Rehabilitation of Common Running Injuries

Basically, the subject of running injuries comes down to static versus dynamic runners. Static runners get hurt, dynamic runners do not. Have you ever watched a world class track meet and said to yourself “boy she runs so smooth, that’s what a runner looks like.”  Running injuries are simple to assess but difficult to treat because how do I make a “regular” runner look like a world class runner?  The truth is, you cannot make a mule into a miler.  But what you can do is teach the principles of efficient running.  Lets begin with a vocabulary lesson.

Ground Reaction Force: the reaction to the force the body exerts on the ground. In other words, this is the pounding a body takes while running. Running ground reaction force has been shown to measure about 3-5 times the persons body weight during easy to moderate running and as much as 7-9 times with sprinting.

Vertical Displacement: the shifting of the center of mass in a vertical direction, resulting in a change in elevation.  Or, how much your body bounces during running.

Running Efficiency or Running economy: the measure of how efficiently a person uses oxygen while running at a given pace.  Or, the ease in which a person runs.

To sum up these terms, the more economical a person runs the more he/she controls the amount of ground reaction force by minimizing vertical displacement.  The more fluid the force moves through the body the more dynamic the runner runs.  If a person is bouncing too much–maximizing ground reaction force–the less economy, and  the more pain a person will experience.

Now lets get back to injuries.  Running injuries can be treated palliatively with fancy equipment like foam rollers or “sticks” ( a popular massage device). Rubbing/massaging makes for short-lived relief but at the end of the day the running gait must become more economical.  The force must be minimized.  Here are principles of efficient running:

Proper Foot strike: Studies cannot say that forefoot or midfoot is the best way to go.  The reason is that whether your forefoot or midfoot hit first only matters where the foot hits in relationship to your center of gravity, which is where the ground reaction settles.  If you reach out the leg to strike with the heel, your leg is working way to hard.  Moving the foot strike to underneath the center of gravity makes for less vertical displacement and more efficiency.

Proper Strength: If it comes down to force transmission and you are unable to decrease the ground reaction force, the body must increase the strength to dissipate ground reaction force.  The muscles most commonly requiring more attention are glutes, quads, calves, and toe flexors/extensors.  The glutes control the hip and knee position while the quads support the shock absorbing knee.  Calves/toe muscles work to use the foot as a force “dampener.”  When they all work together they function like a symphony to run more economically.

Proper Pacing: What if you are going too slow?  What if you are going too fast?  There are plenty of tools available online to assess your proper pacing by using various race results.  Here are a few, mcmillan or Vdot.

Proper footwear: Not too much shoe or not enough shoe.  See “You mean I cannot wear the cute ones?”

When you report to physical therapy, make sure you do your homework.  Not every PT knows about running.  We get very minimal run training in school.  Ask around. Find out who is performing one on one care and knows about running.  Interview the PT. Ask them how many running-specific continuing education courses they have attended. As you can see there are many factors influencing healthy running. If you run dynamically you are running economically.  Finding a balance between lowering ground reaction force and increasing muscle strength is the difference between running pain-free and economically and running poorly with pain.

-Ron

“You Mean I Can’t Wear the Cute Ones?”

While you can go a lot of ways with women and shoes, I am going to stay away from the obvious.  No Laura (Rubeli), this is not a fashion discussion nor is a lesson on how to organize shoes Renee (Ursem).  My wife will be happy we are not discussing how many of them we have.  It is about functional footwear for running.  As a health care provider prescribing footwear for runners, I am not so concerned about style or whether or not the colors match.  (Although it is a bonus when the colors DO match.) I am concerned about footwear that is functional.  How do I know what footwear is functional for my running?

Shoe companies love to dazzle you with claims of “weight loss,” “shaping,”"no injuries,” or “promise of performance.” There are no studies to support such claims.  Ultra engineered footwear can lead to more injuries or difficulties.  Our feet are designed to move.  Our knees and hips are designed to withstand force.  The body is very efficient at the transfer of force.   If you try to control motion or force with plastic another compensation will occur.  These gimmicks may become a crutch for lack of foot strength.  Every day you wear them your foot and body are not learning to function effectively.  The barefoot runners are doing better than the over engineered runners.  Barefooters rely on the body to rise to the occasion. There are many factors influencing proper shoe selection and may require a professional evaluation to be accurate.

The running store. When you arrive at your average everyday running shoe store your shoe selection can be overwhelming.  We place shoes into categories with increasing levels of support in the way of engineering.  Here is the progression from least support to most support:  Minimalistic, neutral, stability, stability plus, and motion control.  Now, what is the first thing your handy salesman will have you do?  ”Lets see you walk.”  The response, “OH NO…YOU ARE A PRONATOR.”  Pronation is a very complicated motion your foot undergoes when the arch is flattened.  Flat feet are sometimes referred to as: over-pronated feet.  There are plenty of runners with no arch that run perfectly healthy.  The salesman will say “You need these shoes. ” “These” shoes are over prescribed, over posted hunks of plastic to stop your pronation in the form of a motion control shoe.  Pronation is perfectly normal and not a death sentence.  Your feet absolutely have to pronate to dissipate force.  The effect of a motion control shoe is muscle weakness due to the unnatural support the plastic is providing.  The shoe is doing the job of some muscle or even muscle groups.  The salesman may not know how much pronation to protect for.  At best he guesses.  Injury history, previous footwear, current fitness, current running goals, current strength, and gait analysis contribute to proper footwear selection.

