Merry Christmas and Happy Holidays to all!
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Tendinitis
is often used incorrectly as a generic term for overuse tendon injuries. The term that should be used is tendinopathy. Tendinitis and tendinosis both refer to microscopic changes that are seen on biopsy. Even spelled as “tendonitis”, it is still incorrect. The current view is that long term overuse tendon injuries display little to no inflammation. While the original meaning of the word inflamation refers to something feeling like it is “on fire”, the medical term refers to histopathology and microscopic examination. While it may still hurt and in a sense feel as bad as if it were on fire, we need to start calling the injury tendinopathy. Of course the biggest problem is that when a doctor tells you that your problem is “tendinopathy” it will take a 20 minutes of discussion to define what is meant by that.
The running injuries website has been updated to include an overview on the science of tendinopathy. We’ll update this page as new information and research appears.
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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.
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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
| Place | Bib | Name | Time | State | Country | Citizenship |
| 1 | 117 | Derartu Tulu | 02:28:52 | Ethiopia | ETH | |
| 2 | 140 | Ludmila Petrova | 02:29:00 | Russia | RUS | |
| 3 | 115 | Christelle Daunay | 02:29:16 | France | FRA | |
| 4 | 111 | Paula Radcliffe | 02:29:27 | Great Britain | GBR | |
| 5 | 112 | Salina Kosgei | 02:31:53 | Kenya | KEN | |
| 6 | 118 | Magdalena Lewy Boulet | 02:32:17 | CA | USA | USA |
| 7 | 121 | Buzunesh Deba | 02:35:54 | NY | USA | ETH |
| 8 | 124 | Serkalem Biset Abrha | 02:37:20 | NM | USA | ETH |
| 9 | 114 | Yuri Kano | 02:39:05 | Japan | JPN | |
| 10 | 123 | Desiree Ficker | 02:39:30 | TX | USA | USA |
Men’s Results
| Place | Bib | Name | Time | State | Country | Citizenship |
| 1 | 8 | Meb Keflezighi | 02:09:15 | CA | USA | USA |
| 2 | 6 | Robert Kipkoech Cheruiyot | 02:09:56 | Kenya | KEN | |
| 3 | 4 | Jaouad Gharib | 02:10:25 | Morocco | MAR | |
| 4 | 5 | Ryan Hall | 02:10:36 | CA | USA | USA |
| 5 | 11 | Abderrahime Bouramdane | 02:12:14 | Morocco | MAR | |
| 6 | 9 | Hendrick Ramaala | 02:12:30 | South Africa | RSA | |
| 7 | 15 | Jorge Torres | 02:13:00 | CO | USA | USA |
| 8 | 19 | Nick Arciniaga | 02:13:46 | MI | USA | USA |
| 9 | 10 | Abdi Abdirahman | 02:14:00 | AZ | USA | USA |
| 10 | 16 | Jason Lehmkuhle | 02:14:39 | MN | USA | USA |
| 11 | 12 | Jackson Kotut Kipkoech | 02:15:10 | Kenya | KEN | |
| 12 | 21 | Peter Gilmore | 02:15:22 | CA | USA | USA |
| 13 | 39 | Migidio Bourifa | 02:16:01 | Italy | ITA | |
| 14 | 29 | Mike Sayenko | 02:16:38 | WA | USA | USA |
| 15 | 28 | Mike Reneau | 02:16:45 | WI | USA | USA |
News Updates:
Keflezighi’s Breaks the Tape First
Pre-race Chat With Meb (At Runner’s World)
Bring It On Home: Led Zeppelin
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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
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
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)
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After unusually persistent aches
and pains during training or after your race, you may decide it’s time for a visit to your sports doc. Of course, we hope you’ve increased your training slowly, checked your shoes and done your best to learn how to avoid the doctor’s office.
Now that you’ve decided it is time for a visit, how can you make that visit work in the best way possible for you? What should you bring? Of course bringing yourself in is the most important thing. The following items are helpful. And the running shoes are often contributors to the injury and it can be very helpful to examine them.
Try to bring in the following items:
Notes on your injury:
- When did it start?
- Where does it hurt?
- When does it hurt?
- What has changed in your training?
- What speedwork or harder than normal running have you been doing?
- What shoes did you wear before you were injured, when injured and what are you wearing now?
- What surfaces have you been running on?
- What have you tried to make things feel better?
Things to bring:
- Current running shoes ( the newest running shoes you have used)
- Previous running shoes (recent ones which may have contributed to your injury)
- Orthotics (if you use them)
- Running/Exercise Log (if you have one)
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- Look for a sport specific shoe.
- Go to a specialty store. Runners should visit a specialty running store.
- Take injury history into account.
- Measure feet each time shoes are fit.
- Wear the customary socks for to be worn for sport participation. Sock thickness affects the sizing and fit of shoes.
- Bring orthotics to fit shoes, if you wear them.
- Fit shoes later in the day since feet expand slightly by then.
- Leave a finger’s width in front of the longest toe.
