protein and less carbohydrates. Forgo the pasta dinners and add lean protein! Resistance training with light weights and high repetitions at least 45 minutes, three times a week. Make it a habit you will take into your senior years!

You will thank me when you are still running in your 70's!

Can I Run on a Stress Fracture?

Lots of good questions in my Grapevine, Texas office and on the website this week. It is definitely marathon time of year! Lots of aching feet and legs from erratic training and “too much, too soon, too fast syndrome”.My favorite is “I have XYZ Marathon in a few weeks, Can I run on a stress fracture?” This was actually asked three times in two days by a patient and once in an inquiring email on www.myrundoc.com

Of course, my answer was, “Really?.....” Ok, so you think you are a tough guy and can run through a stress fracture, but this is a very bad idea!

1. Hurts like hell!



2. Probably break it into many more pieces



3. Probably end up not running for months



4. May end up on my operating room table for pins, plates and/or screws!



5. Are you really that stupid???

Seriously? A stress fracture is a small crack in the bone that hasn’t fractured all the way through. Guess what happens when you run on it? It breaks all the way through!

So, if you are running in the Olympic marathon and think you are amazingly tough, then try it; but bottom line: NO! You can’t run on a stress fracture! If you try, you probably won’t be running for quite some time after that race, so it better be worth it!

Learning point: If you even think you may have a stress fracture, an x-ray is indicated pronto! Remember that they often do not show up on plain films for up to two weeks after the injury. The tip of my index finger is usually right! Give us a call and we can squeeze you in. The best part of having 5 doctors at Foot & Ankle Associates of North Texas in Grapevine, is that we can always find an emergency spot with one of our doctors!

Are Custom Orthotics Worth the Investment?

If you are a frequent visitor to Foot and Ankle Associates of North Texas in Grapevine, TX, you probably already know about orthotics. Maybe you have even purchased orthotics. A foot orthotic is an insole placed into the shoe that helps control foot position.

There are two main types of orthotics: Functional and accommodative. These can be prefabricated; like Lyncos that are popular at Healthy Steps or custom; which the doctor fabricates unique for your feet.

A functional orthotic controls foot movement and helps a person walk in a way that best supports joints and muscles. An accommodative orthotic helps distribute foot pressure evenly over the bottom of the foot. Most patients use a functional orthotic and usually these are custom for long term usage. A functional orthotic can be useful for many problems and are used to balance the biomechanics of your feet. Think of them as an in-shoe tire realignment for your feet. Accommodative orthotics are very useful to distribute stress in the elderly, diabetic and arthritic populations.

In the foot care aisle at your local drug store or grocery store, you may have seen readymade orthotics for sale. Does it really matter whether you buy store bought orthotics or custom orthotics from your podiatrist? Well, some people may be able to get away with wearing store bought orthotics for a period of time. We often even start our treatment plans with these type of prefabricated devices so we can get you on the road to better foot health immediately; but most patients do need custom for long term control of their foot type.

When you think about the long term health of your feet, custom orthotics are the way to go! Store bought orthotics are made to fit many foot problems for a large variety of people; one size fits all usually means one size doesn’t truly fit anyone! To be truly effective, an orthotic must be fitted for YOUR particular needs. Wearing an ill fitted orthotic is not only a waste of time, but it can also make your foot problems worse. Over time these problems can lead to leg, knee, hip, and even back problems. Store bought orthotics tend to not offer long lasting comfort. If you find yourself buying store bought orthotics every few months because of foot pain, it may be time to schedule an appointment to see one of the doctors at FAANT. Your podiatrist will produce orthotics that fit only YOUR feet. The materials used will be those that are best suited for your walking and running needs.

Everyone deserves special treatment! With a real custom orthotic that is exactly what you have. Yes, custom orthotics can be costly, but so can surgery from walking incorrectly over the years. I’m always amazed that many insurance companies will often not cover orthotics, but will pay for surgery! Doesn’t make any sense!! Think of the orthotics as an investment and an investment in your health is one of the best choices you can make for yourself.

Marine Corps Challenge!

This looks like fun!

Do you have what it takes to pass the Marine Corps Combat Fitness Test?

Join the marines of dfw and put your skills to the test!
· Go over standards of movement
· Go head to head with marines
· Put your fitness skills to the test as you take the cft
· Open to the public and all branches of military

Where: Stripling middle school
2100 Clover lane fort worth, TX 76107

When: Oct 29th, 2011 open registration 900am - 3pm

First heat begins at 930

Cost: free – donations are welcome

For more information contact sgt eaton
– phone: 419 957 9925
– email: Jacob.eaton@usmc.mil – jaceat83@Hotmail.com

PS. Wear long pants and long sleeved shirt since you will be crawling!!

Who needs a Muddy Buddy run! This is real adventure training!

Winner of the Facebook Google Contest!

Well its been a fun two weeks! Dr Giacalone and I actually ended up in a tie!! I guess we both win dinner! The other docs are having a fit because now we both have more funny and informative reviews than they do. We might have to let them in on the fun???? Maybe....

The winner if the free pair of running shoes was Julie Wolfe! Come claim your prize at Healthy Steps!

More contests to come! This was too much fun!!

Poconos 70.3 A Perfect Storm…and 68.1 Really!

Crazy Weekend! Wet, Rainy, Cold, Hilly and the most ridiculous course I’ve ever ridden! Let’s be serious. The weather was awful! I had picked a race in the Northeast because I was sick and tired of feeling like I was running on the face of the sun! God has a sense of humor. I was thinking it would be a balmy 65 degrees or so and warm up to 70? No, how about 41 at the start that warms up to 55! Did I mention the rain? Yes, it rained for something like a week before the race so the river was so high we couldn’t swim.

The Delaware River Gap was 7 feet above its banks and had so much debris they were worried one of us would get killed. I get that. Honestly, I was a little miffed until I went down to the river and saw how high and how fast the current was flowing. Then I was glad we weren’t swimming. It was scary looking!

So we started with the bike. Hmmm…how do you get 2,000 people on a bike course without killing themselves in a mass start? Time trial start…sorta. They started the pros with 30 second intervals at 7:25am….yes, a little late. The rain and clouds made it a little dark at 7am. Then they started with the age groupers at 3 second intervals…really! So much for no drafting. We were all bunched up on wet roads that were absolutely scary at times. The first half of the bike course was all bunched up and very, very hilly, with a lot of scary turns. Lots of crashing! At one point I was going 34 miles an hour down a hill and watched the guy in front of me wipe out on the turn. At that point I hit the brakes and thought perhaps a slower ride was the better side of valor. The hills were unrelentless. At 50 miles, there was a 5% grade after turning a corner. I did something I have never done since grammar school. After watching one guy fall off the hill with his bike (no time to unclip), I got off and walked the hill! I was embarrassed until I saw about 10 people after me do the same thing! This course was crazy, sick hilly!