So what shoes are good for me? The shoe for you is the shoe that feels right.  You must love them.  If you think they are going to grow on you, your making a mistake.  The shoe must be comfortable out of the box.  If not the shoe will break you before you break it in.  LOVE THEM.

• Shoe selection example #1: Sara is a twenty something, recreational runner who walks/runs about 4 days a week, her goal is to lose 30 pounds by the beginning of the summer. Lately she has been experiencing “foot pain.”  She has been exercising is a big name brand motion control shoe.  In the last few months she has added more miles and more days a week of exercising.  Her strength program is getting stronger and stronger.  Gait analysis shows a moderate pronator.  SELECTION=Stability or stability plus.  Which ever shoe she loves the most in those categories.  The foot pain is a result of the plastic wearing out and now not supporting her feet.  If the motion control shoe is refreshed then the muscle go right back to not working.  Lets allow the foot to move, give the foot less help, and ask the body to do more work so it is not dependent on outside force.   The result of the foot getting stronger is more efficient, happier running.  The foot will be tired but will progress with time.  If by 3 weeks you are not happy about that, the shoe you selected is not appropriate.  Consult the shoe provider for return policy.

• Shoe selection example #2: 50 year old male, Mark.  Training for his 4th marathon but has not run one in several years.  Mark runs about 60 miles a week on a build and 40 miles on a recovery week.  He has an annoying shin splint issue that is not changing one way or the other.  His pain occurs especially on long runs toward the end.  His strength program is non-existent since he is busy with 2 jobs and running.  He has no abnormal running biomechanics.  He has been running is a very popular neutral shoe.   SELECTION=STABILITY.  He is not strong enough at the end of his runs to support his foot and is asking the achilles to overwork.  Maybe he requires more shoe and stability will help over time.  He could add more strength work or add more shoe.

A few tips: Do not move 2 or more shoe classification up or down the list.  Too little or too much shoe too soon will be hard to overcome.  Do not be suckered by too good to be true marketing.  Put your faith in your body: it is resilient.  Be an informed consumer.  Running a few marathons does not qualify you to prescribe shoes.  Understand your needs, ask questions, and gather good information. Try to buy well known, reputable brands and models to be consistent on your choices.  The off shoot (like Sports Authority) shoe store gets an exclusive contract with the shoe company and may not be consistent.  Healthy running is a combination of a multitude of factors.  Do not let footwear be a reason you are not running healthy.  Have a good run!

-Ron

The Truth About Barefoot Running

After recently reading one of the most popular running magazines around I had a good laugh.  I am noticing tons and tons of hoopla surrounding the barefoot running craze.  I am amazed at how people just jump on bandwagons without asking appropriate details.  

Here is the scoop.  There is no easier way to run.  Running is hard.  That is actually why it is so beneficial.  Barefoot running is not the unknown that unlocks a pain-free, super fast running experience.  Barefoot running is a lateral move. Remember happy running comes down to force.  There is a scale; one side the force produced by the ground (ground reaction force) and on the other side is the force your body can produce (strength/connective tissue tolerance etc).  When the scale is tipped to the ground reaction force you get injured, when it is tipped the other way you run without injury.  Barefoot running CHANGES both sides of the scale.  It does not increase or decrease the force, it makes it move laterally.   You need more strength to run barefoot; strength in the form as stability.  The demand for Core, hip, knee, ankle, and foot stability is higher.  That CAN be a good thing.

If you can get your body acclimated to barefooting and the necessary stability is achieved then you CAN run barefoot, but should you?  The injury rates are the same.  The injuries that barefooters get, runners with shoes do not get.  Broken glass?  Didnt see that rock or bump?  Stub a toe?  It is easier to get a stress fracture without shoes.  How long can you run barefoot without something like this happening?  The other traditional running injuries are basically the same.  If you can learn to run efficiently with shoes, wouldn’t that allow for longer, healthier running?  Wouldn’t the long term, cumulative effects of years of healthy running outweigh a short term, eye popping barefoot running career?

Can barefoot running contribute to healthy running?  Sure!  Barefoot drills, maybe some strides in the grass barefoot, or strengthening with no shoes on help you develop some of that stability.  Common sense prevails.  160 bucks for “barefoot” shoes? Spend that money on quality coaching or a gait analysis and trust your body.  Your body knows how to be efficient, it just might need a push in the right direction.  Lets make a lifestyle change, learn to handle force appropriately, and let that cumulative effect take place!!

