The Diane Rehm Show will host Christopher McDougall (author of Born To Run), Amby Burfoot (winner of Boston Marathon, 1968, Editor at large: Runners World) and myself on Monday. The topic will be “Running In America. We should cover a lot of ground. Both Amby and Christopher are knowledgeable and entertaining. It should be an interesting show. The discussion will be on NPR starting at 11 am. If I’m early, according to the schedule, it appears I could stop in for a spot of tea.

You can tweet your questions to the show on twitter or ask via the show’s Facebook page. More information on calling and email is available at the show’s website.

The Diane Rehm Show is  archived online and is available as a podcast through iTunes or as an rss feed.. I highly recommend Diane’s intelligent discussions and diverse subjects as food for the brain.

Blisters are a common sports injury caused by a combination of friction and moisture. Blisters normally

Blister

cause pain that limits your activity and resolve and go away. You should take good care of blisters to avoid infection. Running in pain with an altered gait can cause you to injure another body part. A couple of days off if needed can prevent a longer down time.

And no, you will not get gangrene from a friction blister. However, if you are diabetic with insensitive feet caused by diabetic peripheral neuropathy you will not have a normal response to pain. In that set of circumstances there is a higher danger of infection which can spread deeply and widely and cause serious problems. If you are diabetic please check your feet regularly and get professional care at the first sign of any problem.

More information on blisters can be found on my running injuries website.

PEN has partnered with ESPN to create the PEN/ESPN Literary Sports Writing award. This award will honor the best non-fiction book on sports for 2009. The winner will receive $5,000 and be invited to speak at the 2010 CUNY Pen Literary Awards  ceremony on October  13, 2010.

Any guesses on the possible winner?

Two Steps Forward One Step Back: Marching To Marathon Success

The 10% rule of limiting weekly increases in mileage to no more than ten percent is widely quoted as the sin qua non of incremental training. In many cases even this may be too much. An invariably rising load of 10 percent each week may not give your body time to recover from the stresses of running.

In marathon training, I believe that for beginners, the long run is the key to successful completion of the marathon. Many years ago, in a very early survey, it was found that if an individual had completed 3 long runs of  18 miles or more (for example two 18 mile runs and one 20 mile run) the chances of completing the marathon were well over 90 percent.

Good questions are: 1) how to get to those long distances and 2) how long should your longest run be. The reason we ask these questions are to both be successful in completing the marathon and to limit injuries and enhance recovery.

I like what I call a “two steps forward, one step back” approach. I recommend this as a guide to the long run, up to about 17 or 18 miles. What this means is that you move up gently in your long distance running mileage for two weeks, than have a considerably easier and shorter long run. Once you have reached a long run of about 18 miles, you take two easier weeks to allow your body a good recovery.  And the long run only has to top out at about 20 miles for a successful completion of the marathon. Two to three other days of running and one to two days of cross training would work well with this approach to the long run. There are some programs that advocate an approach like this, while a good many just keep moving up the mileage. For beginners, I favor this gentle approach with recovery that is built into the schedule.

Weeks until Marathon : Long Run Distance

19: 8

18: 9

17: 10

16: 6

15: 12

14: 13

13: 8

12: 15

11: 16

10: 10

9: 18

8: 10

7: 12

6: 18

5: 10

4: 12

3: 20

2: 12

1:  8

Marathon: 26

There is much variety among the blogs at Runner’s World. But not long ago the Penguin flew off and waddled away. He is missed by many and has left a void among the determined blog reading, but non-elite runners.

Journalism professor and fitness geek Ted Spiker has started a new blog at Runner’s World called The Marathon Virgin. He is trying a program with a lot of innovative cross training including tire flipping and basketball. Recently he caught me for a bit of an interview and chat, and wrote it up very nicely on his blog.

A study published in the Journal of the American Medical Association, Jan. 13, 2010 gave disappointing results in using plasma rich protein to treat non-insertional Achilles tendinopathy. It showed no difference between using a sham injection of saline and combining it with a painful eccentric stretching protocol  in comparison with an injection of plasma rich protein injection along with the standard painful eccentric stretching protocol.

The authors note that previous studies did not have good control groups. In this small study, 27 patients were in the placebo group and 27 in the treatment group. The VISA-A score was used to assess improvement. Both groups improved somewhat without a significant difference between the two groups.

