Monday, December 12, 2011

After running 50 miles, it's time to rest and recover

My last blog post looked at the battle between the body and the mind.  I spoke of how I was preparing to run a 50 mile trail race, but then decided against it due to lack of proper training (remember the 6 "P's"?).  Well, for some reason it was really important for me to complete a 50 mile run this year.  Why, I can't exactly say, but let's just say I don't like to leave any goal just hanging out there.

The goal was to try and run a 50 mile race with as little training as possible.  Don't get me wrong, I would have liked to have trained like a madman and won my age group, but with a new baby at home, that wasn't a possibility.  So how little is little?  As was learned with the 100 mile race last year, the most important training runs are the long runs.  So with this race, all the fluff (shorter runs) was eliminated and other than a handful of 8-10 milers, I only ran once every week to 2 weeks.  Starting at a base of 2 hours, each long run was increased by 30 minutes until the 5 hour mark was attained with 4 weeks to go.  I had to take 2 weeks off due to some muscle tightness (courtesy of lack of sleep and lack of proper conditioning), and ran 3 hours with 2 weeks to go, 90 minutes with 1 week to go and then the race.  Also, if it weren't for the Graston tools my good friends at Central Mass Physical Therapy "inflicted" upon me in the weeks leading up to the race, there's no way I would have made the starting line.

Race recap:

On November 5th, along with a few hundred others, I set off in the woods of Ipswich for the StoneCat 50 ultramarathon.  It's a 4 loop, 12.5 mile course that included a small river crossing as seen in the photo introducing this blog (4 times of course), and nice, rolling, non-technical terrain.  It couldn't have been a more perfect day weather-wise, and along with my close friend and running partner Jim Hughes, we set out with a plan.  Jim's was to break 9 hours, mine was to not break my pelvis (again).  Fortunately, Jim won out.  We ran smart and steady.  The first loop was in just under 2 hours, 12 minutes.  We refueled, ate and left right on 2 hours, 15 minutes.  The second loop was run in just under 2 hours 11 minutes.  We refueled, ate and left right at 4 hours, 30 minutes.  The 3rd loop took just under 2 hours, 8 minutes and the last loop around 2 hours 10 minutes again.  We were sure to drink enough and eat enough at the aid stations (the bacon, grilled cheese and steamed potatoes and salt my favorites) as well as nail the pacing so that we never had to back off due to over-exertion.  In fact, my last mile felt really good around 7:30 pace, only to be outdone by Jim's sub 7 final mile!  Click here to see the Garmin file of the race.

So now what??  Seeing as how my next goal is the 2012 Boston Marathon, it's time to rest and recover.  Mentally, physically and especially physically.  If I have a chance to run Boston in under 3 hours, it will only be with a recovered body, an improved strength and movement base (there was none this past year), more focus on trying to attain sleep and consistently good nutrition.  Because I preach this daily to my patients, it's imperative that I practice it as well.  Massage treatments have started up again, i'm consistent with mobilizing my problem areas (T spine, shoulders and hips) and I'm soon ready to add strength.  Notice what I haven't!  I will not run again until my body can move in a stable and efficient manner, be it another month if that's what it takes.

I do look forward to writing more blogs of hopefully interesting and pertinent topics in the coming weeks and months.  In the meantime, be sure to enjoy the holidays, eat without guilt, be safe, and make realistic goals about what you want to achieve in 2012. 

Also, please consider supporting me in this years race as I'll be running for Team Hoyt.  It will be Dick and Rick's 30th Boston Marathon!

Wednesday, July 27, 2011

Brain vs. Body

It’s been a little while since my last blog, and as it was left before, I was preparing to run the Pineland 50 ultramarathon.  As nice as it would have been to run the race, I just didn’t have the right base to run it safely.  And if I didn’t prepare properly, did I really want to run the race? Especially a race that would have taken almost 10 hours to complete!

Coming to this realization is something that becomes far easier when you have a history of injury, a history of already running these types of races, and knowing that there will be other races down the road.  The hard part for patients and athletes I treat who are trying to run their “first ever” races is the tendency to want to do the race, but not understanding what it takes to prepare.  A great Jim Gibbs quote a friend of mine introduced me to highlights this: “The will to succeed is meaningless without the will to prepare.” 