- Make sure both the heel to ball fit and the shoe length are both matches for your foot.
- Make certain the shoe feels comfortable. It won’t be feeling better in a week, if it doesn’t feel good right away.
- Check the shoe for manufactured defects. It should line up perpendicular to the ground and not wobble.
- Replace your athletic shoes regularly. Runners should replace the shoes every 350-450 miles.
- Remember to forget about the size and focus on the fit
- Don’t wear a new shoe in a race or in a long distance competitive event.
For more information see:
Dr. Pribut’s Running Shoe List
Dr. Pribut on Fitting and Selecting Running Shoes
Elvis: Put On Your High Heeled Sneakers (Master Out-take)
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Now that you’ve trained properly after having a medical exam and clearance to run, you are nearly ready for the big day. Prudence should keep you upright for the next 26.2 miles. Some have said “Start slow, and finish slower”. But that may not be your plan. Make sure you run within your means. Be certain to taper for 3 weeks. And let’s make another list:
- 3 training runs of 18 – 20 miles should have you set for your marathon.
- Taper and run much less for 3 weeks.
- You may gently carbo load. Don’t “deplete”. Don’t gorge. And don’t eat new or spicy foods for the 4 – 5 days before the marathon.
- Sleep well the nights before the marathon.
- Don’t drink too much the night before. Don’t use drugs. (In Woodstock the word was to avoid the brown acid.)
- Don’t take herbal diet or stimulant mixes. They are not checked by the FDA and may have unhealthy contents.
- Hydrate wisely. You may hydrate before the race. Don’t drink till you slosh. Don’t overhydrate. For the slow marathoner, hyponatremia (low blood sodium) from taking in too many fluids is a bigger danger than dehydration. Some races have scales for you to weigh yourself on. If you weigh more as the race goes on, you are drinking too much.
- Wear a medical condition and allergy bracelet or have the information attached to your shoe.
- Eat your regular long run breakfast.
- Warm up gently.
- Don’t start out too quickly.
- Pay attention to your body. Dizziness, faintness, chest, shoulder, jaw pain or tightness should be checked with the medical team immediately.
- Drink and eat foods you’ve used before on your training runs.
- Don’t sit down abruptly at the end of the race. Walk around a bit as a gentle cool down. If you sit, your muscles will likely tighten up and you may not get back up again easily.
General Tips
- Wear shoes that you’ve had good success with and shoes that are broken in.
- Make sure the rest of your clothes are also comfortable and broken in also including your sports bra or other sports underwear, shorts, singlet, sweats and socks.
- Use broken in Coolmax socks or another “wicking” fiber for all of your runs and on race day.
- Try to get adequate sleep over the last month so your body can be as well recovered as possible from all the training you’ve been doing.
- Eat healthy throughout your training. Don’t overeat or drink much alcohol on the night before your race. Do eat a carbohydrate rich meal for a few evenings before the marathon.
- Wear outer layer clothes you can throw away as the race goes on and you warm up. If you are going to be at the race line early, dress warm for the morning chill, and be prepared to ditch your outer layers as the race draws near or as you go along and warm up.
- Use the same fluid replacement and gel that you’ve practiced with on your long runs. Beware of under hydration and over hydration. If you are running for longer than 4 hours, consider using weighing stations if your marathon has them available to attempt to avoid hypernatremia.
- Remember to go out slower than you think you should so you can have a negative split and not burn out somewhere before mile 20.
- Figure out where some of those cameras will be taking your photo so you can look good for your marathon portrait.
- Don’t forget after the race that you should rest about one week before running again and then “reverse” taper.
Things To Bring:
- Race number and safety pins. Pin this to your clothes two nights before the race.
- Running Shoes and all your racing clothes
- Clothes to toss, if it is cold. Long sleeve teeshirts, sweat clothes.
- Change of clothes for after the race.
- Money for emergencies.
- Body glide, if you’ve used it for areas that rub on previous long runs.
- Your own food for after the race in case the race runs low.
- Plastic container of water or sports drink to drink before the race
- Toilet paper to carry in your carry-along, in case of emergency.
- Very light weight, miniature camera if you don’t expect to win.
- Throw away reading material for the long wait before the race.
For post marathon recovery, I have some tips on recovering from the marathon and a reverse taper program.
I just came across the following “tips” video performed by Toby Tanser via Mark Remey at RW
Last Minute Marathon Tips: shot with Nikon D90 from Mike Kobal on Vimeo.
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This running season has seen the devastating news of several half marathon deaths. Runner’s as young as their 20’s and 30’s have died. While the odds of dying in a marathon are quite low, it can and sometimes does happen. Some of the latest numbers show that the estimates of 1:50,000 marathoners has now lowered to a bit less than 1:100,000. Figuring that each of these runners at the start has run about 100 hours on the average during training, that works out to be 10,000,000 ( ten million) hours run per marathon death. Clusters are seen in many medical conditions, and often they are not linked to anything but chance.
