Kevin Kirby, DPM has posted a biomechanical description of the orthotic modifications he uses when treating chronic peroneal tendinopathy. They mesh well with what we’ve presented here and Kevin provides an excellent diagram along with his description. Be sure to read his post.
Dr. Pribut’s New Rules of Training
A top 10 +1 listing of training tips
Summertime is when many begin training for a fall marathon. But whatever season it is you read this, here are some training tips to keep in mind.
- Don’t overtrain
- Train within your current fitness level. Your safe training speed limit will vary from one distance to another.
- Train at different distances and speeds.
- Forget the 10% rule while you build up your distance for marathon training. I recommend a two weeks gentle increase followed by a drop back in the third week. Then you can pick up where you’ve left off. This is called “two steps forward, one step back”.
- Aerobic conditioning should come before speed. Consider going for aerobic conditioning, strength, and speed in that order. Arthur Lydiard was one of the first to systematically recommend this in the order o: Distance, Hills, Speed.
- Get adequate rest. Make sure you rest after hard workouts and be sure to try and get a good night’s sleep.
- Pay attention to your nutritional needs. Be sure to get adequate nutrition in a healthy balanced diet. Assess your needs. If you are diabetic, fine out what you need to do. If you are overweight, determine your real caloric needs. Find out where you are going wrong. Seek advice on a sensible diet. Follow the diet, document what you eat, and weigh your portions. If you have other eating issues, assess it and be honest. Get help if you need it. Don’t cut calories or relatively cut calories by working out hard without replacing your needed nutrients.
- Gradually ease into your speed work. Begin with small speed spurts 100 meters, 200 meters scattered into a longer run after a warm up of a few miles of easy running. Later add in speed play, fartlek and then defined intervals. Tabata workouts are fine for fitness enthusiasts but won’t do much for your marathon training.
- Use the running shoe, running stride, and foot strike that works best for you.
- Pay attention to your body. Don’t ignore pain, learn from it. Know what is normal and what is not normal. Seek professional advice if it is not getting better.
- Don’t forget to taper before a race and reverse taper after the race.
Two articles currently up on the Runner’s World news and blog areas take opposite approaches to Achilles tendon problems. One cites a study of normal individuals who were asymptomatic and measured “load” in the Achilles tendon and concluded that there would probably be no help given by a heel lift. This was not a clinical study of treatment however and it has no validity regarding statements made about treatment. In fact the least helpful part of many studies is in the “discussion” part of the study where the authors speculate about what their study means, but which their study did not show. Please beware of author speculation. There are only a few who are accurate in their speculations. And some of them win Nobel prizes.
The other article is a blog by a coach who noted that her runners seemed to be having an inordinate amount of calf and Achilles problems. These are clinical and coaching observations and not a published study. But, there truly may be wisdom in systematic observations. Over the past 6 months she noted that this injury seemed to have surged and become a trend. The calf and Achilles problems were often seen among runners who had thought they were purchasing the same shoe they had run in for years only to find that the “heel drop” (heel to forefoot height differential) had dramatically decreased. Initially I was going to post on Coach Jenny’s blog article but I’ll just link to it and make my remarks here. I believe she is right on top of things in her blog.
Over the past 3 years many manufacturers have attempted to “minimize” nearly their entire product line. A shoe which had a 12 mm heel drop, now has 8 mm. And of course zero to 2 mm are often touted as the ideal. But the reality is that not everyone responds well or even the same to changes.
As George Sheehan said “we are all an experiment of one”. And the modern reality is that studies, trends, and memes are aggregate while injuries happen to individuals. And individuals need tailored solutions that are not always the trendy advice making the rounds.
So in spite of some “nay-sayers”, who adamantly disagree, I side with Coach Jenny. Often returning those 4 mm or so back as a heel lift, can make the difference between comfort and pain. Instead of a soft gel or foam heel lift, I prefer a solid heel lift made of firm layered plastic film, hard rubber, or leather. You may find that after months of icing, foam rolling, massage and even lower heel drop shoes, this may be your answer. But if you’ve had the pain that long, you may need to check in with your sports doc. (And hope the advice is different from what has failed during your experiments!)