Into T2 I went with completely screaming quads! I put my running shoes on and took off only to find that my legs were dead! Really dead! I jogged a few miles and they seemed to warm up, but then I hit someone’s version of a joke! Crazy, rolling hills on the run. All kidding aside, they were nothing like the hills on the bike, but we were all bitching and moaning. I saw more people walking than any race I have ever run. I pathetically jogged into the finish. Happy to be done. Freezing! Crazy, cold, rainy weather plus sick course makes for a miserable day. Whatever doesn’t kill you makes you stronger.

Perhaps I should venture down to the Longhorn 70.3 in three weeks in Austin and kick some butt, because honestly the Poconos 70.3 kicked my butt! Happy to be alive and smiling! Time was pathetic but I finished. The older you get, the more that matters than the watch!

Facebook Contest For Google Places

Dr Giacalone and I have a bet at the office about who can get the most Google reviews in the first two weeks of October. Help me win by posting a review to Google Places formerly known as Google Local. If you post a review of the practice and/or review just me and email me a copy, I will enter you in a drawing for a free pair of Brooks running shoes or a pair of orthopedic sandals from Healthy Steps Shoe Store. Yes, I am bribing you. Shhh! Don't tell Giacalone! You can get two entries if you do both the practice and me individually. I will even throw in a third and fourth entry if you review me and/or review the practice on Yelp! Contest starts right now and ends on Saturday October 15th! I will keep all of you updated on how the contest is going so please help me win!!

Knee Woes From Running: Iliotibial Band Syndrome

I had a great question this weekend at a running forum in Grapevine. One of the runners had lateral knee pain that came and went with no obvious cause. She thought she had ITB (iliotibial band) syndrome (sounded like symptoms her friend told her about) but she had been doing stretching and icing with no avail. What else could she do? Is it possibly from her shoes? Is rest enough?

Let’s talk about ITB syndrome.

The most common cause of lateral knee pain in runners is ITB syndrome, related to repetitive friction of the band sliding over the lateral femoral epicondyle as the knee flexes and extends.

Runners may complain of a sharp or burning pain about 2 cm superior to the lateral joint line (above the outside of your knee); exam may reveal tenderness to palpation there. Swelling and redness are usually not present unless it is severe.

Runners who are predisposed to this injury are typically overtraining. They often have underlying hip abductor muscle weakness; leg-length discrepancies may contribute to ITBS. They also have been found to have either a really high arched foot (cavus foot type) or an extremely flexible flat foot.

Acute phase treatment includes relative rest, ice, and anti-inflammatories. Physical therapy modalities like ultrasound and e-stim can also be helpful to break the inflammation cycle. In cases of severe pain or swelling, corticosteroid injections may be used.

During the subacute phase, stretching of the ITB is emphasized, along with soft-tissue therapy for any myofascial restrictions. Orthotics and shoe gear changes are also often indicated. Many patients actually are running in too heavy or too stabilizing shoes, especially if they have a cavus foot type.

The recovery phase focuses on a series of exercises to improve hip abductor strength and integrate movement patterns.

The final return to running phase is begun with an every-other-day program, starting with easy runs and avoidance of hill training, with a gradual increase in frequency and intensity. Remember: too much, too soon, too fast is what got you hurt in the first place!

Rest alone is usually not enough! This can be a painful chronic injury. Surgery can be considered in refractory cases, but this is rarely indicated.

The Hottest Hotter than Hell Hundred in History!

Wow! If you ever think about doing the Hotter than Hell Hundred Triple Threat, check the weather forecast! This weekend was absolutely crazy, borderline insane, and if nothing else….HOT!

Janet and I, in our usual fashion, were wandering the office causing trouble, when Janet said, “Hey! Want to do the Triple Threat at the Hotter than Hell Hundred bike ride?” I thought it might be fun, and had missed the ride the last few years due to scheduling conflicts. Janet went on to explain that it was a 12 mile beginner mountain bike ride on Friday night, the 100 mile road bike ride on Saturday, and a tiny little half marathon trail run on Sunday morning. Sounded like a full weekend, but what the heck.

We wrapped up seeing patients on Friday and jumped in the truck, heading for Wichita Falls. We checked into the nicest hotel in the whole city (Yes, they have one Marriott Courtyard) and made our way down to the expo to get our numbers and directions for this madness.

After a little bit of shopping and losing a timing chip, we made it to the mountain bike start with a whole 15 minutes to spare. I had already chickened out (I don’t own a mountain bike, didn’t want to borrow one, and heard way too many crash stories), but Janet was ready to go. A good group of about 10 people from our running peeps, Lake Grapevine Runners and Walkers, had also decided to try their hand at this madness; so group psychosis was also occurring. Did I mention the temperature was 103? The head official explained all the loops and turns and a little water crossing right near the end. The gang took off and I decided that perhaps watching the race at the water crossing might be fun.

Fun it was! Not one person made it across the water crossing without dismounting, either by choice or falling face first into the water! I saw one broken front wheel and one flat tire, but mostly just very graceful water landings. Janet came through and was smart and portaged her bike. I ran to the finish to meet the gang and knew immediately we had a problem. Janet had a bruise the size of a small dinner plate on her shoulder and had her not happy face on. Turns out she challenged a tree and the tree won!

We decided to head back to the hotel for ice, Advil, a shower and of course beer. Beer and a good dinner cure all bumps and bruises. We hooked up with our friend Debbie and had a great steak dinner and more than a few beers. Then it was time for bed. 5am comes early!

The alarm went off at 4:30 am and that was the first time I had the thought, “Why do we do this?” We got our bikes and gear together, shoveled down a little breakfast and we were off to meet the peeps. The three of us were awake and ready to take on 100 miles with 10,000 of our closest friends. The temperature at the start was 80. Not bad, with a little breeze. We saw our LGRAW friends, but they decided to start toward the front of the group called “the Scorchers”. That’s the people who ride from 20-25+ mph. We were in “the Keepers”, planning to average 17-20 mph or so. We positioned ourselves at the front of the Keepers, or the back of the Scorchers; however you want to look at it. We all had our bike lights on because it was still dark and that made an impressive sight with all the blinking tail lights, in fact, I felt like if I stared at them long enough I could hypnotize myself into thinking I was still in bed! The cannon went off at 6:15am (they allowed an earlier start this year for those that wanted it or you could start at the official 7am start but given the heat, why would anyone do that?)

Off we went. The first few miles was slow and had a few stops due to the crowd, but by 10 miles or so it started to thin out so you could ride comfortably. The three of us were riding together and then Debbie dropped her sunglasses. (Yes, it was still dark so they were in her side pocket) She went back for them, but only found pieces.

We all skipped the first two aid stations and stopped at 30 miles. So far, so good. Everyone felt good and the heat was not a factor yet. We then stopped at every other aid station until we got to “Hell’s Gate”. This is the official spot (around 60 miles) that you have to get to by noon, or they turn you onto the 100K route and make you go home. We got there about 10 am, so Hell’s gate was still open and we got our picture taken with “Pyro Pete”, a gigantic devil blow up doll!