This is true for anyone as it relates to any task, be it running a race, changing a lifestyle, losing weight, starting to exercise or changing a diet.  Most people come to the realization that they want to start something then go full steam ahead without understanding what it takes to get there.  Commitment, focus, discipline and hard work are the essentials to achievement, as well as surrounding yourself with those also dedicated to helping you reach your goal.

I usually give this pep talk to patients who have made the decision to do something that was a drastic change for them, and ended up injuring themselves by forcing the body to try to catch up to the mind.  It was sad not to do something I wanted to do, but it would have been worse to be injured during the process; or worse yet, lose my mind and passion for doing something that has been a part of me forever.  When you become frustrated or burnt out on something that you had at one point set your mind to do, it will reinforce failure instead of success.  And really, which would you rather have, failure or success?  The brain will clearly say success, just be sure that your brain understands what the body has to do in order to achieve that success.

Wednesday, May 18, 2011

For the Love of Running - Part 2

If you want to love running, you need to embrace the fact that it’s in your nature to do so.  The challenge I find with my patients, friends and family who want to find a love of running, find it either difficult to run (hard work) or find themselves hurt every time they try.  That stems from the fact that many of us have adapted out of our natural running form because of basic social pressures of the Western World.  Two things in particular confront us at just the wrong time:  Being forced into wearing shoes as a child and being forced to sit our growing bodies in a chair during our adolescence/growing years.  How many young children WANT to wear shoes?  Of course, most of us don’t listen to what they are trying to tell us: shoes don’t feel right, they aren’t natural and kids are more comfortable barefoot.  By the time we’re old enough to be in school, we understand that it is our responsibility to sit down in chairs, so rarely do any children put up a fight.  But fundamentally, and I have explained it in prior articles and blogs and will continue to do so in future articles and blogs,  we changed the way we learned to walk into a type of walk that adapted to poor posture (from sitting) and shoes (allowing heel striking).  It’s why most of us remember being able to run effortlessly as kids for hours on end, yet now struggle to make it up the stairs or out to the mailbox.  It's the same reason I've never had a 4 year old present to the office with Shin Splints!  For those who struggle to run and/or get hurt doing it, it is important to recognize where your body is at now, and try and get yourself back on the path you started on when learning to walk the first time around.  It will take the help of a skilled practitioner to identify where exactly the body has adapted to and what it will take specifically to get you back on track.  It will take even more effort to find the motivation (a.k.a. focus, discipline, will power, mental strength) to try and correct or undo the many years of those adaptive habits.  For those who feel they love it though, it will be worthwhile.  Just start out slow (remember, we learned to crawl before we learned to walk, and learned to walk before we learned to run), run relaxed and smile...For the Love of Running.

Friday, May 6, 2011

For the Love of Running - Part 1

Some people HATE to run.  Some people LOVE to run.  Some run to get in shape, stay in shape or to achieve a goal they think may be rewarding.  Because I am writing this, and because I LOVE to run, I will explain why it is that I love to run. 

For those who have read my experience of running a 100 mile trail race last July, you should have a pretty good idea of why it is I love to run.  It connects me to my youth; the happy times.  I can feel myself as a 10 year old running through the woods of Sharon, Massachusetts or around the lake or through the golf course near my childhood home.  Though my body and experience have changed over the years, it’s the same eyes, the same mind, the same lungs and the same feeling of becoming one with the world.  It was then, and continues today, an escape from the daily rigors that life brings; it’s my “Chicken Soup for the Soul.” 

It begs the question; why is running so fulfilling for some, and such utter drudgery for others?  The answer is complicated, yet compelling.  Those who love running almost universally find that it helps them clear their minds.  It’s an escape from the stress of life and a way to help keep a healthy frame of mind, or mind state.  It’s why there have been amazing success stories of people who have been able to go from inner or external turmoil (cancer survivor, overcame obesity, drugs or crime) to marathoner.  It all begins with the mind state.  To love running, you have to WANT to run.  It’s not enough to want to run to lose weight or get in some exercise.  You can choose any activity to accomplish that.  Think about the things in life that are truly important to you, and to what means you would go to get whatever it is that’s important.  If it’s something you really want, then you will have the right mind state to get it.  If you just want to exercise, then that doesn’t mean you necessarily want to run, so there is no real underlying desire to run. 

