98.6 : Dr. Pribut’s Blog

Being interviewed today about Ultra events and multiple marathon running made me reflect on really long distance running and how special the people are that do it. Then that was followed by news that the third Tour de France race in a row is being “drowned” in an ocean of drug use and scandal. So, let’s get right to running.

I don’t know how they do it, but ultramarathoners can do amazing things. An ultramarathon is defined as anything over the marathon distance. Mixing names and distances, some popular distances include the “metric Marathon”, 50 mile races, The Comrades Marathon, and 100 milers. Dean Karnazes is well known for his 50 marathons in 50 states in 50 days. This accomplishment drew much media attention and Dean has written several books detailing his experience. The reaction in the ultra community was mixed when this was undertaken.

On October,19 2006 the New York Times quoted at the time 45 year old, ultramarathoner Pam Reed, as saying that … much of the enmity toward Mr. Karnazes is “plain old-fashioned jealousy,…We complain about him, but would many runners change places with him in terms of sponsors and endorsement deals and magazine covers? In a heartbeat.” Well, I don’t want a sponsor, but free shoes and being able to run those distances would be fine with me. So, yes, of course, I respect the ability to run those distances without breaking down and admit to being jealous of being able to run those distances.  No, I don’t believe we can all do it. Nor can we all break 10 seconds in the 100 meters. But many of us can do better than we are doing today. Gradual training increases and slow introduction of speed work, along with frequent replacement of shoes which are meant for your biomechanical form, and proper moisture wicking socks, can all go a long way in making you become the runner that you can be.  For many of these special class, ultrarunners though, one of the most troubling injuries is blisters.

Right now there is a 12 marathons in 12 months effort being underaken by Mark Young, 41 of Germantown, Maryland. He is working to raise funds for awareness of the Dwelling Place, the Make-a-Wish Foundation and Germantown HELP, which provides food and supplies to the needy. Mark began with the Disney Marathon in Orlando on January 13th, and will finish with the Disney next January.

Young started Jan. 13 at the Disney World Marathon in Orlando and has since hit races in Fort Lauderdale, Fla., the District, Frederick, Cleveland and Coudersport, Pa. His last scheduled marathon is Jan. 11, 364 days after his first, also at Disney World. Young, was quoted in the Washington Post describing that  “he sees completing the races as faith in action, taking what he calls a “me-oriented sport” and turning the focus outward, compelling others to act.”

Alberto Salazar has also described his running in essence as an act of faith. George Sheehan in contrast described it as the play of children but also as a manifestation of the ability to “be a good animal”. This reflected Emerson’s thinking as relayed by Herbert Spencer in “The Principles of Ethics, Vol 1, Part III: The Ethics of Individual Life, chapter 5″.

The most amazing and inspirational runner for me though is little known Suprabha Beckjord who has garnered only a small amount of press while on her way to a 12th consecutive year of completion of a 3100 mile race. She is the only person to have completed the first 10, and the only female. She has already run over 1700 miles over the past. The race takes 50 days give or take a few. This means each and every day for well over a month and a half, at times, for nearly 2 months, she and the others doing the race must cover over 50 miles. For the first 28 days of the race this past June - July, Suprabha averaged 56 miles. The running usually continues for 15 - 18 hours per day. In years past she has averaged over 60 miles a day.  Suprabha can be described as humble, peaceful, calm and one of the most pleasant people you could hope to know. She runs a Cleveland Park card and gift shop called “Transcendence, Perfection, and Bliss of the Beyond”.

I won’t list all of the runners who over the years, I’ve personally found inspirational. I’d hate to accidently leave anyone off of that long list. They do range though from the 100 meters up to the 3100 mile race. Many championship runners have inspired many thousands and even millions over their career. Some like Jesse Owens, Pre, Joan Benoit-Samuelson (still a competitor), Greta Waitz, and many others do inspire long after they have left the field, but Suprabha is right now is quietly amazing.

Recommended Reading:

George Sheehan Official Website

Washington Post Article on 3100 Mile Ultramarathon

Washington Running Report 2006 Article
Suprabha Beckjord: Ultra-Runner
By Rhea R. Borja

3100 Mile Race Website

Running For Others: 12 Marathons in 12 Months

Dean Karnazes and Sam Thompson profiled in Sports Illustrated:

Ultramarathon Man: Confessions of an All-Night Runner

Achilles tendinitis prevention and recovery are issues faced by many runners. As anyone knows who has spent time on my web site, I am not a fan of excessive stretching for this problem. In individuals who are experiencing pain, I advise against the stair stretch, particularly if you’ve been trying it already for 6 weeks or more and found only more pain, and no improvement. In early cases of pain, I like to restrict stretching, than  graduate to the wall stretch, and then the wall stretch with a bent knee.