Hell’s Gate is appropriately named, because the route passed that point is rolling farmland with very little shade, bumpy roads, and it was getting hotter by the second. We started stopping at every aid station and I started putting ice in my jog bra to try to cool down my core. I actually felt alright as long as I kept drinking, but Debbie was starting to look bad and Janet was getting very quiet. I have to admit, between 70 and 90 miles, it felt like someone had opened the oven door and shoved my head in! Or maybe a blast furnace? Even the wind was hot, so it didn’t cool you down at all. We were all feeling the heat, but were still plugging along. We dropped from 18-20 mph to about 16 mph. The carnage all around us was remarkable. The SAG wagons had tons of people and bikes on them, but you still saw the occasional biker under a tree or passed out on the side of the road. My day was complete when I saw an armadillo and a coyote in the same 5 mile stretch! Gotta love Texas in the summertime!

Debbie and I stopped at the 90 mile aid station to try to get more ice, but Janet plugged on. She said there was beer at 98 miles and she really wanted one! We got to the “Unofficial 98 mile aid station” and I thought I was seeing a mirage. There had to be at least two hundred people hanging out and drinking beer, eating chips and sausages, and having a party in an old machine shop on the side of the road! It was hysterical. We found several of our friends just hanging out there, and made many new friends after a few beers. One guy said he finished at 10:30 am then came back to his favorite aid station. Lots of people were completely hammered! Too funny! After a few beers, we collected our friends and decided it was time to make it to the finish line. Two miles of slightly impaired cycling, we were finally finished!

They had a fire hydrant open and spraying everyone at the finish, so we stripped off our shoes and went dancing in the water. So happy to be done!

Back to the hotel for showers and a long deserve nap. It was the local news that let us know it was the hottest Hotter than Hell Hundred on record, topping 109! No wonder I felt like I was in an oven!

After our naps, we joined our friends for beer and BBQ at their campsite. (Yes, a lot of people bring campers and stay the weekend near the trails) Janet and I like camping at the Marriott better!

Then the alarm went off at 6 am this morning! Again, I was thinking, “Why do we do this?”, but I got up and putting on my running gear. Yes, it was time to do a trail half marathon. On the same course as the mountain bike ride on Friday night! Yes, a water crossing and everything! We met our still crazy friends at the start. Everyone had survived so far with just a few bumps and bruises. Janet decided we should walk run the course given our legs hurt from the previous day’s small endeavors, so we walked. And ran up and down these crazy hills and valleys, singing over the river and through the woods. The two of us finished up together laughing to the point of almost crying because we had both reached fully nuts when Janet almost stepped on snake #3 that we saw on the trails just about 400 yards from the finish! That will get your heart rate going!

Happy to have finished, Janet got a really cool cyprus plaque proclaiming that she had survived the Triple Threat….and yes, it was 104 at the finish! What a weekend!

Ps. stay tuned to my Youtube channel, I made a video of the weekend.....

Spareribs Sure Fire Injury Cure

Thanks to the shout out from my friend and running peep Spareribs LaMothe in the Dallas Morning News Running Blog this morning. He made a few great points about injury management in his blog. The two best were to seek professional help early in the injury course. The faster you obtain a correct diagnosis, the sooner you will get better! The second point was to find a doctor who runs! As a sports medicine podiatrist who endulges in border-line crazy endurance sports, I speak your language and have a network of other doctors and therapists that are all on the same page! If your doctor thinks that "LSD" is still a drug and not an acronym for "Long Slow Distance", maybe you need another doctor for your running injury! Thanks again Spareribs!

John J. Kelley, May He Rest in Peace

My heart is saddened by the passing of John J. Kelley, the first true marathon champion who influenced my life. I remember many cold mornings in Mystic, Conn. Sharing soup after a freezing penguin run from Kelley’s Pace, the store he ran after his retirement. He was an amazing man and a true mentor to high school and college students in the area.

I grew up in Ashaway, Rhode Island, just over the Connecticut border. He was a coach to everyone, not just the kids on his team. His store was the closest true running store in the area. I always wondered as a young tenn how he made any money since he chatted with everyone for hours at end. Turns out, he never did. The store was just an outlet for his passion. He always had a New Years party that included a run and a dip in the Atlantic Ocean for the crazy! Many years I joined in during high school.

He died on Sunday in North Stonington, Conn, just a few miles from my hometown. He was 80. I probably saw John for the last time in 2002 at the Boston Marathon. My last conversation was in 1986, just before I graduated from high school and ran away from my little rural hometown as fast as I could. I only wish more young people could’ve been touched by Mr. Kelley. I remember most a day in his store when he told me that I could do anything I put my mind to as long as I developed pain tolerance! He was quite the man!

John J. Kelley will be missed.

Joining the Mile High Club? Tips for Running at Altitude

Are you a member of the Mile High Club? No, not the one that involves airplanes and yoga poses! I’m talking about running at elevations of 5,280 feet and higher.

I’m on my way to Colorado to spend a week with my kids at Keystone. Of course, I’m excited to get in some trail runs, but a little worried about the altitude. I called a few of my friends who live in the Mile High State and got some tips on running at altitude that I figured I would share.

Running at a higher altitude can make you feel like a slug, and an asthmatic slow one at that. However, if you’re careful, and keep some of the following tips in mind, high altitude running can be very enjoyable and great for racing at lower altitudes!

1. Hydrate. Drink plenty of fluids before, during and after your run. Then drink some more. Dehydration occurs quicker at higher altitudes, so this is good advice even if you won’t be running.
2. There’s less air up there. This is a good news/bad news situation. The bad news is that according to my buddy, Dr Jack Daniels (coolest running coach on the planet!), at an elevation of 6,500 feet you lose 10 percent to 12 percent in VO2 max and at 7,500 feet you lose 12 percent to 15 percent. The good news is that a lower density of air means lower air resistance and better running economy. You just keep telling yourself that when you’re winded like an overweight smoker climbing to the top row in the stadium.
3. Enjoy the view. You should prepare yourself for a slower paced run than you’re accustomed to and you’ll find that focusing on the surroundings instead of your watch will make that easier. Running with peeps also helps! Bring a friend or two and you can be asthmatic together!
4. Wear sunscreen. Putting yourself a mile closer to the sun may seem insignificant when you think about how far away the sun is, but I assure you that it will not feel insignificant tomorrow if you fail to heed this advice. Think ahi tuna!
5. Lip Balm, and plenty of it. When you pass another runner you want to be able to wave and crack a smile, not your lips.
6. Take it easy. Stick to easy runs until you become acclimated; if ever. Wear a heart rate monitor so you can see when you are out of your zones. Don’t look at your watch, just set the heart rate alarm. Time means nothing! Don’t try to go out and run a tough session of intervals on your first run at altitude. If you’ll be racing at a high altitude, plan to spend as much time as possible at that altitude prior to the race.

Bottom line: Take it slow and easy and enjoy your runs!

Really? Invisible Shoes For Running

I received a really neat package in the mail that included two pairs of “Invisible Shoes”, sent to me by the folks at Invisibleshoe.com to try out. My first thought was, “This is crazy!”, but as most of my readers know, I will try anything once! I have in the last few years embraced minimalism and have transitioned many of my more elite patients to a more midfoot striking natural running style in minimalist shoes. This is only about 15% of my patients, while the rest still need the control of an orthotic due to foot abnormalities and old injuries. (Yes, I know the debate continues on these issues, stop sending hate mail!)