The study was called a “preliminary communication” which is often done with small studies. Other studies on similar topics with fewer than 30 individuals studies have also been billed as “preliminary studies”, but when they are talked up afterward, the “preliminary study” status is usually forgotten. As far as study design goes, the design, blinding, and performance of the study seems just right. I am not entirely convinced of the efficacy of the painful eccentric stretching protocol and would have not minded another study group omitting that treatment. Apparently it is not a panacea (or there would not be studies looking to add to the results), although the initial preliminary study made it sound as though it would be. Follow up journal articles by the primary author of the first study have been positive and are referenced below. Others have expressed reservations on the methodology. (see Woodley et. al. 2007 and Kingma et. al. 2006) Eccentric stretching and overload for tendinopathy has mixed results at best in other body areas.

Note: VISA-A is the Victorian Institute of Sports Assessment-Achilles

References:

Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial
Robert J. de Vos; Adam Weir; Hans T. M. van Schie; et al. JAMA. 2010;303(2):144-149 (doi:10.1001/jama.2009.1986)

Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22(4):727-741.

Alfredson H and Cook J (2007), A treatment algorithm for managing Achilles tendinopathy, new treatment options, British Journal of Sports Medicine, 41, 4, 211.

J J Kingma, R de Knikker, H M Wittink, T Takken. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 2007;41:e3 (http://www.bjsportmed.com/cgi/content/full/41/6/e3). doi: 10.1136/bjsm.2006.030916 (concludes: Studies on the effectiveness of eccentric overload training in patients with Achilles tendinopathy show many methodological shortcomings)

Woodley, B.L., R.J. Newsham- West, and D.B. Baxter, Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med, 2007. 41: p. 188-199.

Additional Information:

Pribut, S.M.,  Top 5 Running Injuries. Podiatry Management, 2008

Blog on: Heel Lifts and Achilles Tendinitis

Dr. Pribut on Achilles Tendinopathy

Dr. Pribut on The Science of Tendinopathy

An article written for the January, 2010 issue of Podiatry Management Magazine entitled “Challenging Running Injuries: Be Knowledgeable, Be Prepared” is available in PDF format. It is at the PM site along with a quiz for continuing medical education credit. The target audience is health care professionals. Much of the information has been or will be incorporated at the running injuries site. All are welcome to download and read the article.

PDF Version at PM Magazine

Holiday wishes and Happy Thanksgiving to everyone. This is just a quick note.

I’ve added some new material and updated some older material. The topics and pages are:

Injuries To the Hallucal Sesamoid Bones: Sesamoidopathy and Sesamoiditis

Hallux Rigidus and Hallux Limitus

Turf Toe

These can all be challenging problems for athletes. They are less common than certain other problems, but they still occur very often. Hallux rigidus, sesamoid area pain and sesamoid injury, hallux limitus and turf toe are inter-related problems. The articles review the conditions, classification, and treatment. The tone of the articles is fairly hardcore science, but hopefully they are still accessible enough for everyone to understand.

Meb Brings It On Home!

The winners are in for the 2009 New York Marathon. Another exciting and great race with some surprises. Paula Radcliffe placed 4th in the race and suffered from ongoing injuries. Derartu Tulu of Ethiopia finished in first place. Meb Keflezighi, wearing a USA singlet, 34 years old, set a PR (2:09:15) and came in first. He finished strongly pulling away from Kenya’s Robert Cheruiyot, 4 time winner of the Boston Marathon, over the last few miles. He became the first American to win the race in 27 years, since Alberto Salazar did so in 1982. Ryan Hall came in 4th. Six of the top ten men’s finishers were American. This is the first time that has happened since 1979, when Bill Rogers won.  Joan Benoit Samuelson, the first woman’s Olympic Gold medalist (1984), set a New York Marathon, over 50 women’s record, finishing in 2:49:09.
Congratulations to all of the many other competitors and runners today. For those of you looking forward to the 2010 New York Marathon, you can start signing up for the lottery on November 2, 2009.

Women’s Results

Men’s Results

News Updates:

Keflezighi’s  Breaks the Tape First

Tulu Wins Women’s Marathon

Pre-race Chat With Meb (At Runner’s World)

Bring It On Home: Led Zeppelin

I wish good luck and a strong finish to everyone running tomorrow in the New York Marathon and to the runners participating in other marathons coming up the rest of this fall!

