Running During Pregnancy

So my last blog was about running after pregnancy.  The questions that followed were more about running while pregnant. It seems that there are lots of women getting mixed messages about running while pregnant. Is it safe? The answer is, it depends.

Let me start with I am not an OB/Gyn specialist. I am a podiatrist who specializes in sports medicine. That being said, I am the mother of three girls; and ran a marathon 3 months pregnant with my daughter Caitlin (who is now almost 15). I ran during my first two pregnancies; but during my pregnancy with Sasha, my youngest, I had to stop due to complications. Age definitely was a factor, since I was approaching 40 at the time. Conclusion, talk with your doctor. I can only tell you about my experience and the experiences of many of my patients with running during pregnancy.

Alysia Montano, a former University of California star, ran the 800 meters at the US Track and Field Championships last summer, at the age of 28 and 34 weeks (8 months) pregnant. Her doctor cleared her to run and she ran a slower than her normal, at a steady even pace but finished with a respectable time. Her goal was just to compete.

I ran a marathon pregnant at the age of 31, and 14 weeks pregnant (3 months), but wore a heart rate monitor, and had a Sherpa on his bike checking on me along the course. His job was to make sure I didn’t get dehydrated or have any issues along the way. I finished in a respectable time; not my best, but not my worst!

So what are the recommendations about running while pregnant?

Running is actually good for the Mom and the baby, as long as you are not high risk AND it is part of your normal routine PRIOR to your pregnancy. It is not recommended to start a vigorous exercise program while pregnant.

During your first trimester, you should continue your normal routine; but be mindful of getting over heated. Make sure you stay hydrated and cool.

During your second trimester, time to talk with your doctor. Some women have to stop running because they have weakness in their cervix. This was why in my later pregnancy I had to stop. I was slowed down to a brisk walk. Kegal exercises are also important during the second trimester.

During your second trimester, it is also important to realize that you need to shorten your stride and watch your posture. Hunch back is not a good look; and it puts too much pressure on your knees and feet. This is also the time to change your shoes to at least a half size bigger. You may need wider as well. You may also need a more supportive shoe than what you normally wear. As you start to add bulk to your frame, your feet tend to swell and get a little longer, wider and a little flatter. (This does not change after you delivery – most women stay at least a half size larger in shoe size after pregnancy)

The third trimester is usually where many women stop running just because they are uncomfortable. There are bands that can help with the bulk of your belly; but you want to avoid anything that hampers fetal blood flow. Brisk walking and slow jogging can really be helpful to keep the swelling down in your legs and help in delivery. No studies have shown running is harmful to your baby.

After delivery, it is important to get back to your routine. This helps with your recovery and also can help avoid post-partum depression. See my last blogs for tips on getting back out there.

Bottom line: Pregnancy is not the time to start a new running program, but if you are a veteran runner and just happen to be pregnant; talk to your doctor about continuing to run. Other than woman with cervical weakness, most runners can continue as long as they are mindful of increasing heart rate, over heating and dehydration.

Update on the goal to run 2,015 miles in 2015: Art and I continue to churn out the miles. We are approaching 700 miles this weekend and will be in Chattanooga, Tennessee for the Ironman 70.3 Chattanooga this weekend. Full race report to follow next week.

Run Happy! Run Healthy!

Running After Pregnancy

So you are holding your new little bundle of joy, and after the first few weeks of sleepless nights and exhaustion are over, you start to think, “When can I get back to running? I feel FAT!”

You are not alone! After having my first daughter, Alex, I started a marathon training program to lose the weight and find myself again. Running makes Moms more sane (better than Prozac, ha ha). Seriously, a mother who feels better has happier children (ask mine - they send me running when I’m cranky).

So when is it OK to run again? And how should you approach it?

Most physicians will tell you that you need to wait at least 6 weeks before trying to resume exercise. Your body needs to heal. It is important to discuss this with your doctor and realize that with each subsequent pregnancy it may take longer. I couldn’t run effectively for 4 months after having my youngest daughter, Sasha, at the age of 40. Older Moms need more healing time. Talk to your doctor and listen to your body. If it hurts, wait a little longer.

It is fundamentally important to understand that new Moms experience several changes in their biomechanics due to post-partum gait changes. The greatest of these changes is a forward-tilting pelvis. This forward tilt of a typically stable area of the body can cause hip, lower back and leg pain due to compensation. Due to the strain of pregnancy and labor on the abdominal muscles, it is important to focus on strengthening them on your way to getting back to running.