-Ron

Inconsistent...

So things these days are all over the place.  I know, I know same story as last post but that whats cracking these days.  In some ways faster and better then ever and could be significantly better with more consistent effort.  It just is what it is.  This blog serves as a personal diary, a training diary to look back at how I have modified and changed, and this blog serves as a means to other runners and triathletes.  I have been lacking on the blog but if there isn't a whole lot to report then there isn't a whole lot to post.  I am going to go through the last 2 weeks.....here it goes:

Monday-Swim.  I decided to keep with the same swim workout since it felt so right.  Right meaning that I felt like I was learning how to swim faster.  Same thought process as running the track.  Here are stats: 7:52 warm up, 6:16, 6:02, 6:19, 6:37, (2 min rest in between) and cool down of 5 min.  44 min total.  Very hard effort and feels good to get some 250s at 6 min.  Overall spent.
Tuesday-easy 45 min run.
Wednesday-None
Thursday-None
Friday-Travel
Saturday-7 miles in the santa rosa, unbelievable run.  the kind of run that you refer to when your having a bad run.
Sunday-travel home

Monday-Swim.  no data but it was faster than last week.
Tuesday-Easy run 40
Wednesday- Hills.  4 x up (1more than last time) and it was much hotter.  Faster up hill than last time.
Thursday-None
Friday-soccer.
Saturday-Long open swim.  1250 in 30 min.  Had trouble with rhythm.  If i could get a better rhythm that would have been 2-3 min faster than rage last year.  Flat tire flattened a bike ride.  I know karl I need more bike.  Overall not a bad first open swim.
Sunday-Pushed a big workout for possible strain/soreness.
Monday-today.  Swim.  7:02 wu, 5:54, 6:09, 6:03, 6:24, 6:30 and 5 min cd 51 min total.  My first 250 under 6 min, also saw my first lap at 56 sec.  Am I finally getting faster in the water?  I am feeling the speed more and the water moving faster.  Its pretty cool.  I felt great.  Quote:


“I pray to be like the ocean, with soft currents, maybe waves at times. More and more, I want the consistency rather than the highs and the lows.”
 Drew Barrymore

A little bit of a low but I am working out if it.

In and out....

The last couple of weeks have been hectic. Some family drama, some training, and a whole lot of working. Here are the last 2 weeks:

Monday-skipped my swim.

Tuesday- easy run 45 min will sully.

Wednesday-track night. Warm-up, drills 15 min, 8X150's. Those are so tough. Then 5 min rest with abs. Then 8X400. Goal was 1:40-1:45. Here are the actual splits:1:41, 1:38, 1:44, 1:42, 1:45, 1;45, 1:42, and 1:39. 10 min cool down. Felt strong and was sore.

Thursday- had drs appointment and travel day.

Friday- rainy long run in San Diego. 8 miles. Hard effort turned into easy 8. I was so tired.

Saturday/Sunday– rest/travel

Monday- swim. Wanted some speed. 1500 m total with the first and last 250 be warm up and cool down. 250X5 with 2 min rest. 7:10 wu, 6:20, 6:17, 6:15, 6:48, and 7:45 cd. 47 min total. I was spent. I think this is the effort I need to be putting into the swim. When it warms up this will be an open swim workout.

Tuesday-easy run. 50 min easy.

Wednesday/thursday- rest

Friday-6 mile Progression run. I wanted to feel it out as I went. I have been wondering if I have been going too slow to start. So here is how I went: 8:29, 8:36, 8:28, 8:19, 17:45 ( lol....had a number 2 issue, ruined my workout), and 8:41. Hate that! It happens.

Saturday-FF 8. 5 at less than 9, around 8:55 then 8:45, 8:30, and 8:19. 8:52 ave in 1:10. Moderate workout. All at unlv so it was super flat. Hella sore the rest of the day.

Sunday (today)- didn't get out of bed. Got caught up around the house.

Patching things together...

Life is crazy, as it is for every age grouper.  I have not put anything on paper as far as planning goes.  I am getting ready for RAGE and now the OC 1/2 marathon in May.  I am pushing myself more than ever.  I was thinking about this just today on my bike how my perception of hard has changed.  What I did today would not have been possible in years past not because of ability but because of what I think I am capable of.  Here is how the week went:

Monday-Swim.  1500 meters or race distance.  I pushed it and was tired.  I definitely can be better in the pool.  I just hate the pool.  Today it was way too cold for open water so the pool will have to do.  Here are details.  12:31, 13:43, and 14:43 per 500 m for a total of 41:09.  No rest but was very tired as it went.
Tuesday-Run and bike.  45 min easy run.  Me and sully battled the wind.  The whole time I am wondering if I should bike to work.  I decided to push myself.  It was cold and windy.  Half way there I realized I left the clinic keys at home.  Total of the 45 min biking in the wind.  I am glad I didn't ride to work.  It was horribly windy and rainy at the time of leaving home.  Would have been trouble.  I felt fine with todays effort.
Wednesday-Pushed a track workout due to time and weather.
Thursday-Off
Friday-Hill repeats running.  1 mile warm up, then up one street then down the other.  Up 3 different streets with differing each trip up.  Between 0.5 to 0.8 mile in length.  Up hard with easy running coming down.  No stopping no walking trying to not save it.  Don't do the first one easier so the next one is easier trying to go hard each one then force myself to recover.  Overall, 4.25 miles total in 38 min.  Overall a good effort with a workout I will definitely do again.  I will add on hills in the future.
Saturday-Long run.  8 mile progression run.  I was pleased with this effort.  I liked this workout.  Here are splits: 9:15, 9:08, 9:00, 8:54, 8:48, 8:48, 8:35, and 7:56.  I ran on a new trail near my home and this is definitely somewhere I will run in the future.  I am wondering if the 9s shouldn't be part of this workout.  It felt so easy and I was holding back very hard.  May be I will duplicate this workout with all 8 under 9?  If the half was this day I felt like I had more left in the tank and I feel that 1:55 would have been attainable.  These are the gems i am going to need more of.
Sunday (today)-Long bike.  Olympic bike course with a repeat on each hill.  My weakness is climbing.  So why not find the biggest hills around and repeat on them?  They happen to be race course too.  So I approached each climb in rhythm, recovered down, then power back up.  Try to do the second climb faster than the first climb.  Also, get the gearing for each hill and where to stand and fight for each climb.  I want to put together a total effort come race day and having confidence and knowledge of each climb is important.  Did I mention the wind?  There was a gnarly head wind coming home and it added to the difficulty of this ride.  Last year if you told me this is the workout for today and then tell me how I would feel, I wouldn't believe it.  Here are the details.  Total time of 2:23:41.  I repeated 3 sections.  Here are the sections: Boulder beach rd-4:19/4:00, 13:44 to the Look Out due N, 4:25/4:43, 16:08 to Northshore, 19:46/18:50, 12:58 to the Look Out due S 4:47/4:46, and 28:13 home. I left out rest in between the hills.  I concentrated on not leaving anything in the tank.  The second trip up the lookout with a head wind and legs gassed I hammered it to get the same time.  Hmmmmm.  I was gassed the rest of the way.  It was a big day on the bike and got some good work done.  Quote:


After climbing a great hill, one only finds that there are many more hills to climb.
Nelson Mandela

isn't that the beauty of it?  I am really enjoying the process.  More and more fitness leads to harder and more fulfilling things to do.  I am stoked.

FEELING LIKE A TRIATHLETE

No post last week secondary to Mountain West Indoor Championships in Albuquerque, NM (my home town).  It was a lot of fun to watch our girls perform and also very stressful and tiring.  I ran while I was there but I didn't even compete and I was pooped.  So I rested last sunday and monday and no post.

Things are hectic.  Work, home, training, and training.  My training and the track team.  I had my first brick/transition run today and I felt awesome.  Here are two weeks of training:

Monday-Long swim.  30 min of swimming and about 1000 m.  Nothing really to report.
Tuesday-Easy run.  45 min of easy running.  Sully and I.
Wednesday-Track night.  15 min easy w drills.  8 150's.  4 X 800.  10 min easy. 5 miles total.  The 800's at 3:30 pace with 2 min break.  Felt strong.  Those 150s are rough.  KD calls them sneaky speed work.  Not only that, I like how they work on mechanics.  Overall good workout.
Thursday-Travel day.
Friday-6 mile tempo run on the Bosque.  I was so pumped to take a trip over to a new trail for me in ABQ. I have not run that trail and it was nice.  It was cold and windy.  At elevation I could not hold my tempo.  I wanted to stay under 8:50 for all 6 and I only made 4 at tempo then I pooped out.  Overall a tough run in harsh conditions.
Saturday-Travel
Sunday-Pushed everything. lol.

Monday-Pushed a swim.
Tuesday-Easy 45 min.  Me and sully out for 45 min and it was hard going.  Legs felt sluggish.
Wednesday-Track night.  15 min warm up with drills.  8 X 150's.  2X 1 mile.  KD and I were talking about the 150's and I was doing them wrong.  I cleaned that up and they are even harder.  Awesome start.  Then KD and I got talking and the wind/cold kicked up.  Miserable night and I only completed one mile.  7:48 pace.  Then just shut it down.  Wasn't feeling it.
Thursday-Hills.  Went out and back on the sisters and felt strong.  Despite a rear derailer issue it was a good ride.  The bike is coming around.  I need more time on it.
Friday-Tempo run.  I wanted to recover that 6 miles from last week.  I did, barely.  6 miles at 8:58 total.  There were some issues but got through them.  Funny run.
Saturday-Track meet, no training.
Sunday-Ahhhh my first brick.  Full olympic bike course/3 mile run.  I felt awesome.  The bike was moderate, I didn't press.  I didn't attack.  It was 1:30 slower than last years race pace.  I felt so strong.  I feel the aerobic capacity so much better.  My legs werent that tired.  26 miles in 1:39.  I ran the sprint course and it ended up progressing really nice.  I have been wondering how my running would feel after a decent bike.  I started out with a goal of 9:15 pace and ended up at 9:40 but I didn't stop.  Usually I have to walk.  No walking today, never even occurred to me.  9:40, 9:29, and 8:52.  Total 9:21.  I have never had a run this fast after a bike.  I am looking forward to this 10K at the race.  I feel the fatigue resistance and I recovered during the run.  Overall, a great day.  Quote:

“The great thing in the world is not so much where we stand, as in what direction we are moving.”
 Oliver Wendell Holmes

Feels like I am moving forward

Hello 4th sister...

First I would like to thank those who reached out to Chelsea and I over the last week, it has been awesome.    She said make sure everyone knows that she appreciates the encouragement.  For those who wanted an update here is the last text message from her, "I just ran 3.5 miles in 31:14!"  So she is doing very well.

I have had some tangles with the river mountain loop trail and its "3 Sisters."  Now that recent improvements have been finished the 4th sister is now in play.  I have been excited now that I am back to cycling to see what my fitness is like.  I can tell you for fact that I have not felt this good on a bike before.  Although my legs are super sore I have never had this quality of cardio during the climb, recovery during the ride, and after the ride.  My legs were hosed but I go through them quite well.  So our perception of hard changes.  I have lost my intimidation of them and I welcome them.  My plan is repeat them once a week and continue to progress this cardiovascular fitness.  One phrase that Karl said that sticks out is "fatigue resistance."  I feel that for sure.  Overall I had a good week, here is how it went.

Monday-Long swim.  30 min.  Drills not included in the time.  I found some new drill that seem to be a lot more functional so if anyone wants that posted let me know, I can even send it via email.  I did keep 250 m splits because I am a dork.  6:28, 7:36, 8:04, and 6:50.  1000 m in 30 min easy.  My swim fitness is catching up as my shoulders/core remember this motion.   No post swim soreness and looking forward to open swims when it heats up a bit.  I also had 4.5 miles of biking at practice.
Tuesday-Run Easy 40 min.  Nothing really to report.  Sully and I out there feeling good.  I am kicking around logistics of biking to work on tue/thurs.
Wednesday-Track night.  400 repeats.  10 min easy, then my first attempt at alternating 50 with 150 of good swing and 150 meters of good speed.  I did 4.  2 total laps but good quality work.  Tough and I can see how that builds aerobic power and also tunes mechanics.  Something of a gem, I think.  Then repeat 400s with a minute break.  I didn't know where to start so I thought under 2:00 should be good.  Here is what I got: 1:51, 1:53, 1:54, 1:52, 1:55, 1:55, 1:51, and 1:46 (with 1 minute in between).  Then 10 min easy.  I was tired but not bent over or anything.  I was able to go faster in the last 2.  I think next time I may do under 1:50.  Minor soreness.  Great workout.
Thursday-Supposed to bike but windy, cold, and sleepy.  Pushed it.
Friday-5 mile tempo run all under 9.  I was wondering how this workout would compare to the track.  Harder or easier?  I realized quite early on how the track carried over.  I felt very comfortable at faster paces.  Here are my splits: 8:19, 8:43, 8:53, 8:48, and 8:29.  Ave 8:38 in 44:14.  Sully loves going faster.  I felt good.  I went out too fast but felt super comfortable I am not sure how long I could hold that but felt good nonetheless.  Sustained effort was harder.  I guess I need to step up that track workout.  Minor soreness, overall felt great.
Saturday-Long easy bike.  I originally wanted to go longer but had time limits.  I cut it down to 90 min.  I have been thinking about this RAGE bike course.  The hardest part is the turnaround.  A mod steep climb, decline, and then long drawn out slow grind.  I want to kill that section.  With the new RMLT I can get there easier.  But I didn't get it there.  But I did get some climbing in.  1:33, 20 miles, 14 mph, and 1330 elevation gained.  I am moderately sore but happy with my first hard bike effort.
Sunday (today)-Long Run.  I wanted somewhere between 6-8 miles.  When I woke up I layed there and said, OH boy.  Then I remembered that biking and running dont effect each other.  You have to run on those legs and they translate to each other.  SO off I went.  7 miles at 9:30 pace.  I got tired near the end and was happy with the effort.  Get out there and go longer.  No issues.  Just tired after a good week.  Quote:

“The first step towards getting somewhere is to decide that you are not going to stay where you are.”

Nope, Im gonna go there faster.  In fact, I had to look at last years post to see where I am at compared to last year.  How funny how things change.