As the media frenzy leads up to the New York Marathon, there is more than one story to pay attention to. There is history, current competition, excellent runners, ordinary runners, and a whole city gearing up for a big day. For most runners, today is a rest day and for the evening, a bit of pasta. I recall watching the New York Marathon all the way  back when Bill Rogers and Alberto Salazar each won it multiple times. The first year Salazar won, I watched along first avenue and wondered who was this guy in the bright yellow shorts running so upright and far ahead of everyone else. I then jogged over to Central Park to see the early finishers. Then at the end of the race, I’d be out for my run and watch the “slow runners” coming in at over 4 hours. Of course, no fussing or teasing about a 4 hour finish now! Back then it was also wonderful to watch Greta Waitz win consistently year after year. The New York Marathon continues to be exciting. Paula Radcliffe has an amazing string of victories. And the race itself going through all the boroughs with so many people watching and cheering, and crossing so many (difficult) bridges is a tremendous event.

The New York Times joined in the media frenzy. After a “run-up” of articles the last few months that have been quite good and resulted in a lot of participation at their forums, the marathon made it to their OP-ED page today. Unfortunately the article on the op-ed page lamented our missing champions and the fact that an American hasn’t won the men’s division in 27 years since Alberto Salazar won. The author deems this failure a lack of “narrative”. The piece concluded by making fun of runner’s world for having general articles on improving muscular fitness and articles for beginners.

In actuality, I’m going to recommend the Runner’s World New York Marathon coverage as the best place to read about what is coming up and for fine overall stories and profiles of the runners participating. Runner’s World both profiles world class runners and offers excellent information on the sport of running to lesser mortals. Running is a participatory sport. At a time in which 65% of U.S. adults are overweight, a magazine offering tips about starting running without feeling bad because you are slow, how to improve, what shoes might be best for you, nutritional recommendations, recipes, motivation tips, and even advanced training, can not be a bad thing.

With Runner’s World publishing excellent articles on stretching, overall fitness, strength training, nutrition, along with articles on the best and the fastest, it can only help the overall health and fitness of their readers. I’d encourage all runners to both visit their web site and get a copy to read. There is much inside for every runner, and the articles go deeper than the newstand cover may suggest. Other fine magazines geared to runners include: Running Times, and Marathon and Beyond.

There are a few things we can consider doing to improve our runners. At the same time we need to work on the overall fitness and health of everyone. Runner’s World encourages everyone, and has always done so. While there were many exciting past races, many are still excited to be out running and doing the best they can. To improve the sport (and our health) we have done a disservice to everyone by requiring only one year of gym in high school. Childhood obesity is at an all time high and this does not help. Encouraging more athletic participation and demonstrating team, carry over sports,  and individual sports and making it school centric would be helpful.

Better coverage of track and field and running events  in national news and sports shows would be helpful. Live coverage of major races and track events on television would be a good thing. And how can we not have live coverage of the Olympic events? With a million cable stations available why was there not a package for sale that included multiple channels along with many different events for those few weeks. Years back this was done, and it would have been quite successful the last few Olympics.

We have no failure of narrative, publishing, or research. The American College of Sports Medicine is the most respected organization of professionals in the world. Their journals (especially Medicine and Science in Sports and Exercise) are eagerly awaited by researchers and clinicians working in the field of sports medicine. We have the tales of Dean Karnazes. This year has seen one of the most enjoyable reads on running in Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, by Christopher McDougall.  We have research, topical magazines, participants, web sites, bloggers, and as much narrative as we could hope for.

The media could certainly do a better job in presenting running events, and the benefits of the sport and helping to publicize  appropriate goals and how they can be established. Complaining that not enough Americans have won lately doesn’t give adequate credit to those who have both talent and have worked hard for their success. And we need to remember that we are all a part of the human race. Going beyond sport is a book published earlier this year by Johns Hopkins Professor David Calleo, Follies of Power: America’s Unipolar Fantasy which points out the reality and significance of  a multipolar world. The international lessons here extend beyond politics, trade and international affairs and into sports. If one pays attention, you may yet find yourself bringing back accolades to your country perhaps even in the form of a Nobel prize.

The United States has a fine and growing group of excellent men and women runners, yet New York is open enough over the years to have welcomed and been joyful for all of the marathons winners and their participants from wherever they come from. (Even those from Boston during the world series. )

Runner’s World NY Marathon Coverage

New York Times Marathon Coverage

Related:
Running In Central Park: Interactive Map

Frank Sinatra: New York, New York

24 Hours To See New York: Gene Kelley, Frank Sinatra

Empire State of Mind (Jay Z, Alicia Keyes)