Multiple exercises that strengthen your abdominals can help: Squats, bridges, and planks are great examples. Couple this with shortening your stride and increasing your cadence to decrease impact. Some new Moms need pelvic floor exercises and even physical therapy to get back to normal; don’t hesitate to ask your doctor for a referral if you feel like you may need additional help getting those abs back to the new normal!

Important safety tips prior to walking outside to run!

1. If you are breast-feeding, feed your baby or pump yourself dry.

2. Buy a slap-them-to-your-chest running bra (4+ barbell strength at Titlenine.com).

3. Buy a new pair of running shoes and realize your shoe size usually increases at least half a size with each pregnancy. You may wear a larger size or even a wider size.

4.  Go pee, even if you don’t feel like you need to (New Moms tend to be leaky while running L)

5. If you are planning to run with a baby jogger, wait a few weeks because it takes more abdominal strength to push a jogger.

You have to walk before you run. Start with walking briskly for 10 minutes. Then run slowly for 5 minutes; walk for a minute. Repeat. Then walk a ten minute warm down. You’ve been out of the house for 32 minutes. Time to go home.

The next day, walk for 10 minutes to warm up; run 5 min: walk 1 min; repeat twice, then walk 10 minutes to warm down. You should notice a pattern. As long as you are feeling fine, increase by one interval each day. Do not run more than 6 times a week and drink lots and lots of water!

Running after pregnancy can be your only ME time! It’s important to have that time for your sanity. Let’s get back at it, but slowly and listen to your body! 

Returning to Running After Injury or Surgery

Returning to running after an injury or surgery is often frustrating to the runner, and also to their doctor! Most veteran runners start back too much, too soon and too fast. The opposite can also be true; newbie runners are often afraid to re-injure themselves so often are extremely cautious making themselves borderline paranoid in their return to sport. Which is better? Neither! Somewhere in between is the most prudent, and less frustrating way to return to activity; especially after surgery!

God’s basic rule of bone healing is that the average person takes at least 8 weeks to heal a fracture or a surgically cut bone. It is important to understand that it’s his rule, not mine - made up to torture my patients! It is also important to understand that age and extent of injury can make this 8 weeks longer! Yes, I said that bad word – age! Listen to your doctor and don’t try to run too soon, or you may cause yourself a set back laden with swelling and more pain!

So you’ve been cleared to return to running! Yea!!! But what does that really mean? Well, it depends. Great answer, I know J. The rate at which you can return to running is limited by your soft tissues ability to adapt to increasing stress. Gradual increase in running stress is paramount to this adaptation.

Here is a good basic plan to return to running after an injury or surgery:

Walk 5-7 minutes to warm up, run 5 minutes, walk one minute, run 5 minutes, and then walk 5-7 minutes to cool down. If you have no pain during this walking and running (Important tip! IF NO PAIN); then progress by one more interval each day. Day two would be walking 5-7 minutes, run 5 minutes, walk one minute, run 5 minutes, walk one minute, run 5 minutes, and finish with walk 5-7 minutes. You get the idea.

The next question is always, “When can I get rid of the walk breaks?” If you are under the age of 50 and a veteran runner, the walk breaks can be eliminated after you can walk:run with no pain for 45 minutes or so. In my opinion (and understand this is just my opinion), most newbie runners and those over the age of 50 should continue walk:run either forever (Yes, I love the Galloway method) or until they can comfortably walk:run for an hour.

Another good tip is also to start with a pace that is comfortable, even easy; then after you can walk:run for 45 min to an hour with no pain - then you can start increasing your pace. Long, slow distance is good for your adapting muscles, tendons and bones.

I know this seems very slow to many of my readers, but return from injury can be fraught with setbacks. This is a plan to continuously move forward in your fitness and avoid more time off! You will progress quickly through this algorithm if your body is healthy and sound - ready for the running challenge! Listen to your body and progress at your own pace!

Update on the Running 2,015 miles in 2015 Challenge: Art and I are still going strong! We reached 600 miles just before the end of April, and although we were slightly less than our target of 671; we are planning on doing quite a bit of racing this spring and summer, so I think we still can easily reach our goal! Next race is Ironman 70.3 Chattanooga next weekend! Full race report to follow!

Run Happy! Run Strong!

Advice for the Aging Runner! Spring into Spring!