Roxanne Darling of Beachwalks with Rox does an excellent job of demonstrating a variety of stretches from the hard to the easy. For those without pain, you may carefully follow Rox’s example of the stair stretch if you’d like. If you have pain, skip that one for now and start with the straight leg, wall stretch and about 3 weeks - 4 weeks later add the bent knee portion. Read the article on Achilles Tendonitis (and Achilles Tendinopathy). A small portion of that article is summarized below. In the meantime, if you need a little downtime and some chilling, visit Beachwalks With Rox for words of wisdom, thought and relaxation.

Stretching With Rox

Achilles Tendonitis / Achilles Tendinopathy Brief Summary of Treatment

Full Text (Achilles Tendonitis)

Exercises to Avoid
Excessive stretching is not good for your Achilles tendon. The stretch that I most often recommend is the “wall stretch”. I do not recommend the “stair stretch”, the “incline stretch”, or the “put a towel around your feet and pull up until it hurts stretch”. If any of these are working for you, that’s great, you don’t need any advice. In most cases, for the patients I see, these stretches put too much tension on the already tender achilles tendon. Contracting the muscle when it is in a stretched position, as initial therapy of an injured achilles tendon is not a good thing. However, as seen in Rox’s video, she demonstrates some super stretches, and if you are not in acutely painful phase, you may cautiously give them a go. But, if you have found the stair stretches to be painful and counter productive, skip them, and look at the others.

Treatment Outline:

Relative rest
Cut back mileage
Lower intensity
Avoid hills, speedwork, plyometrics

Avoid over-stretching
Gentle stretch after warm-up
Start with Straight leg calf stretch, build up much later to bent leg, consider eccentric stretch later.
Ice Massage 10 to 20 minutes after exercise

NSAIDs (some recommend avoiding NSAIDS)
- Alleve, Motrin, etc. 10 - 14 days.

Check Running Shoes
- Replace if heel is worn
-Replace if excessive heel shock absorption (soft air sole cushion, excessive gel shock absorption)
Replace if shoe is excessively stiff at the “break point” (ball of foot).
Consider using a “heel lift”

Physical Therapy Modalities
HVGS (electrical stimulation)
Ultrasound
Exercise instruction: Strength and flexibility

Current Concepts of Achilles Tendonitis and Achilles Tendinopathy

While Achilles tendon problems are widespread, the terminology used to describe them is often inaccurate and is undergoing a significant transition. First to be precise we must consider where along the course of the tendon does the problem exist. This may be in one of three main areas:

1. Insertion
2. Musculo-tendinous Juncture
3. Non-insertional (main body of tendon)

While the term that most people use and that most individuals will search for on the web is “tendonitis”, most Achilles tendon problems could better be called a tendinopathy and more specifically a tendinosis and are a non-inflammatory problem of the tendon. Inflammatory cells are not found on microscopic examination.

Clinically there may be two differing entities in acute achilles tendinopathy:

Peritendonitis

o Inflammation in the tissue surrounding the tendon
o Often 2 - 6 cm above insertion

o Possible crepitus with long standing injury (paratenon with fibrin exudate)
o In chronic tendinopathy approximately 20% of the injured peritendinous area are scar forming myofibroblast cells.

Tendinosis
o Impairment of circulation with resulting damage to tendon structure
o Focal areas of tendon degeneration

Much future research and better understanding of these injuries is needed. In spite of the vagaries of scientific understanding of these entities a successful approach using training modification, stretching, strengthening and appropriate return to exercise may be undertaken. At this time there are few significant clinical studies with valid results for treatment. There is often disagreement on approach and much is likely to be changed in the future. At this point treatment and treatment recommendations for this problem remain an art practiced with varying degrees of success. When evaluating new research, it is hard to recommend major paradigm changes in thought and recommendations based on studies of fewer then 20 cases or even 50 cases.

For those of you on the go and keeping everyone updated via Web 2.0 - Twitter, Facebook, Jaiku, Pownce, etc. we have a limited use beta code for Ping.fm.

Ping.fm let’s you update your social networks from anywhere, including your phone, via an on the go interface or from email.

Visit ping.fm to sign up and the code - good for only about 500 users or so is: pingyoulater

Now you can Twitter or Pounce your jogs from anywhere.

The New York Times had a fine article highlighting running in Central Park. Many years ago, when I regularly ran in Central Park, the north hilly end was even better for speed work than it is today. There was significantly more crime in the area, and to feel safe while running there, you had to move fast. Central Park has a diversity of terrain, interesting sights, and is one of the best green places to be in mid-Manhattan. An exploration of the interactive map will point out some of the best spots to run in the Park. From the hilly north end, to the lush valley also in the north, to the reservoir, the horse trails, the 7+ mile loop you should have enough variety to keep you going all year.