I currently run in the Saucony Kinvara and wear the Saucony Hattori for walking and gym workouts. I am curious to see how the “Invisible Shoe” compares to the Hattori. I am still not a fan of totally barefoot due to the concrete jungle we live in and I have never liked the Vibram Five Fingers; but mostly because so many of my patients have hurt themselves in them and the shoving my toes apart thing I personally find totally annoying. I use my pair of Vibrams for open water swimming. They protect my feet from rocks in the lake!

A little over view for those trying to figure out what I am talking about. There is no other shoe in the minimalist footwear industry as truly minimalist as the huarache. Think a piece of rubber on your foot is as close to barefoot as it gets. Your feet are free to move in the most natural way with no fabric upper to impede or constrict foot movement in any way. Yes, on the surface I still was thinking this is nuts!

The “How to Make Your Invisible Shoes” directions on the website were easy to understand, but took a little longer than expected to put together. A punch tool was needed but I didn’t have one so we improvised.
All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.

My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.

Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.

If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.

Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!

Wow! This week I had the worst chronic peroneal tendon rupture I have ever seen! My patient had sustained an “ankle sprain” about two years ago and wondered why her ankle looked more like a “cankle” two years later. She had a large lump just behind her fibular malleolus (a.k.a. the bone on the outside of your ankle). She noticed swelling on and off, but it never really went down all the way. She also had intermittent pain and felt like her ankle was unstable. Like most women with several children, she ignored it until it really became a lifestyle issue. She felt like she couldn’t exercise at all because her ankle felt so unstable.

Peroneal tendon injuries often occur with ankle sprains and are commonly overlooked until your ankle pain becomes chronic. The peroneal tendons stabilize the outside of your foot and ankle and allow you to turn your foot outward. There are two tendons which run side by side, behind your outer ankle bone, then split in the foot; one to the outside while the larger one dives under your foot and inserts in the arch just behind your big toe joint.

People with high-arched feet are more likely to experience peroneal tendon injuries.

Peroneal tendon injuries fall into three categories: tendonitis, tears, and subluxation. They are more common in active, athletic patients and can be acute (sudden) or chronic (lingering) in nature.

Tendonitis is inflammation, acute tears are caused by an injury and tendonosis (chronic tears) are usually caused by overuse and repetitive stress or chronic tendonitis. Subluxation usually occurs in an acute injury, like an ankle sprain, where the tendons actually dislocate onto the outer ankle bone and snap back and forth with activity.

The symptoms of a peroneal tendon injury can include swelling, pain, warmth, weakness and instability of the foot and ankle. Subluxation can also include a snapping feeling and sporadic pain with activity.

Treatment of peroneal tendon injuries is often delayed by misdiagnosis. If you are experiencing any of the symptoms of a peroneal injury, seek medical attention from a foot and ankle surgeon urgently. The longer the tendons go untreated, the more damage occurs. X-rays and physical examination usually lead to an MRI to solidify the diagnosis.

My patient’s MRI showed a severe rupture of peroneus brevis with a bulbous scar tissue formation which you can see in the below picture. Peroneus longus was normal.

Treatment include rest, casting, functional orthotics, anti-inflammatory medication or injection therapy, physical therapy, bracing, and in some cases surgery. Obviously, my patient needed a repair. We excised the torn and hypertrophied part of the tendon, then repaired the rest and fixed her ligaments so she would stop being so unstable and finally lose her “cankle”.


Here is the piece of abnormal tendon we excised. Wow! Big chunk!!



Your disability from a peroneal tendon injury can be significantly reduced by early intervention, so if you are experiencing any of these symptoms, call or contact the office and be evaluated. The sooner you have a proper diagnosis, the faster you will return to normal activity levels pain-free. If my patient had come in earlier to have her “ankle sprain” evaluated, conservative therapy might have healed her tendon injury!

Podiatrist Raises Money for Muscular Dystrophy Carrying Patient in Triathlon

I rejoice every time I see another podiatrist doing great things in their communities. I was so excited when I read an article about one of my colleagues, a fellow sports medicine podiatrist and Ironman triathlete, who raised money for muscular dystrophy by carrying one of his patients, a local 10-year-old boy with MD, for an entire sprint triathlon last weekend.

We have all been inspired by Dick and Rick Hoyt's many adventures in marathon running and triathlon; but to carry another person while competing is actually an extrememly difficult task. Paul Sommer, DPM, a podiatrist in Valparaiso, Indiana, found this out when, after finishing the Valparaiso triathlon last weekend, he was rushed to the emergency room with shortness of breath and a rapid heart beat. Luckily he was OK after his escapade! He did manage to raise over $6000 to help a little boy named Kyle put wheelchair ramps on his home.

If you would like to help Dr Sommer in his fight to help families affected by muscular dystrophy, click here.

Recovery Drinks? What Should I Eat and/or Drink After a Race?

Ok, I have been joking all week with my triathlon peeps that beer is the best recovery drink! But seriously, I think there are two questions that need to be answered:

1. How much do I really need to drink after exercise, especially in this ridiculous heat?

2. What is the best thing to drink and/or eat?

So, here are some simple answers to what is actually two very complex questions! Remember that individuals all differ and our sweat ratios also differ. A great way to determine how much fluid you need after a race or long run or ride is to weigh yourself before and after exercise and replace fluid losses by drinking 20-24 fl oz water for every 1 lb lost.

What should you drink and/or eat? Yes, I like beer after a race but science shows that you should consume a 4:1 car/protein ratio. (I hear all those fans of chocolate milk cheering).

Research has shown that eating 0.3-0.6 grams of carbohydrate for each pound of body weight within two hours of endurance exercise is essential to building adequate glycogen stores for continued training. Waiting longer than two hours to eat results in 50 percent less glycogen stored in the muscle. The reason for this is that carbohydrate consumption stimulates insulin production, which aids the production of muscle glycogen. However, the effect of carbohydrate on glycogen storage reaches a plateau.

Research also shows that combining protein with carbohydrate within thirty minutes of exercise nearly doubles the insulin response, which results in more stored glycogen. The optimal carbohydrate to protein ratio for this effect is 4:1 (four grams of carbohydrate for every one gram of protein). Eating more protein than that, however, has a negative impact because it slows rehydration and glycogen replenishment.

One study found that athletes who refueled with carbohydrate and protein had 100 percent greater muscle glycogen stores than those who only ate carbohydrate. Insulin was also highest in those who consumed a carbohydrate and protein drink.

Consuming protein has other important uses after exercise. Protein provides the amino acids necessary to rebuild muscle tissue that is damaged during intense, prolonged exercise. It can also increase the absorption of water from the intestines and improve muscle hydration. The amino acids in protein can also stimulate the immune system, making you more resistant to colds and other infections.

Good replenishment food?
1 medium banana and glass of low-fat milk.
A bowl of granola with 1 C low-fat milk.
Low-fat yogurt with 1/2 C of fresh berries.
Almond butter on whole wheat toast.
A bowl of whole grain cereal with low-fat milk.