Spring has sprung in Texas after a crazy wet and icy winter in the DFW area. Rain, sleet, snow and ice have kept many runners on the dreadmill. If you follow this blog, you realize that Art and I are on a quest to run 2015 miles in 2015! This has been quite a challenge with the insane weather patterns and record cold temperatures; but we are still on track to get it done!

The end of March brings not only warm spring weather, but also Art’s 50^th birthday! Hard to believe! So today’s blog musings are dedicated to Art’s birthday and the aging runner.

A wealth of studies show that proves running well into your AARP card age bracket brings far more benefits to the body than risks, particularly since the reality of degeneration is inescapable.  Running can delay and significantly reduce many of the impacts of aging. One study out of Stanford University supported the long accepted anecdotal conclusions that compared to non-runners, running seniors are 16 years later to experience heart disease, diabetes, high blood pressure, some cancers, and neurological ailments. As a group, they experience better mobility, coordination, weight control, bone density, muscle strength, and an overall sense of well-being. As a physician, I have long held these facts to be self-evident, but it’s nice to see our assumptions backed up by hard evidence.

Here are some tips for aging runners:

1.     Start with a good platform. Most fit seniors are actually losing a lot of their fat pad on the bottom of their feet. They also have more pronounced biomechanical issues due to the lovely aging process. Having the correct shoes with a good fit is paramount! Many require functional orthotics in a cushioned running shoe for optimal comfort.

2.    The body as it ages becomes less and less elastic. Warming up, stretching and cooling down are even more important for the aging athlete. Stretch every day!! And yoga and pilates can be your friends!

3.    Listen to your body! The days of “no pain, no gain” are over. If it hurts, stop! Address small issues quickly and they won’t sideline you for months. Come visit your favorite podiatrist J

4.    Plan active rest. Also known as relative rest. When I turned 40 I took up triathlon so that I could have a good reason to cross train with swimming and cycling. Rest and adequate sleep can be an amazing youth elixir.

5.    Vary your workouts. Different surfaces, different intervals and mix in some cross training. Stop pounding the same joints and muscles every day.

6.    Choose less (but higher quality) speed workouts and more sustained distance/time efforts to counter the natural and inevitable decline in aerobic capacity.

7.    Race from time to time to keep yourself motivated and to enjoy the social part of running!

8.    Make running fun again by picking destination races and events. I like to say that “I don’t race anymore, I participate.” Many times it is way more fun to just participate and enjoy the events, especially when the venue is a new city or country.

9.    Volunteer at races or coach a running club. Your longevity and energy can really help newbie runners keep the boom moving!

Despite a few opinions to the contrary, running as we age can be a literal life-saver and can slow down the aging process! The aging runner is making strides in achieving the greatest physical and mental well-being possible. For an overall excellent quality of life, hit the roads and trails. Just run happy!

More on master’s running to come…..

Run Happy and follow us to 2015 miles in 2015! 500 miles down, 1515 to go…..

Strengthening Your "Foot Core" May Reduce Injuries

Running injuries are often caused by failure of the stabilizing muscles of your feet that make up your “foot core”. We all talk about how important “core” stability is in preventing injuries, but most of the focus is on our hips, pelvis and back. What about the tiny little “foot core”? There was a really interesting article in this month’s British Journal of Sports Medicine, which make the case that we shouldn't ignore our “foot core”.  In fact, the  authors challenge us to move beyond lifetime orthotic control; and after treating an injury with stabilization and rest with an orthotic, slowly wean the runner away from their orthotics by gradually stabilizing the “foot core”. Interesting paradigm shift! I'm not ready to get rid of my orthotics, but perhaps this is really not so new; but just another way to meet the demands of runners who want to go back to natural running style without the use of corrective orthotics or stabilizing shoes. Hmmm. Sounds like the exercises we presented years ago to stabilize your feet in order to introduce minimalism? I definitely see where this could be helpful in treating all of our runners that don’t have overwhelming biomechanical issues. It certainly can’t hurt!!

So what makes up the “foot core”?

Your feet have extrinsic and intrinsic muscles.  Extrinsic muscles originate far away from the joints that they move.  These are the toe muscles that start on the shin bones and turn into tendons that attach on the ends of the toes.  They can curl and extend the toes, but they do it by crossing over the many small bones and joints of the foot.