The Post I have Been Itching to Post (Warning somewhat Graphic Pictures)

One normal day at work I get word that my new patient in the next few days is a triathlete.  I already get pumped about that but once I reviewed her chart I knew this case was special.  During the initial interview my jaw dropped.  The words BIKE VS BUS shook me.  I have had close calls personally and can identify with that as a possibility, she lived it.

Chelsea decided she was going to do some cycling hill repeats on a minimally busy road with a long challenging hill.  She climbed and came down the same side of the road.  She saw the bus, the bus did not see her.  In fact, the bus did see recognize her until the driver heard the screaming.  She was screaming because the bus WAS STILL ON TOP OF HER.  The bus ran her over her, stopped on her, then rolled off.

I am sitting there taking this all in.  I keep reviewing the list if injuries in my head.  I review it and review it and I am trying hard to keep my composure.   CAN I RUN?  I stumble and stumble to put these pieces together.  Multiple spinal fractures, pelvic fractures, complex open femur fracture, ACL/MCL tear, compound ankle fracture, multiple skin grafts on both ENTIRE quads, non healing superficial wounds with infection, and now I am seeing her 2 days after her ACL and MCL are reconstructed....and she says CAN I RUN.

CAN I RUN.

My first thought is "grrl you are lucky to be alive and you want to RUN?"  I LOVE IT.  My advice at this point is not an uncommon thing for me to say.  I say "Chelsea, you and I are going to be close.  I am going to promise you at no time will I sugar coat things for you.  No one benefits from that.  I will provide you with what the science and literature says and I will provide the facts and you will decide.  I will say that you have a lot of work to do in order to run.  The way this goes is to get on the progression to run and see what happens." She replies, "If I am OK by next years RAGE can I race?"  My first thought was that I would be surprised if she can even run a 5K at that point.  I say "If you are ready for RAGE, we will do it together"  She says DONE.  Straight face and confident.

At this point she is 3-4 months into this recovery already.  The multiple skin grafts, various fractures, and infections had to heal.  She had to graduate to be a candidate for the ACL/MCL reconstruction.  She is not your average triathlete or ACL reconstruction.  Her rehabilitation was hard.  We held her back and went slow.  We applied the latest running science and traditional rehabilitation to her and she put the work in.  She did everything the Dr and I asked and she simply put the work in.  She is going to go from this:

to this:

to top it off:  We are doing the OLYMPIC.  Another PT in my office will race with us.  Chelsea has been running at or around 9:30 pace and can go for up to about an hour.  She is an absolute winner and has never taken no for an answer.  She's had and will continue to have set backs and still is struggling.  She is overcoming the challenges with a grace hard to find in most people.  She was lucky she had tons of fitness at the time of injury, she needed it.  She's lucky she had a mental attitude that stayed positive, handled pain, and kept her nose to the grindstone.  She's lucky she had experience with triathlon and personal training and knows what real pushing is.  You see people like her are reason I go to work everyday.  She requires me use every once of knowledge, experience, and personal courage that I have.  I am so exponentially proud at the work she has done, at the commitment she has made, and at the job she has done to get herself ready for a healthy and fit life.  Chelsea gave me permission to use these pictures and write this post.  THANK YOU CHELSEA for showing me how real life challenges can be overcome and allowing me the opportunity race side-by-side with you.  This situation is the real reason I love triathlon and I am honored to share this experience with you.  I just hope I can beat you.

FInally a triathlon blog...

Now that I am on the clock with RAGE, olyimpic, I am getting back to triathlon training.  I have not been on my bike since August and so swims since Honu.  Thats July people.  I emptied my Garmin for the first time since mid december.  My swim felt fairly comfortable and so did the bike.  This race is super special and hopefully I will get to why this week.

This week has been cool.  I watched Kona and got all emotional like usual.  I got jazzed about someday hearing that I am an Ironman.  I also watched Ironman AZ and I got pumped up thinking thats where my first IM is going to be.  2013?  With Lance getting in on the action, I am just getting pumped on triathlon.

Injury update:  After the race I had very minor soreness.  I was surprised.  The left quads and toes were sore from trying to unweight the R calf.  Today actually is first pain free day since December 22, 2011.  I ran this morning with no pain.  The compression does help.  I dont know how they will contribute to the future but for now I will use them.  Cautiously optimistic about what the next week/months will hold.  Here is how my week went:

Monday-Easy swim.  First swim since august.  My shoulders were fairly sore but no big deal. 2/10.  I went 1000 meters with some rest in between laps.  I also was able to alternate breathing sides.  Overall, I felt good about the workout.  I have some work to do in the water but no big deal.
Tuesday-None...overslept
Wednesday-None...trying to figure out the timing of things and when I got home it was too dark to ride.
Thursday-Easy bike.  45 min bike.  Easy pace more like a hardware check than anything,  Feel my biking legs and get back into that mindset.  It is very different.  No issues.
Friday-Easy 45 min run.  I had time and I told myself to wait on running but I need to run.  My calves had moments of no pain and I got into a groove then they would be sore but overall a good run.  Sully was amazing.
Saturday-I am starting to get some mountain bike time in with practice.  Overall 8 miles on the mountain bike.  Then after practice since I was nearly at red rock I should ride from there.  I wanted to go moderately hard and see what I have.  What I had was a total of 17 mph on the bike!  Really?  My first REAL bike ride and got some good results.  I wasn't sore or anything, my back was a bit stiff for about 30 sec off the bike.  Overally it was 26 miles of biking, 18 on the road bike and at 17 mph.  Good day.
Sunday (today)-Plan was for an easy 60 min run and then about a 20 mile bike.  I have good news and bad news.  Good news 45 min of the run was totally pain free and didn't need to recover or walk. Then the bad news, a migraine.  No big deal.  Happens sometimes when I dont get enough sleep.  A nap removed the majority of the head ache.  The nap meant I cancelled the bike.   I am happy for a good run today.  Quote: (first quote in months)


“This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
 Winston Churchill

lol, where am I again?  Feels good to reboot.

The big surf board continues to elude me

That big surf board is the medal for the full marathon at surf city.  2 years in a row I was signed up for the race and had to drop down to the half.  At least this year I am was able run, well, kinda.  2 years a in a row I have had calf issues.  Separate and very different mechanisms but calf issues nonetheless.  This year humbled again, I learned some lessons.    

 

I called Karl to get my head straight.  Generally not interested in devices that artificially improve performance, I wasn't sure if I was thinking straight.  I considered compression socks.  I know marni and tawnee will be pleased because they love it.  I knew it wouldn't hurt me but was it worth it?  I am able to say that my recovery was no different but during I had no sharp pain.  A lot of pain but no sharp tendon pain.  It was all muscular burning pain.  I nearly quit at the first mile.  Gnarly calf in the first mile?  How can I get through it?  It never got to be more.  Lesson learned:  the way it feels now is not necessarily going to be worse later.  My pt/responsible brain said why?  My competitor brain said you have to finish this.  It got better as I went as long as I didn't go too fast.  I was able to keep rolling through as long as it was above 9:30.  It killed me to go that slow. I was happy to be out there and enjoying this wonderful race.  It really is an outstanding race.  It kills me that I got to 10 miles and felt fresh.  No muscle fatigue, cardio wise felt strong, but the calf was killing me.  

 

Karl was in my head.  I wanted to run the hill he yelled at me 2 years ago.  I am happy to say that dam hill with no stops and I laughed at the thought of Karl yelling at me.  Truth is that hill is weak.  I am so much in a different place.  Funny experience.  Good in that I know I can suck it up and get it done but I want that course as a full.  I want to come through on the goals I set.  Overall a learning experience.

Running Injuries: The Balance of Running

There is something majestic about a skilled runner. Adequately moving across the ground with ease and finesse. How does that happen? Is it just genetic? The answer is no. Skilled running is  developed. Running skills are developed over time and miles. The ability to run those miles depends on consistent training and staying healthy. Efficient running depends on balancing force.

Healthy running depends on the body’s ability to withstand the force of training. When there are holes in training, the injuries follow. Running injuries are always related to force. The treatment of running injuries comes down to the balance of producing too much force during running (ground reaction force) or the bodies inability to tolerate force (lack of strength and conditioning).

Here are a few of the basic themes on how to manage ground reaction force:
-Controlling vertical displacement. How much up and down is the runner using?
-Foot strike. Is the foot strike out in front of the body or right underneath the base of support? What am I striking with? The foot landing under the belly button with a mid-foot or forefoot strike is the best way to manage food strike. Footwear may influence how foot strike occurs but the body should be dictating how successful foot strike is.
-Training/Pace errors. A pace too slow or too fast can influence ground reaction force. Running too many miles or the wrong amount of miles at the wrong time may influence an increase in ground reaction force. Proper coaching or a running physical therapist can plug in those holes.
-Stride rate (the number of strides per minute). Am I using a rhythm my body can move force up the body with balance? If the feet move too slow the vertical displacement will be too high, if the feet move too fast the force will not spread fast enough to dissipate. There must be balance between stride rate and overall pace.