Bottom Line

If you are looking for the best way to refuel your body after long, strenuous endurance exercise, a 4:1 combo of carbohydrate and protein seems to be your best choice. While solid foods can work just as well as a sports drink, a drink may be easier to digest make it easier to get the right ratio and meet the 30 minute window. Personally, I’m sticking to beer and will add a peanut butter and jelly sandwich!

How Do You Know When You Need Rest?

Good question. Personally, I err on the side of caution. If I’m tired when I wake up in the morning or I feel like I was run over by a truck…..well, that’s a good indication to take a day off. Many runners and triathletes burn the candle from both ends. The old saying is that it is better to be 15% undertrained than 1% over trained. This is my motto that allows me to take a day off here and there when the fatigue of the mega miles is kicking in. I find that I race way faster when not fatigued! Really!! (Sarcasm)

So, do you get adequate rest? How can you gauge your fatigue if you are a sadomasochist training for an Ironman or marathon? The June issue of Runner’s World has a great article on gauging rest. I had to laugh, because you can actually pay someone to tell you to take a day off! Simple solution: Pay me!! Just kidding, let’s look a little closer at guidelines for rest days.

On a serious note, there is a service called Restwise, which looks at simple biological markers input by the athlete first thing each morning, calculates a daily recovery score from 1 to 100, then trends it over time. (Rest-wise subscriptions start at $119 for six months; go to restwise.com.) You certainly can pay them, or you can look at 10 biological markers and rate yourself.

1. BODY MASS: You lost weight from yesterday
A two percent drop in weight from one day to the next indicates a body-fluid fluctuation. Most likely, you didn't hydrate enough during or after your last workout. Dehydration negatively impacts both physical and mental performance, and could compromise the quality of your next workout.

2. RESTING HEART RATE: Your resting heart rate is elevated
Take your pulse each morning before you get out of bed to find what's normal for you. An elevated resting heart rate is one sign of stress. It means your nervous system prepared for fight or flight by releasing hormones that sped up your heart to move more oxygen to the muscles and brain. Your body won't know the difference between physical and psychological stress. A hard run and a hard day at work both require extra recovery.

3. SLEEP: You didn't sleep well or enough
A pattern of consistently good sleep will give you a boost of growth hormones, which are great for rebuilding muscle fibers. Several nights in a row of bad sleep will decrease reaction time along with immune, motor, and cognitive functions—not a good combination for a workout.

4. HYDRATION: Your pee is dark yellow
This can be an indicator of dehydration, barring the consumption of vitamins, supplements, or certain foods the evening before. The darker the color, the more you're struggling to retain fluids, because there's not enough to go around. You need H2O to operate (and recover).

5. ENERGY LEVEL: You're run down
If your energy level is low, there's something amiss. The key is honesty. Athletes can block out signs of fatigue to push through it, thinking it will make them stronger. It won't always work that way.

6. MOOD STATE: You're cranky
When your body is overwhelmed by training (or other stressors), it produces hormones like cortisol that can cause irritability or anxiety. Stress also halts chemicals like dopamine, a neurotransmitter in the brain that has a big bummer effect on mood when depleted. Crankiness probably means not enough recovery.

7. WELLNESS: You're sick
Any illness, or even a woman's menstrual cycle, will increase your need for energy to refuel your immune system, which is having to work overtime. This means fewer resources available for recovering from training.

8. PAIN: You're sore or nursing an injury
Whether you're sore from overworked muscles or an injury, your body needs more energy to put toward repair, lengthening total recovery time.

9. PERFORMANCE: Your workout went poorly
This is a subjective measure of workout quality, not quantity nor intensity. If you felt great on yesterday's run, you'd evaluate that as good. If you felt sluggish on that same run, you'd count it as poor. Trending workout quality—multiple poors in a row—is one of the easiest ways to identify the need for more recovery.

10. OXYGEN SATURATION: Your oxygen level has dipped
The amount of oxygen in the hemoglobin of the red blood cells can be measured by placing your fingertip in a portable pulse oximeter, a gadget available online for about $40. The higher the percentage, the better: Above 95 percent is the norm at sea level or for an athlete who is fully acclimated to a given altitude. This is a new area in recovery science, requiring more research, but there may be a link between low oxygen saturation and the need for more recovery.

Count Your Red Flags

The restwise algorithm assigns more weight to some markers (e.g., performance) than others (e.g., mood), along with other factors to generate a precise recovery score. But you can get a sense for your ballpark recovery quality by tallying the red flags (left) you average per day in a week.

0-1 GREEN LIGHT
You are clear to train hard.

2-4 CAUTION
You can go ahead with a hard workout if your training plan calls for it, but cut it short if it feels too hard. Better yet, take an easy day, or a day off.

5-6 WARNING
You're entering the danger zone, which could be intentional according to your periodization or peaking protocol. If not, back off.

7-10 DANGER
You require mandatory time off, ranging from a day to a week, depending on the severity of your fatigue and what you've seen over the previous few days and weeks. You may need to visit your doctor.

FEEL Better: Too much rest has its own problems: Your performance stalls. On your recovery days, do something active; go for a leisurely bike ride or swim (I take my 11 year old out on her bike), walk, or do yoga.

Keep in mind that muscles need 48 hours to recover from a hard workout. Always follow a hard day with an easy one. Watch your red flags and rest accordingly. Your times will show improvement!

Patellofemoral Pain Syndrome in Runners: Pain in the Knee!

Knee Pain Slowing Your Run to a Crawl? You may have patellofemoral syndrome.

What is patellofemoral pain?

Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.

The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the "patella") moves on the groove of your thigh bone (called the "femur"). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been implicated as a cause.

What can I do to help my knee mend and relieve the pain ?

Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.

Physical therapy is the mainstay of treatment. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.

Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease excessive foot motion that causes stress on the knee. Even just a simple arch support insert can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.

Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.

Will I ever be able to run again?

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won't get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability. Remember, you'll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”. Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

My new favorite sign!

Safety Tips for Running in the Summer Heat

Hot running is here again this summer. A little too soon for me! It’s 80 degrees at 6:30am, 100 degrees by 1pm; and let’s face it: it’s really hard to get motivated to run!

Goals are important during the summer training months. When you look at your calendar and see the races you have penciled in, getting out of bed is a lot easier. Pick a race in the fall and enter! I have already entered the Ironman 70.3 Pocono Mountains in October and the White Rock Marathon in December. The power of the race calendar gets me motivated to get the workouts done on these hot, hot days.

I also encourage everyone to try to get their workouts in either early in the morning or inside at the gym in the afternoon. Ozone is so high during the afternoon hours and poor air quality warnings abound this time of year. No reason to stress your upper respiratory system; do it early or do it inside!

Just a few tips to keep yourself safe this summer while running in the heat:

1. Hydrate. Sounds obvious, but I don’t mean only when you are running. I keep a water bottle next to my computer and try to drink on and off all day. The heat outside mixed with the air conditioning inside is a recipe for dehydration even before you start running. While you are training, make sure you carry a water bottle. Don’t rely on there being water on a course or water fountains on the trail being in working order. Drink 15 minutes before your run and at least every 15 minutes while running.