Intrinsic muscles originate and attach within the same body part.  In the foot, they originate on the heel bone or long bones of the arch of the foot and attach on the toes.  The intrinsic muscles are like the “core” muscles of the foot.  Because they are deep and don’t cross over too many joints, they can work well in stabilizing and protecting the arch and structures within the foot.  There are actually 11 tiny little intrinsic muscles in your feet, but they have a big job to do. When the foot intrinsic muscles are weak, the foot structures are more prone to increased stress and injury.  Strengthening the intrinsic muscles of the foot is good for people with foot injuries (especially plantar fasciitis) and of course those looking to prevent injury.

So how do we strengthen the “foot core”?

Here are some examples of foot intrinsic strengthening exercises.  They can be done either in sitting or standing, one foot at a time, or both together.  At first, the movement may seem impossible, but if you practice for a few minutes a day, you will start to see the toes working with better control.

1)    “Toe Swapping” – Start with your foot flat on the floor with equal pressure on your heel, the base of the big toe, and the base of the little toe.  Raise up the big toe while keeping the other 4 toes flat and pressed into the floor.  After holding a few seconds, try the opposite.  Flatten the big toe down into the floor and try to lift up the 4 small toes.  Try not to let your whole leg roll back and forth as you swap back and forth between the big toe and the 4 small toes.  You can start by using your hands to hold the toes in place to help your body learn how to isolate the toe movement.

2)    “Playing the Piano” – Start with your foot and all the toes flat with equal weight on the inside and outside of the foot.  Raise the big toe up by itself as in the previous exercise.  Keeping the big toe up, raise up the second toe to join it.  Then add the third toe, the fourth, and the pinky.  Try to make each toe come up separately.  Once all the toes are up off the floor, start putting them back down one at a time starting with the little toe.  Keep rippling them up, and then down, like someone playing scales on a piano.

3)    “Doming” – Start again with the foot flat on the floor.  Try and press the underneath side of the small knuckles of the toes down into the floor.  This should make the main knuckles closest to the foot raise up like a dome.  The toes need to stay long and straight.  When the toes curl under, it’s the extrinsic muscles working, not the intrinsic.

These movements will be a little frustrating at first, but they will strengthen the “core” muscles of the foot.  They also make good party tricks. 

There is a great video on strengthening your feet to prepare for minimalist running (by yours truly) that gives you 6 more simple exercises to strengthen your feet! Check it out! And of course, if you have any foot pain that is not resolving, consult your favorite podiatrist!

On a side note: The quest to run 2015 miles in 2015 is still moving forward! We hit 400 miles this weekend at the Dallas Athlete’s St. Patrick’s Day Triathlon! Fun Times…..Now 1615 miles to go…..See you at the Dallas Rock & Roll Half Marathon this weekend! 

300 Miles Down.....1715 to Goal!

It’s Snowmageddon in the DFW area this weekend. The Cowtown Marathon scheduled for tomorrow morning is up in the air at blog post time, and they’ve already cancelled the 5K and 10K today.  Roads are icy and snow has actually accumulated! Crazy weather all over the US and yet we are all still getting our miles in! 

Tomorrow is March 1^st and as of this morning’s treadmill session, we have run 300 miles since January 1^st! That puts us about 25 miles behind schedule to make our goal of 2015 miles in 2015 but with lots of time to make it up!  I figure, given the weather and the short month, we are doing just fine! Best of all, racing season is upon us in March.

Snuggle up this weekend and make a plan for spring! Pick a race and put it on the schedule! 

Keep moving forward to your goals peeps! See you out there……

Running in Icemageddon 2015? Get Some Yaktrax Run!

On my way slip, sliding away during Icemageddon 2015, I saw several people out running or attempting to run in the neighborhood. Now I’m at the office, and already have three add-on patients for this afternoon with slip and fall injuries.

Here is a little public service announcement from your favorite podiatrist. If you are going to run in ice and snow conditions, and not default to the treadmill, please invest a few bucks in a pair of Yaktrax’s.

The Yaktrax Run is an ice traction device anatomically designed for use with running shoes. Run naturally on packed snow and ice with the Yaktrax Run's combination of removable spikes and steel coils, providing 360° of unbeatable traction. Continue your training during the winter with the same stability you are accustomed to on dry surfaces. The Yaktrax Run can be worn in temperatures as low as -41-Degree Fahrenheit.

Smarter runners with a pair of Yaktrax don’t fall down and go boom as often!!!

And yes, we are open today at FAANT!