This is still not the entire answer for many individuals and there are other things to analyze. Shoe changes, training changes, terrain, and recent racing history along with individual biomechanics all come into play for a more complete analysis of the causes and the likely solutions. YMMV
It’s that time again. Hot and sticky. Take a quick look at some summertime do’s and don’ts.
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. Get fit each time you buy new shoes.
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 running is just fine for many people. In general though, be careful when running or walking barefoot outside. Cuts and bee stings are not fun for your feet.
4. Build up to your longer distance training slowly. Consider running your long distance runs earlier than usual to avoid midday heat and pollution.
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. UVA and UVB protection are important. Don’t forget your feet at the beach. Try to avoid mid-day exposure between the hours of 10am-2pm. Protect your eyes with UV safe glasses.
8. Don’t forget to replace your fluids on long runs, but avoid overhydration on events over 4 hours.
9. Do wear sport specific running shoes. Running shoes do not have the lateral support needed for tennis. Help yourself avoid ankle sprains and other injuries and do fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Do replace your running shoes often. Replace them at least every 350 – 450 miles run.
10. Be careful running in low light conditions both because of road traffic, uneven pavement and also be aware of increased balance problems.
See Dr. Pribut On Running in The Heat for more information.
The Mental Mistakes of Running
The cause and prevention of many running injuries is still a mystery. The treatment of most of them is not a total mystery. To lessen the possibility of the injury returning you will need to alter your training, improve core strength, flexibility, evaluate your recovery, obtain adequate sleep, nutrition, check your stride, muscle strength and symmetry, evaluate your biomechanics, your training shoes, and check on a variety of other factors.
With all the studies that have been done on running injuries they still are reported to occur in somewhere between 24% and 65% of runners. Those numbers themselves speak to the lack of precision even in studies that measure running injuries. Studies which attempt to measure whether a slower progression in ramping up mileage have failed to demonstrate that also. Design errors and interpretation errors contribute to this lack of precision and clear information. To fill the knowledge gap on running injuries, some would find one thing to explain most injuries. Shoes can contribute to injury. So some have looked back a few million years to say we should not wear shoes. Others have gone back a few million years to say that we need a paleodiet. Or perhaps we need a paleo-footstrike.
Does it all come down to shoes, minimal shoes, no shoes or midfoot, forefoot, or “gentle” rearfoot strike? Is it a matter of the terrible too’s: too much, too soon, too fast and too often with too little rest? That seems to be a large contributor. Overuse and overtraining contributes to many injuries. Is the knowledge of all things 15 million or 500,000 years ago all we need to run outside today? That is debatable but I’ll avoid that debate at this time and look for something more practical.
Life is complex. While there is wisdom and embedded knowledge in the past, the philosophy that the past is prologue, carried to the extreme of the past is still with us, may not may not invariably tell us where we are headed with the unpredictable future of life and scientific knowledge. Let’s look at something that we often skip.
We often ignore the mental mistakes that lead to running injuries. “Too much, too soon” is a mental mistake. Overestimating your readiness for harder, faster, and more training is a mental error. Ignoring warning pain is a mental error. Failing to distinguish between discomfort and pain from healthy training versus that from bone, muscle and tendon injury is a mental error. It is often hard to tell how signficicant pain is and to interpret what it means.
There is value in some of what has been said before. George Sheehan declaring “we are all an experiment of one” is signficant and the Delphic Oracle saying “Know Thyself” is another significant statement. (Although Aristophanes in the play “Clouds” used “know yourself” in a harsher sense which I’ll skip here.). The Delphic Oracle of ancient Greece had another aphorism that is not widely quoted among runners: “Nothing in excess”. These are wise statements. In fact an entire Philosophy course is available on Coursera called “Know Thyself” with Professor Mitchell Green of the University of Virginia. The bulk of my MOOC experiences at EDx.org and Coursera.org do run a bit more to harder sciences, but being well rounded is something that most of us would benefit from.