2. Dress for the heat. Naked is never a good idea, but I have thought about it. I’m sure the Grapevine police wouldn’t mind! Seriously, this is not the time for cotton t-shirts. Splurge on some moisture wicking shirts and shorts. There are even some new sun repellent, yet surprisingly cool, long sleeve shirts for the fair skinned ones among us who can use the extra SPF.

3. SPF is what it is all about. Sunscreen or you will burn in as little as 15 minutes of sun exposure. Bull Frog makes an SPF 100 water proof sunscreen that rocks! Wear it! No sense being in great shape but dying of skin cancer!

4. Salt Tablets. If you are going long, salt tablets are helpful to keep your systems going. I take at least two an hour when training in the heat, more if sweating like crazy. Hyponatremia (low sodium) can become a medical emergency!

5. Wear a heart rate monitor. You will be amazed in how much your heart rate goes up when it is hot. Stay in your zones, even if that means walking up hills! You want quality miles, not garbage miles!

6. Use common sense. Get heat acclimatized by running short distances in the heat and building up slowly. Don’t go out the hottest day of the year so far and do a track workout at 3pm in the afternoon! If you are pushing the envelope, be aware of the sign of heat exhaustion. If you are feeling light headed, have goose bumps or your heart is racing; time to find a tree or a neighbor’s house. Heat stroke kills too!

Get motivated and get out there, but run safely in the heat so we can all enjoy the fall race season!

National Running Day! Let's Celebrate!

Today, June 1, 2011, is National Running Day! You may run alone, but on National Running Day, we celebrate together! On this day, runners everywhere share their passion for a lifestyle that is one of the best, and simplest, ways to stay fit—and so much more. You can head out solo to clear your mind, gab with your regular running peeps, or turn an unsuspecting friend into a running fiend. This day is for us!

Pass on the passion! Today is a great day to inspire a friend to start running! Tell us why you run!

Black Toenails are Common in Distance Running

Over my 30+ years of distance running, I've had many black toenails. In fact, I suffered one at Ironman Texas last weekend! A few of my friends, who also participated, stopped by the office this week for black toenail treatment. The following is my advice in trying to avoid and treat this common problem.

Almost everyone who runs will eventually get a black toenail. Getting your first one is a sign that you are now part of the endurance club. Its kinds like cycling. There are two types of cyclists; those that have fallen and those that will fall. While most runners blame a shoe that is too small, this is often not the main cause. Mine was from the well-meaning volunteers who soaked my running shoes trying to cool off the triathletes with their hose! Squish, squish, squish for 26.2 miles equals blisters and black toenails!

If a toe is under pressure from the shoe or a sock that is too tight or too thick, the sustained pressure, step after step, produces an impact or a friction problem between the toenail and the tissue surrounding it. When the tissue gets damaged, fluid accumulates. This is known as a subungual hematoma. The red or black color is the result of a few blood capillaries that become broken in the process. The more fluid that accumulates, the more pain. The extra fluid, colored by some blood, accumulates below the toenail. When the pressure gets too great, the existing toenail will be separated from the nail bed.

Really, most of the pressure that results in this "toenail injury" is produced by the regular action of the foot coming forward, thousands of times every mile. Each time your foot swings forward, a little extra blood is pushed into the toe region due to the force of the foot coming forward. If you increase your distance regularly and very gradually, your toes will adjust to each new maximum distance and only complain when you extend farther. In a marathon training program, almost everyone gets at least one black toenail. Running faster too soon and too long will increase the chance of this injury.
Hot weather also improves your odds of getting one. When it's warm, your feet swell more than they would on cold days. Because there is more pressure, and more fluid, there are more black nails generated during the summer months. This is especially true when it is humid!

How do I prevent black toenails?

You'll reduce the chance of a black nail if you ensure that you have enough room in your toe area when you fit your shoes. At least half an inch is needed, when you're standing in the prospective shoes (in the sitting position, the toes aren't all the way forward). If you've had a history of black toenails and summer is approaching (or here), you may want more toe room. When you add more room at the end, ensure that the arch of the shoe matches up with your arch. Also, run in the shoe before you buy it to make sure that the shoe isn’t too big and that your foot doesn't slide forward as you're running, which can aggravate the toe more than a tight toe box.

Do all black toenails need to be treated?

Leave black toenails alone and allow them to grow out if they are not painful. About 70 percent of the black toe problems are best treated by ignoring them. The damaged part of the nail is gradually pushed out, and the foot slowly returns to normal. If they are painful, red, or swollen; time to see your podiatrist.

Can I just stick a needle in it to drain it?

Do not attempt bathroom surgery! Many runners will heat up a needle and drain the fluid under their nail. Often this introduces bacteria and now you have a painfully infected toe!
Take any sign of infection seriously. If it continues to hurt or the pain increases, this is a bad sign. Toe infections can lead to cellulitis (blood poisoning), gangrene, and worse, especially if you have diabetes. See your podiatrist first, not last!

Will I lose my toenail?

The short answer is - yes. It will take a few weeks or months, but as the toenail continues to grow, eventually it shoves out the damaged, blackened toenail. The black toenail is raised off of the toenail bed, and underneath it is often the healthy remainder of your toenail. Your black toenail will gradually loosen from the sides and you will be able to trim it away.

When will my toes be pretty again?

If pretty toes are important to you, you can paint the black toenail or even the thin new toenail, or the bare skin. You can also stop by Healthy Steps and have a prosthetic nail put on by our licensed medial nail technician. Most people won't notice the difference if you use a darker shade of polish. Full replacement of your toenail takes about 3 to 6 months, and the new toenail will often be a bit wavy, thin in some areas and thicker in others. After 8 to 10 months your toenail should be back to normal (unless you get a side infection of fungus….another topic).

Black toenails are part of distance running, but take them seriously or they can stop you in your tracks!

The Last Road to Ironman Texas: FAANT Style!

Follow Dr Crane and Janet on their journey to Ironman Texas 2011!




Comment freely :)

Thoughts on the Eve of Ironman Texas

I'm leaving with Janet in the morning to drive down to outside of Houston, Texas, to check in for our first Ironman. The Inaugural Texas Ironman. Six months ago I felt like I had all the time in the world to train for this event. Three months ago it felt like time was standing still and it would never come. Last week I started freaking out that I hadn't done enough training and I may perish on the streets of The Woodlands, TX. Wow! The journey really is the destination. No matter what happens this Saturday morning, I know that Janet and I have grown as athletes, bonded as deeper friends, pushed our personal barriers past even our own imagination and really enjoyed all the miles we have covered together and apart over the last few months.

My thoughts turn to 30+ years of distance running and all the marathons I have done in the last 12 years; and I realize that they have prepared me for the race ahead by allowing me a glance into the depth of my soul. Let's face it, the race really happens in your head. It is a constant battle between the urge to stop so your pain goes away and the mental push to keep going because pain is temporary and the finish line is forever!