The marathon is not a pre-requisite to fitness, it is optional. The first 30 minutes are for your body, the rest is for your mind. But it is something many people enjoy and it is safer than driving in your car or sitting for the next 20 years in front of your TV or computer. We’ll examine this again later. For now, since these are quick tips, let’s get to them.
Your race form has a consent form that uses language that requires you to certify that you are medically fit and have trained for the event. Before training for an event as long and involved as the marathon (and the general advice is before beginning any new exercise program) a visit for a physical examination is a good idea. Colleges, high schools and even elementary schools require a medical examination and clearance before participating in sports. A sample college medical clearance athletic form shows the level of detail requested. An EKG can be helpful and most definitely Blood Pressure measurement should be done. Among many things the EKG can detect are signs of cardiomyopathy, enlarged heart, a variety of arrhythmias including Atrial Fibrillation, PVCs, and certain changes in the T Wave that are associated with sudden death. You should probably set up a lifetime plan to check your blood pressure regularly. Your blood pressure can go up unexpectedly and leave you at risk for serious problems. There are often no signs of this, that is why high blood pressure is called the silent killer. The following are my suggestions and not an official recommendation of any organization. Following my perhaps over exuberant and obsessive recommendation are more official recommendations.
Suggested BP Checks With Risk Factors
- Over 18 – Under 30 – Every 12 Months
- 30 – 40 – Every 6 Months
- 41 – 50 – Every 3 Months
- 51 – 60+ – Every 2 Months
Several organizations have gentler, less stringent recommendations. According to their web site, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (see JNC 7 for documents and complete recommendations) strongly suggests “screening every 2 years in persons with blood pressure less than 120/80 mm Hg and every year in persons with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 90 mm Hg.”
Recommendations for getting your training started:
- Before starting a new training program, a pre-participation physical is a good idea.
- Check your blood pressure regularly.
- Eat healthy food.
- Train within your limits.
- Avoid herbal food supplements.
- Avoid stimulants and be careful with supplements which may contain ephedra, caffeine, etc.
- Don’t short change your energy supply by dieting aggressively while working out hard.
- Increase your training gradually.
- Rehydrate wisely. Use a combination protein-carbohydrate drink after the long run for glycogen and fuel replenishment.
- Pay attention to your body. Note dizziness, excess fatigue, chest tightness or pain, pain in your upper back or shoulder, chest or jaw. All can be serious warning signs. Stop and get checked. In a race, stop and seek medical attention.
Be careful out there. Prepare for the big day. Remember, by the time you get to the marathon, you’ve already run several half marathons in training and more – likely up to 20 miles. You should be ready. But do pay attention to your body on marathon day. Taper and rest up before it. Don’t get smashed the night before the marathon. Toxins in your body won’t help your performance.
Read Part 2 “Staying Alive: Tips For the Marathon”
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Best quote of the day was by Chris Mcdougall in the New York Times:
“You know any sport has gone off the rails when you have to remove body parts to do it,” said Christopher McDougall, the author of a recent book about ultrarunning called “Born to Run.”
With it’s motto of “all the news that’s fit to print” the Times seems to have not had room to fit the rest of what I’m sure Chris said. First, “Born To Run” is about a quest to run, and Chris’s quest was answered by running barefoot or in minimalist shoes. What I’m sure Chris said was that it might be easier to remove your shoes than have your toenails
removed at their roots.
The article highlighted ultramarathoners who had elected to have all of their toenails removed rather than suffer thick nails, ingrown toenails, and bleeding underneath the nails. This is not something that would be done often or by many. It is not something that should really be necessary to do. Many runners, tennis players, and other athletes have problems with “black toe” or bleeding underneath a toenail or two. The first thing to do is make sure there is enough room at the front of the shoe. Be certain you have a fingers width in front of the longest toe. Make sure your socks fit well and don’t pinch your toes. Your socks should be made of a wickable material. Cut your toes just at the end of your toes, not too long, and not too short.
If you’ve developed bleeding under your toenail and it has turned black, don’t panic. If you have Diabetes, or any other medical problem that could cause foot insensitivity or a neuropathy, get to your doctor or some place to be checked fairly quickly. If it hurts see your podiatrist for evaluation and advice. You may gradually have the nail fall off, but the new nail will reattach properly over 90% of the time. With repeated injury the toenail will usually thicken and in some cases it may not attach quite as well.
For toes that repeatedly grow in at the corners, having a portion of the ingrown part permanently removed might be the best option and a wise choice. For a toenail that has fallen off after bleeding underneath, and has a new toenail growing, the new nail will usually reach the end with no problem. It moves forward slowly like a glacier and pushes the skin down in front of it. On occasion a corner won’t grow out and it will have to be removed. Only rarely does the entire front edge dig in and require removal of the whole nail. But, removing 10 toenails permanently? Sorry, I don’t expect to be doing that any time soon. I’d rather have you toss your shoes, and find a better fit. And Chris would get you out for a barefoot run.
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Walk This Way