If you’ve figured out that you truly want to run, then you have to understand the proper mind state of the runner.  We don’t think of it as boring.  It’s not.  It’s fulfilling in every way imaginable, and that is why we love it.  Is it fulfilling to go to the gym and hop on a treadmill?  I can’t think of any runner I’ve met over the years who loves running and loves running on a treadmill.  We are not hamsters and we are not programmed to run in place.  Running is supposed to connect us with our childhoods, our past experiences, even our ancestry.  We are a hunter gatherer species, and, if you’ve read Born to Run, persistence hunters in particular.  We evolved in large part, due to our ability to run long distances!  We all have the same ancestry, and therefore, we all have that cultural legacy inside of us.  I scoff when people say that we weren’t meant to be upright or run.  We wouldn’t BE if it weren’t for our ability to run.  It’s in our nature, and it’s what those that truly love to run are tapping into.  So why fight it?  It is obvious to all that treadmills are not the natural place where running was meant to be.  Treadmills, typically in basements and gyms, are a way to exercise at a time and place of your choosing that occurs in a very controlled environment.  That last phrase is key: controlled environment.  That is NOT nature and that is not natural to humans.  The Earth has texture and the air has a spirit that you should feel.  The Earth provides natural challenges and obstacles that need to be felt, experienced, and overcome if necessary.  The treadmill is like a prison.  The roads are an improvement over the treadmill, but asphalt and concrete aren’t embedded into our past.  You can love running and never set foot on dirt, but I would find it hard to imagine that those who are honest with themselves would opt for Main Street over a nice open space in the hills somewhere.

Stay tuned for Part 2: How to love it!

Wednesday, May 4, 2011

Sometimes, I just think I'm Crazy...

Though, of course, it's running that probably keeps me sane. I snapped this photo towards the end of the run.  Good thing too, I may have had to cut it short!  Pineland Farms 50 miler is on the radar in just under 4 weeks.

Rebuilding the Distance - Leominster State Forest by thefeldys at Garmin Connect - Details

Wednesday, April 27, 2011

Why do our kids walk funny?

I had a great patient who I treated recently.  She's an 8 year old girl whose parents brought her in wondering why her shoes were wearing out oddly and why she walked "funny."  The examination was very revealing, and relevant to ALL parents with young children.  She only complained of some discomfort occasionally in the ankles and does admit to getting tired easily when running around.  Her feet pronate, or collapse inward, slightly and she has tight calves that are obvious when she walks.  The treatment that most everyone would prescribe would be either orthotics (corrective shoe inserts), stretching or do nothing and let it resolve as she grows out of it.

My treatment was based off exam findings not typically done by Podiatrists.  In performing gait analysis, it was evident that both hips were somewhat weak and incapable of supporting the body properly in a single leg stance.  Her left shoulder was held high and her right foot was more pronated than the left.  Her arm swing was out in front of her torso and asymmetric.  Static testing (standing, not walking) reveals her to be unable to touch her toes which is almost unheard of in an 8 year old, though when a yoga block was placed between her knees, her flexibility was improved.  Squat testing showed a complete inability to keep her feet on the ground during a squat unless the heel heights were elevated several inches.  So, are her hips and ankles really tight?  If they were really tight, then she wouldn't be able to assume a squat posture in any position, vertical or horizontal (standing or laying down).  When I had her lay on the ground, I was able to put her body into a perfect squat posture with ease.  This indicated that her joints aren't tight, which would be unusual in a young person.  Her problem was with gravity!  When she tried to move her body, certain muscles were firing that weren't supposed to be, and the timing or sequence of which muscle is supposed to fire and when, was off.  Thus, the muscles that should be relaxed to allow joint mobility were engaged, thereby preventing joint mobility.

Why does this happen and how do we fix it?