An interactive map with descriptions of Central Park running highlights is on the NY Times website.

On the npr website is a spot by reporter Allison Aubrey on this topic. Allison came by earlier this week and interviewed me on foot problems and footgear, along with west coast podiatrist/pilates instructor Colleen Schwartz, DPM. Allison did a great job on putting this story together, is very nice, and has much high quality health information available at the npr site.

NPR Spot on Barefoot, Flipflops & Plantar Fasciitis

Quote of the day, at the NY Times, from Asics shoe guru Mimura:

“Samurai cannot fight without their swords, it is the same for runners and their shoes.”

For a select group of Olympic marathoners, he likes to make shoes with soles containing rice husks, and some weighing as little as about 3.5 ounces.

Many people are beginning their fall marathon training in June. So keep tuned for training tips.

Gradually Increase Your Running Distance:

One of the keys to increasing your running distance is the long run. I don’t recommend that beginning marathoners increase their running distance and long run invariably each and every week. The tips I recommend follow:

Do not increase your running distances too quickly. The usually quoted rule is 10% per week. But week after week of increases of 10% will soon demonstrate that even this will  be too much. Make sure that as your running is on the upward swing you drop back and have an easy week at least every third week. Don’t combine an intense program to increase your distance, while dramatically increasing your hill work or  speed work.

Most people will benefit from rest and recovery time built in to their exercise week. Absolute rest, strength training, or cross training can all be helpful.

Make sure during increases, you are eating carefully and healthy. Sleep is good and may come even easier as you improve your fitness.

Avoiding Heat Stress Injury

• Drink adequate fluid 30 - 45 minutes before exercise and then a cupful every 10 - 15 minutes while exercising.

  Hydration: Drink adequate fluid 30 - 45 minutes before exercise and then a cupful every 10 - 20 minutes while exercising. After exercise, drink to satisfy thirst. Some research has indicated that thirst mechanism may not be as effective a gauge of water needs for the over 40 or for the young athlete. Drinking fluid, while exercising and after completion will help speed your recovery. Sport replacement drinks may be superior to water at longer distances and times (over 60 - 90 minutes). The electrolytes and carbohydrates in them will also help speed your recovery from the stress of fluid loss and your long distance run. Somehow they do seem to taste great in the heat and the good taste encourages you to drink more and replace your fluids.

• Acclimatization: Gradually build up your tolerance for running in warmer weather.
• Stay Fit and don’t overestimate your level of fitness: Individuals with a higher VO2 Max are more tolerant of heat tolerance than those with a lower level of fitness.
• Watch your health: Make sure you are aware of both medical conditions that you have and medications that can affect your tolerance of exercise in the heat. Medical conditions affecting your heat tolerance include diabetes, high blood pressure, anorexia nervosa, bulimia, obesity and fever.
• Dress Cool: Wear light weight shorts and a singlet rather than a tea shirt, to permit evaporation of perspiration.
• Avoid overhydration for long times of exercise in the heat. In fact, try to avoid training for long times and distances in mid day heat. Read and become familiar with the concept of hyponatremia, particularly before competing in events which will keep you exercising for 3, 4 or more hours.
• A carbohydrate-protein mix at the conclusion of exercise may help your recovery. Lactaid Milk with a Protein supplement and “Chocolate Milk” mix might work quite well.
  

Looks like for us in the northern hemisphere, summer is just starting to hit hard. Here are some selected tips for safe running in the summertime.

Tips For Safe Running In The Summer

1. Wear socks made of synthetic fibers that wick moisture away from your skin to help prevent blisters and athlete’s foot. For long distance running and long duration exercise, cotton is rotten.

2. Fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Make sure you use sport specific shoes. Running shoes do not have the lateral support needed for tennis. Help yourself avoid ankle sprains and other injuries.

3. Don’t wear sandals when playing sports! Shoes (or barefoot where appropriate and safe) is a better bet. Barefoot beach volleyball, beach or groomed, safe, outdoor surface Frisbee, and some light running is just fine. In general though, be careful when running or walking barefoot outside. Cuts and bee stings are not fun for your feet.

4. Wear protective shoes or sandals at pools and in locker room showers. This will help you avoid warts and athlete’s foot.

5. Replace your running shoes often, at least every 350 - 450 miles run.

6. Break in new sport shoes before racing or using them for a long run or workout.

7. Use sunscreen to prevent solar injury to your skin.

I’m steering you to Eric Meyer’s blog for his version of the perfect iPhone ringtone. The video documentation of the origin of the perfect ringtone is on Youtube.

The previous candidate for the perfect iPhone ringtone, which gets loud enough to actually hear is available as a “loud iPhone ringtone“.