Good Luck to everyone who is racing this weekend. I will leave you with two thoughts and a short prayer:

Two Great Quotes for Endurance Athletes:

The race is not only to the swift, but to those that keep on running....Anonymous

Beyond the very extreme of fatigue and distress, we may find amounts of ease and power we never dreamed ourselves to own; sources of strength never taxed at all because we never push through the obstruction.... William James

The Triathlete’s Prayer

Oh God, you have taught us to compete with perseverance the race that is set before us.

Give me good courage to run this race to the finish.

Be with me when I am in the water and on the land, so that I may feel your presence in all things

In wind and in weather, in the beauty and the magnificence of nature in the passing scene and in the health and rigor of my body straining to meet this challenge.

May I compete in this race in a way that brings honor to You, myself and those with whom I compete.

When I finish the race, may I do so humbly and should I not finish may I accept it with equal grace knowing that I have done my best.

Thank you Lord for giving me the courage to tri.

Amen.

Tips for Your First Ironman

Tips for Your First Ironman

Since I am officially freaking out about the fact that we are one week from Ironman Texas and Janet is Miss Calm, Cool and Collected; I figured I would compile a list of all the tips for a first Ironman that I could find. Most of these are actually really good advice.

1. Simplicity trumps everything for race nutrition plans. The simpler it is, the more likely you'll stick to it. For example, consider having all your bike calories in a single water bottle.

2. Pack all your bags and race stuff on Thursday afternoon so you have all Thursday and Friday to think through it, make sure you have everything, and aren't rushed. In general, do things early. No rushing equals no stress.

3. Consider taking melatonin or another sleep aid (assuming you've used it before) on race night. Even without the anticipation, it's hard to go to sleep at 9.

4. Bring some spray on 50+ SPF sunscreen. AFTER you get body-marked, put this on every square inch of skin that might be exposed. Enough of it will stay on to save you in case you miss sunscreen later. (Good tip for me since I have been known to look like an ahi tuna after a race)

5. Try to get to transition right when it opens. An extra 15 or 20 minutes of sleep isn't worth rushing. You want plenty of time to deal with anything unexpected (flat tire on bike, long toilet lines, etc.).

6. Make as much of your pre-race breakfast as you can the night before and start eating as soon as you can when you get up. Better not to be hurried and then having to force-feed yourself or, worse yet, skipping cals. It's darn early and eating isn't what your body wants to do, so get it done early.

7. Stay relaxed and enjoy the experience. Don't let race anxiety rule you before race day. It's wasted energy. Remember how much you SACRIFICED to get there, the TOUGH part is behind you, have FUN! It’s all about the finish line, time is irrelevant!

8. THANK the volunteers at every chance you get, from registration through the finish chute.

Swim:

1. The far outside/inside sound like the best place, but they may not be, because everyone else is thinking the same thing.

2. Wear your goggles under your swim cap or double cap so they won't get kicked off. It can be hard to get them sealed like this though, so have someone check to make sure the cap isn't interfering with the seal.

3. Sight regularly. After you get out of the scrum it's tempting to put your head down and swim. Keep sighting or you'll swim extra yards.

4. You will likely be very lightheaded and loopy coming out of the swim. Be ready for it and ask volunteers to help with your wetsuit if you are wearing one. Don't get into a wresting match with it. (IM TX is probably speedsuit not wetsuit so practice getting out of it!)

Bike:

1. Don't forget sunscreen in T1. Trust me. Again the tuna thing!

2. Be steady with your cals. Just do water for the first 30-60 minutes out. A good nutritional system on the bike is using the “super fuel” system. Take one or two water bottles and super concentrate it with salt tablets and mix so when getting a “hand up” the only thing needed is water. Poor the water into the front aero bottle and mix in a small ratio of “super fuel” to make a drink until the next “hand up”. This is handy in that if you get caught in between aide stations in a dehydrated state you have a highly concentrated mix that can help you out fast if you need it. This also keeps you away from having to drink something provided by the race that you are unfamiliar with and may upset your stomach.

3. STAY AWAY from other riders as much as you can. First you'll avoid drafting penalties, and triathletes are often horrible bike handlers, especially when they get tired. Be especially careful around aid stations. Try to stay upright as much as possible.

4. Stay aero as much as you possibly can, except steep hills and corners. Riding out of aero is just wasted time.

5. At about 90 miles you'll probably want off your bike like you can't imagine. Stay focused, you're almost done. Keep your attention on your nutrition and pacing.

Run:

1. Just run aid station to aid station. Don't let the total distance scare you, you'll get through it. Break it into small segments in your mind.

2. Be steady with your nutrition, but keep it simple. Do the same thing at every aid station if you can.

3. Most likely when you get to the marathon you start to feel the day getting to be very long and this is the most critical time to focus on getting to the finish line. The day’s workout starts to compound and it might be time to give yourself a treat. On the marathon the volunteers in the aid stations will have two very important items. DRINK THE COKE! Straight shot of solid carbs and tastes heavenly also because most likely you have been drinking Gatorade until your blue in the face. The volunteers will also offer warm chicken broth. TAKE SOME CHICKEN BROTH! It is heavenly as well. The salty taste is something a little different as well and will give you a boost to the finish line.

4. Do your best to smile and wave to your family and friends. They want to see you having a good time. Fake it if you have to until mile 18 or 20. At that point, they'll probably understand.

5. And remember, a Shiner at the finish is the best recovery drink (or a 12 pack) ha ha.

If you have any other tips for us, the race is in a week! Please comment!

The Race In Your Head

Ryan Hall said about running a marathon, “It's a long, hard road and it's going to have its bumps; there are going to be times when you fall and times when you don't feel like going on anymore, times when you're just crazy tired but it takes focusing on that one step you're taking. That's what I'm trying to do with the marathon; I don't think about the miles that are coming down the road, I don't think about the mile I'm on right now, I don't think about the miles I've already covered. I think about what I'm doing right now, just being lost in the moment.”

I feel this is even truer about endurance triathlon and Ironman. Focus on the moment and don’t think about the miles and hours to come. Most of the battle in the race is going on in your head!

Disregard the negative self talk! Remember your mantras. It's all about the finish line. Pain is temporary and quitting is forever!

The Ironman Taper: Art or Science?

It’s two weeks to Ironman Texas and I can tell you that all my peeps are ready for tapering or are already in taper mode! Is there a science to Ironman tapering? Or is it really an art? I combed the internet looking for guidance, called all my veteran friends and coaches, and guess what? No one agrees - as usual. It seems that tapering is as much art as science and there is no one plan that works for everyone.

Here are some tips on Ironman tapering. (And no, doing nothing for two or three weeks before the race and drinking beer to carbo load is not one of the tips!)

I did read some great advice in an article by the legendary Dave Scott wrote on tapering and then he was instantly contradicted by another, more scientific article, by Alun Woodward. Here are some of their thoughts and my personal commentary (can’t disappoint the fans of my pathetic humor).