As Barney says “everyone is special” which is another way of saying we are all alike in being a “case of one”. Luckily, sports medicine physicians and practitioners usually have a knowledge base and more than one case to draw on while evaluating a new patient’s symptoms. It is still vital that each runner take the responsibility to carefully monitor themselves. Examine on each run on you feel after you have warmed up gently, how you feel during your run, how you are progressing, how you are recovering, and what happens during and after the run.
The only way you can learn from your errors is to pay careful attention and catch them early before they result in a disaster. Improvement is something we are all looking for. Avoiding injury is another. Evaluate the changes you are making. Give yourself time to adapt. And most important pay attention to what your body is telling you. If you avoid most careless mental errors, you’ll run longer, faster and healthier.
In The Long Run: Eagles
“I used to hurry a lot,
I used to worry a lot,
I used to stay out till the break of day.
Oh, that didn’t get it.
It was high time I quit it.
I just couldn’t carry on that way!“
Hot, hot, hot!
It’s that time of year again. It’s hotter than it’s been and you’re not quite ready for it. Marathon training is just getting started and you’ve got a long ways to go. Here are some tips to help you make it through the summer.
- 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.
- Fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Get fit each time you buy new shoes.
- Don’t wear sandals or flip-flops 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.
- Build up to your longer distance training slowly. Consider running your long distance runs earlier than usual to avoid midday heat and pollution.
- Break in new sport shoes before racing or using them for a long run or workout.
- Use sunscreen to prevent solar injury to your skin. Don’t forget your feet at the beach. Try to avoid mid-day exposure between the hours of 10am-2pm. Use sunglasses with UV protection.
- Don’t forget to replace your fluids on long runs, but avoid overhydration on events over 4 hours.
- Do wear sport specific running shoes. Running shoes do not have the lateral stability needed for tennis. Help yourself avoid ankle sprains and other injuries and do fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Do replace your running shoes often. Replace them at least every 350 – 450 miles run.
- Be careful running in low light conditions both because of road traffic, uneven pavement and also be aware of increased balance problems.
- This is a great time to experiment. If you are up for something different summer is a fine time to try barefoot running. But be sure to think about what has been working for you and be cautious in changes and transitions. Avoid the terrible too’s when you are trying something new. Too much, too soon, too often, too fast, with too little rest makes a bad combination and contributes to injuries.
Avoiding Heat Stress Injury
- Hydration: Drink adequate fluid 30 – 45 minutes before exercise and then a cupful every 20 minutes while exercising. If you are over 40 your thirst mechanism, may not be as effective a gauge of your water needs. Drinking fluid, while exercising and after completion will help speed your recovery. Sport replacement drinks are 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. After long runs a carbohydrate/protein mix will help repair tissue, replenish muscle glycogen, and speed your recovery. Chocolate milk is ideal. ( A tad of protein mix such as whey protein tossed in makes it even better.)
- Avoid Overhydration: Hyponatremia or low sodium is a danger on very long runs and slow marathons. Make sure you do not weigh more at the end of the race or run than you did before, or you have over hydrated which can result in serious medical problems.
- 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.
Don’t Eat the Balaclava
A Balaclava is a fine idea for covering your face in cold weather. It will help keep the cold air from triggering bronchospasm, if you have asthma. A number of articles over the years have found that it isn’t merely breathing cold air that contributes to asthma and bronchial constriction, but “facial cooling” that triggers the response. This is a reflexive triggering of the vagus nerve. Facial cooling can trigger other vagal nerve reactions, including slowing up of heart beat, which will limit your ability to exercise.
While we do not recommend speed work in the cold weather, you may as well be exercising optimally. Make sure you have enough fuel, hydration, and don’t overestimate your ability when heading out in the cold. A Balaclava head covering, in addtion to a hat can help. In severe cold you can add a face mask. Other areas on the web offer substantial advice and information on exercise induced asthma, so we will not replicate them here.
Make sure you have clearance from your physician for the exercise you do, and the conditions in which you do it.