Two of the worst things we can do to our children, we do without thought.  We put shoes on their feet and we send them to school where they will be sitting in chairs for hours each day.  If shoes and chairs were part of a human beings "master plan," don't you think we would be born into them?  Humans are hunter-gatherers and are supposed to stand, walk and run.  Especially the growing body!  Shoes do two dangerous things: they do not allow the foot to use all of the smaller muscles that allow fine tuning within the foot, and more importantly, they interfere with the connection between the brain and the earth.  As we start school, our bodies are going through rapid growth and change.  When we sit, our pelvis tends to become fixed forward slightly and it relatively shortens our hip flexors (psoas muscle).  This is the muscle that is supposed to lift the leg and it originates off the lower spine, attaching the the femur (thigh bone).  If we lose our ability to use our core (sitting creates poor posture which leads to loss of core awareness), then we can no longer stabilize our spine, and our hip flexor has nothing to leverage against when trying to contract and lift the leg.  The muscle then becomes shortened and further adaptations will occur.  The brain will begin using other muscles that flex the hip and lift the leg.  Unfortunately, these muscles are also knee extenders and we end up lifting our leg and extending the knee at the same time.  This forces us to lift the toes, stride out in front with walking which ultimately encourages heel striking.  This brings us full circle with shoes as they enable the heel strike by cushioning the heel.  For those who believe what you have been told about heel to toe walking, you should think again.  It's not efficient, nor is it desired in proper mechanics.

Now back to our case.  With further questioning, she happens to be the tallest kid in her class.  Her feet have been growing fast and she has very long legs as well.  Therefore, in addition to the poor timing of her muscles, her body is continuing to change and force the brain to make constant adjustments.  This, of course, is in addition to the dysfunction in her body that is created by sitting and wearing shoes. 

The Treatment  

Our patient will be sent to a physical therapist who will work on neuromuscular re-education to help with the sequencing of muscle contraction.  Stretching will be useless as her muscles and joints aren't actually tight, they are just not working at the right time.  Also, she will be casted for orthotics, which will serve to stabilize her heels (not arches), which have been turning out and forcing her feet to function in an unstable manner.  By providing stability to the feet, we will provide the consistency that her body needs in order to re-learn how to walk over those feet.  Orthotics alone would miss the real cause of her "walking funny" and her leg fatigue.  Though orthotics, stretching and "tincture of time" may resolve some of the symptoms, her body's dysfunctional patterns would ultimately lead to degenerative changes in the hips as they haven't been moving, the feet because of the force through them are greater than it should be, and the back, which will be forced to adapt for the hips that are not moving.  If she does her work and continues to practice good movement habits as her body continues to change, there should be no long term consequences, or at the very least, they should be greatly reduced.  My fingers are crossed...

Friday, April 22, 2011

Belly Breathing

Is there one thing to do, one exercise possibly, that a person can do to help with pain in the foot?  The surprising answer is yes.  Even more surprising; it doesn't involve the foot!

As a physician who treats people who want to walk, run and play without foot pain, I'm given the task of trying to find out why that person is having trouble.  Though the reasons why people hurt vary, there is almost a universal link that all of these patients (people who are having foot trouble) share; difficulty with posture.

Posture is what children neurodevelopmentally "learn" and what ultimately allows them to sit upright for extended periods of time, stand, walk and eventually run.  And the first step involved in the development of posture occurs mere seconds after birth, when we begin to breathe.  A recent blog post written by Mark Sisson on his Mark's Daily Apple site highlights exactly what I've been trying to explain to patients for years.  Breathing is the most fundamental of movements we make as humans.  All newborn and young children breathe the same way, using their diaphragm’s (belly breathing), which is the proper way to breathe.  It is the child's first act in preparing the body's core to become engaged.  In fact, the diaphragm makes up the ceiling of our core!  Thus, when we stop using our diaphragm to breathe, we lose the ability to properly engage our core, and by extension, lose the ability to properly maintain and sustain good posture.

So how does this relate to foot pain?  I'll keep the answer as simple as possible.  If you have good posture, then the body will not have to work very hard to stand and move.  It will be inherently stable.  It is the reason that children and exceptionally good runners move gracefully and effortlessly; they are maintaining their posture with movement.  It allows all the muscles and body parts to work together as they should in the act of movement.  If we start with poor posture, then our muscles have a different job to do: help hold us upright.  Therefore, when we try and move (stand, walk or run), our muscles now have to do additional work.  Movement is no longer effortless and it becomes work.  Because our bodies move over our feet with every step we take, we tend to place more stress through our feet with every step, predisposing us to developing pain.

As I alluded to at the onset, there is one thing we can do, that can be practiced at any time of day, in any place, and can have a major impact on improving posture and reducing foot pain.  That one thing is breathing.  We did it the right way when we started in this world, and we did it that way for a reason.  For more information on this topic and practical information on how to regain our breathing form, please click here.