Despite clear evidence that a shorter taper is most beneficial for endurance athletes, many Ironman training plans today include a full three-week taper. This is actually due to looking at marathoners and their habitual over training. If you are over trained, and on the brink of exhaustion, then a three week taper is for you. If you are more like an ultramarathoner and bounce back from your long rides and long runs quickly, your taper may only be a week or so. The hardest part about giving an answer to the question, “How long should I taper before an Ironman”, is that each athlete is so different. Some athletes repeatedly bounce back from 6+ hour rides and 2+ hour runs as if they were nothing (these folks can taper less, not me - and I hate those people), whereas others are sidelined for 2-3 days in a haze as they recover (these folks can taper more - more like me). So the first place I suggest you start is with your own athletic history. How have you recovered from you longer efforts in training? That will give you an idea of how much time you need. (Guess I need a month, oh no! I only have two more weeks….)

Everyone agrees that no matter how long your taper, it should be a fine balance between these 10 components:
1. Reducing volume (Yea!)
2. Maintaining intensity while reducing the length or volume of the workload (That means don’t turn into a turtle)
3. Allowing the body to rebuild quickly (one to two days) after higher intensity workloads (Sleep more, rest more)
4. Reducing the stress hormones that affect muscle performance; ultimately eliminating muscle soreness and heaviness (Rest, stretch, massages)
5. Maximizing muscle and liver glycogen stores (Eat, Eat and Eat)
6. Allowing the body to repair and rebuild so the power output is maximal on race day (That’s more sleep again)
7. Performing recovery workouts (Active rest, not couch potato)
8. Maintaining "normal" number of training sessions per week (Please, no…)
9. Fueling properly (More eating)
10. Preparing mentally (Stop freaking out!, find your zen)

Every individual taper is unique. Your age, preparation and personal history of your previous tapers should all play into the final formulation. Rest is key, but not too much rest. I recommend that you do something every day and just maintain your schedule. I have gone into a marathon too rested and bonked. I’ve also gone in exhausted and bonked (lots of bonking history) I have learned to listen to my body. Do regular self check every morning and rest as needed. Better to be 15% under-trained than 1% over-trained. Be confident that your body will rejuvenate and respond to resting.

The Gods of Ironman have conflicting stories about tapering, but the truth is in your own history of recovery. If you listen to your body, and are honest about your bonk history; you will know how long of a taper you need. Keep these tips in mind and be ready to rock your next Ironman!

See you all in Houston Texas May 21st!

Next article series is on recovery!

You Know You Are A Triathlete When?

I have a running gag going for the last few years on and off on my website and it makes up the last chapter of my book. “You know you are a runner when….” Lots of my friends contributed to the list from 2008 to late 2009, when we published the first book…. I felt it was fitting to add this year, especially since Janet and I are less than three weeks away from Ironman Texas, “You know you are a triathlete when…” Feel free to send comments back and I will add them to the list. This inaugural list was compiled by Janet and I emailing each other and drinking wine at the same time. Please do not be offended and you are required to laugh. If you do not get it, you need to ask a triathlete……

You know you are a triathlete when…

1. You think it’s normal to wear spandex 24/7.


2. You can blow your nose while on the bike without using tissue. (runners call this a snot rocket)


3. You know the psi needed for your tires, yet can’t remember the garage door code.


4. You have found even more areas to apply body glide you didn’t think were possible.


5. You have no problem loaning body glide or chapstick to a triathlete you don’t even know.


6. You come to the realization there is justification for public nudity in transition, and you are OK with it.


7. You feel that receiving a drafting penalty hurts worse than a tax bill.


8. You think swimming through pee is not so bad, and you pee often in your wetsuit and/or in the lake.


9. You contemplate how to pee on the bike when riding, and you are a girl.


10. You can speed on your bike, eat a gel and yell “on your left” to a pedestrian or other cyclist, all at the same time.


11. You put your helmet on backwards leaving transition and don’t want to stop and fix it because it takes too much time.


12. You think it’s sexy to have your race number sun burnt into your calf and show it off like a badge of honor.


13. You have worse tan lines than a farmer’s tan.


14. Your cycling race wheels are worth more than your neighbor’s car….or your car.


15. You realize flatulance is pretty funny in a wetsuit and warm on cold swim days.


16. You plan for your first Ironman tattoo before you even sign up for the race.


17. You press your race bibs with an iron and file or display for future admiration.


18. You find yourself yelling “on your left” as you pass other carts in the grocery store.


19. You find that a six hour bike ride is a warm up.


20. You wash your bike more than you wash the dog.


21. You look forward to aging as this will be your only way to stand on the podium in an older age group or qualify for Kona.


22. You realize you look like a squid or a sperm in your aero helmet and kinda like it.


23. You realize salt tablets on hot race days are like crack for triathletes.


24. You conveniently happen to have your race medal on you at work for “show and tell”.


25. New tri gear websites make you salivate.


26. You’ve been known to check your Training peaks log even more often then your email on your IPhone.


27. When you start to think it is normal to go to bed before 9pm and get up at 5am.


28. You can’t remember the last time you slept in past 6 am on a Saturday.


29. You rationalize that somehow it’s not completely crazy to try the first open water swim of the season when the lake water is only 58 degrees.


30. You own at least ten swim suits, five pair of goggles, a dozen bathing caps, swim fins, a pool buoy and at least a wet suit and speed suit if not two.


31. You have an entire chest of drawers full of running and biking clothing; but still shop for more practically weekly or even daily.


32. You have more pair of athletic socks with “wicking action” then you have pantyhose or dress socks.


33. You own more than a dozen pairs of running shoes and can justify why you need each and every one.


34. Your inventory of hats and visors equals your running shoes or greater.


35. You have at one time documented and tallied everything you eat or put in your mouth, even a tic-tac, in order to evaluate your nutrition even though you are at least 20 pounds under your “ideal weight”.


36. You have a plan “A”, plan “B”’, and a “try not to die” race plan.


37. You start to think an Ironman is not such an insurmountable challenge and start figuring out how you can qualify for Kona.


38. You regularly have to explain that you are not a victim of domestic violence, those are just your “crash bruises”.


39. Your biggest fear is skin cancer even though you practically bathe in sunscreen.


40. Even your kids start to think they have to swim, bike or run just to spend quality time with Mommy.


41. You have more water bottles than wine glasses in your cupboards.


42. Your refrigerator has more protein shakes and Gatorade in it than milk or soda.


43. You have a following on Facebook that lives vicariously through your training and racing ups and downs.


44. You have peeps that you feel like you have known forever through training, but they may not even know your last name (or your first, come to think of it).


45. Blisters, chaffing, road rash and sunburn (an the occasional broken toe) are just a minor annoyance.


46. You show off your peeling sunburn and chip holder tan line on your ankle with pride on the Monday after a race.


47. All of your t-shirts say things like 70.3, 140.6, etc…and you have at least 100+ you can’t part with.


48. When you wake up in the morning with every muscle and joint in your entire body hurting and think, “I had a great work out yesterday”.


49. When you know the exact distances that make up a sprint, Olympic, Half-ironman, and ironman race segments by heart and keep explaining to your friends that they are not all an Ironman and not all in Hawaii.


50. When your workouts have taken the pace of any kind of social life.


51. When you cross the finish line of your first triathlon.
    
    Smile…..and add to the list!