And yes, you shouldn’t eat the Balaclava. You now know that it is a head covering. Baklava is what you may be looking for if you are hungry. Baklava is a tasty snack, which may help replenish your carb stores and it since it has some walnuts and almond, there is a bit of protein, micronutrients, and other goodies contained in it. (Although of course we still recommend a protein/carb liquid drink after intense or long work outs.). For lots more information on cold weather exercise visit Dr. Pribut’s Running Injury Site where you’ll find more information on Running In The Cold .
And for the hungry among you, here is a recipe for Baklava. Pictures, coming, when I next see it. It has been a while. Sorry, it doesn’t fall in the healthy food category. You can substitute where it calls for sugar, but if you need to, perhaps making something else would be better. This serves 25, and if you take really small portions, it will serve more. Best for skinny runners in search of carbs. (I was informed, however, if I put up a recipe for Italian style Bakala (cod), that would make for healthier eating.)
Amelia’s Tasty Baklava
* 3 cups Walnuts, finely chopped
* 1 cup almonds, finely chopped
* 2-3 sticks sweet butter
* 1 cup almonds finely chopped
* 1 teaspoons cinnamon
* 1/3 cup of sugar
* 1/8 tsp ground cloves
* 1 lb. (16 ounce) package phyllo dough
* 2 cups sugar
* 2 cups water
* 1/2 cup honey
* 1 tsp lemon juice
* ¼ tsp lemon/orange peel
* 1 tsp cinnamon
1. Preheat oven to 350 degrees F
2. Grind the almonds and walnuts in a food processor.
3. Combine the cinnamon, cloves, sugar and nuts and stir to blend.
4. Melt the butter over low heat.
5. Prepare the 13x9x2” pan by greasing with 2 tablespoons of the butter.
6. Place 5 layered sheets of the phyllo dough into the pan. Each layer should be buttered using a brush. Sprinkle 5 tablespoons of the nut mixture over the phyllo sheets. Place 2 more phyllo dough sheets (brushed with melted butter) on top of this layer. Sprinkle with 5 tablespoons of the nut mixture. Continue to layer the dough and nut layers until pan is 3/4 full or about 4 more times. Place the remaining phyllo on top, and butter every second layer.
7. Score the top layer of phyllo dough in a diamond pattern. Trim edges to fit the pan.
8. Bake 45 to 55 minutes in the preheated oven. It should appear golden brown. Let cool in the oven.
9. Prepare the topping by combine the sugar, water, lemon/orange peel and cinnamon in a medium saucepan, and bring to boil. Stir continuously and simmer for 10 minutes.
10. Add the lemon juice and honey, simmer for 1-2 minutes more.
11. Pour the topping over the baklava. Allow to cool.
Well, no Colbert style tips today. Just a straight forward quick and easy tip for your toes.
Training Tip of The Week:
Always use synthetic socks for your runs. Use material will which wick moisture away from your feet. Cotton socks lose their shape and cushioning when wet. They also hold the moisture against your feet increasing your chance of blisters and athlete’s foot.
- Choose your sock thickness to correlate with the fit of your shoes. If you fit and selected your shoes with thin socks, moving to thick socks or double thickness socks may end up squeezing your feet.
- Make sure to bring the socks you intend to wear when you get fitted for new running shoes.
- Consider using socks made of feet friendly, moisture wicking materials and not the 3 for $10 cotton socks.
- Change your socks at least daily.
- Always use fresh, clean, dry socks for your athletic activities.
For more information on socks for running see my website article on socks for running
And we will do a tip of the hat to Laura Milligan and Kelly Sonora who put a listing titled: 100 Best Health and Nutrition Blogs for Athletes at nursingdegree.net . It is missing a few I like. Among them is Leigh Peele’s blog . Leigh is known for her Fat Loss Troubleshoot and covers nutrition, diet, life, the universe, and everything at her blog. (And yes the answer is 42. You may check the answer at Wikipedia.)
On my list of top 10 things to do, is “make a top 10 list”. Here’s one:
Top 10 Ways To Avoid Running Injuries
1) Pay attention to your body.
Don’t ignore what your body is telling you. If something is hurting pay attention to it, find out why, and change what is making it hurt. Rest if necessary, but if the pain doesn’t fade, don’t forget a visit to the doctor’s office if necessary.
2) Avoid the terrible “too’s”.
Don’t do too much, too soon, too often, too fast, too hard, with too little rest.
3) Don’t change things that are working.
Don’t look for the latest and greatest running shoe or even training method. Don’t switch from slow and steady to suddenly doing an all interval workout because someone says you will lose weight quicker and with only 20 minutes of “cardio”. Shoes may be cautiously changed and training should be gradually and sensibly changed. Of course slow and steady is not the only way to train, and for most runners it will not be.
4) Increase training slowly.
The 10% rule for most people is the maximum increase per week, not the minimum. Every third week drop your mileage significantly before moving ahead again from the previous week. The recovery week will allow your body to repair while having a “relative” rest week.
5) Wear running shoes (sport specific shoes) and change them frequently.
Don’t run in tennis or cross trainer shoes. Some people like to alternate pairs of shoes to retain their shock absorbing capabilities. But whatever you do, make certain to replace your running shoes every 350 – 450 miles of running. If you run over 30 miles per week, and perhaps even less, make sure you use your shoes exclusively for running, so that you do not waste them with walking miles. The walking is admittedly easier on the shoe than running, but still creates wear and tear.
6) Eat healthy: Not too much, not too little, and a bit less junk.
Don’t forget to eat enough healthy foods. Make certain to have adequate calcium and healthy fats (such as the omega fats found in certain fish and fish oil capsules). Don’t forget vegetables and protein sources. Check the origin of your food, particularly check farmed fish which may come from countries which have significant issues of safety with their food supply. (In actuality there are some problems, although different problems with farmed fish from all countries and certain safety issues with fish at sea.) Make sure you don’t cut your caloric level too drastically while dieting. You need fuel to exercise.
7) Strength train two to three days per week.
Musculoskeletal fitness is one of the pillars of fitness. Strength training can be helpful for a variety of reasons. Core strengthening helps many people. And improving lean body weight by increasing muscle helps dieting indirectly and is good for your overall health. If you are a serious, competitive, long distance runner be extremely careful with lower extremity weights, and make sure to stop several weeks before a race. Carefully observe how your training sessions go, and make sure they are not slowing you down, or that fatigue from your strength training sessions are not limiting your long runs. It is probably best to do them before a rest day or an easy day. On days where you may be doing both running and strength training, run first, if you are primarily a runner.
8 ) Warm up gently before running, Stretch gently when finished.
Stretching is not a warm up. It is a flexibility exercise. Evidence is mixed on whether it helps avoid injury, but studies of stretching before running do not show any benefit. Stretching works better after you are warmed up. Run easy for your first 10 minutes of running. Take short steps, move slowly, let your body gradually warm up and adapt to the stresses you are about to place on it. There are many changes that your body will be making to make your running go smoothly, efficiently and easily. Give it a chance to get prepared. If you are doing speed work, this 10 minutes will not be enough. You’ll need a longer and more complex warm up.
9) Use a Carb/Protein mix after long runs and after hard runs or workouts.
This can be a chocolate milk shake or a protein powder mix. I find Metabolic Drive – low carb – mixed with a touch of chocolate milk to work well and taste just fine. But then again, in the 1990s, before studies showed the wonders of this mix, I used chocolate milk and brewers yeast (which many found to taste awful) as my post exercise drink.
10) Enjoy your runs and workouts.
This should ultimately be fun time, and something you look forward to. Find new paths if you need them, use old favorites if you prefer. Find something to enjoy on each run. Even the accomplishment of getting through a run on an extreme weather day (cold, rainy, not a code orange day) can feel great.
Click for more information on both treating and avoiding running injuries
And starting a second list of the top ten screwy things wordpress does is take an 8 and a ) and make it look like 8) . Hence the space in number 8 above.