Here are a few basic themes related to running strength and conditioning:
-Toes. Can the toes work as a dampener? Active healthy toe strength is key to forefoot or mid-foot stance during running.
-Calves. If the toes are active the calves will be too. If the toes are not active the calves will be asked to do too much work. The calf must be able to push the weight of the body in order to run without symptoms.
-Quadriceps/hamstrings-These muscles control the shock absorber of the body, the knee. Not only must these muscles be able to stabilize the knee, they must be able to handle the force of vertical displacement.
-Hip stabilizers. The hip musculature is one of the most important muscles when it comes to running. These muscles serve to rotate the femur (thigh bone) so the thigh muscles can control the weight. Hip muscles hold the knee in place while the thigh muscles do the work. They need each other.
-Core. The core serves to stabilize the spine. The spine is the resting place for ground reaction force. If the knee and hip need each other to tolerate force, the core holds the spine stable so the thigh and hip can funnel the force to the spine.
-Shoulder. Runners are always surprised by the amount of rotator cuff strength running requires. The rotator cuffs job is to hold the humerus (long upper arm bone) in the joint. If the bouncing if running is causing the humerus to want to come out, the rotator cuff must be strong and active to stabilize the shoulder

When treating running injuries it is imperative to identify where the abnormality of force is. The balance between the force production and the force tolerance is key. Every runner is different. The degree to which the ground reaction force that must be eliminated and the amount of strength that the runner needs depends on a very complex mixture of factors. Find your local running expert to help you reestablish balance. When you decide to get treatment, be sure the professional is taking your running gait into play. If not, the status of the balance the runner is using is unknown. Happy running and hope you find the balance you seek.

-Ron

REPOST

So the Get Class thing didn't take off but I have some blog posts that I wrote that I do not want to go away.  So I am going to repost them.

If you are human, you are a runner

Yes YOU, biologically speaking, you are a runner. The question is, when did you lose the ability to run? How long has it been since you ran? As youngsters we grow up running then at some point, you stopped.

Some 2.3 million years ago human evolution took a huge leap. Researchers believe it was because of the introduction of protein into our diet. Meat. What is interesting about this fact in this jump in evolution is it occurred prior to the invention of tools. Humans engaged in persistence hunting, chasing an animal for hours until it overheated, making it easy to kill at close range. We are built for distance running. We have a great cooling system (our many sweat glands and little body hair), with upright posture and massive gluteus maximus muscles, springy ligaments, and toes.

In this day and age of computers, cars, motorized wheel chairs, and over-processed foods, we have learned to suppress our natural instinct to run. The hustle and bustle of life has replaced normal physiology. We as humans are lazy. Sedentary life styles contribute overwhelmingly to the health issues as we age, not age itself. Our habits trend toward increasingly sedentary ways as we age.

What’s keeping you from picking up and running? Does the reason have something to do with the biggest misconception about running, that running is bad on the joints? WRONG! There is absolutely no research to back that claim up.  Studies in the last few years are finding that we have BETTER joint health with running than without. Did you know that the risk-factors for heart disease (smoking, obesity, high blood pressure, high cholesterol, and diabetes) are more related to poor joint health than running?  That is correct, a healthy lifestyle will result in healthy joint surfaces.

If you have tried running and quit I would argue that running wasn’t the problem. What if you went too fast, too soon? What if you went too slow?  Is it possible you did not “dose” the introduction of running properly and safely? People tend to jump to conclusions, that they are not capable of such a feat. My favorite words are “I never thought I could do that.” If you have the strength and conditioning to run, it does not hurt to run. It is never too late to start. Can you train to marathon distance right out of the gate? Can you shoot for a 18 min 5K the first time out? No! Slow it down, dose it smart, and move your body forward. I leave you with 2 of the best examples:

Lew Hollander- LewHollander.com. An 80 year old man who has competed at the IronMan World Championships 21 years in a row. Yes, 2.4 mile swim, 112 mile bike, and 26.2 mile run (marathon) in 100-120 degree heat on a volcano. I think he has the key. Check him out.

The Iron Nun. Sister Madonna Buder. Began running at 48 years old. 385 triathlons later, including 30 plus iron distance races she is still competing and forcing Ironman to invent new age groups at the world championships for her to compete in, she is 81 years young. Check her out too!

-Ron

Happy to put January Behind Me

Physically speaking that is.  For the first time in years I have obligations getting in the way of my training and my training is feeling it.  I have had some musculoskeletal issues that are lingering on and putting a dent on how I can run.  Frustrating.  I am going to run the Surf City Half and I will be hard pressed to finish.  This will be 2 years in a row that I have a musculoskeletal issue preventing me from running the full.  At least this year I can run.  I didn't post last week our of shear frustration.  I know training and health/fitness is a roller coaster but that doesn't mean I have to like it.  For 90% of last year I was training really well so this is balance.  I get it.  I am happy to say that a few other things are going on that are noteworthy.  I feel honored to be recognized as one of the top 125 triathlon blogs at number 96.  If you would like to see the list HERE IT IS HERE.  After surf city I am going to highlight my return to triathlon for a VERY inspirational reason.  I am excited and it deserves a full post.  Stay tuned.

Something to Blog about

You know what they say.  If you dont have anything nice to blog about you shouldn't blog at all.  So this week my calf turned a corner.  I am cautiously optimistic about how my surf city race should be.  Had to bag the full but happy to run the half.

Tuesday-Goal was to move forward for 30 min.  I ran/walked it and was able to go about 4 min before it tightened up or got super tight.  I ran about 20/30 min and felt OK about it.

Thursday-30 min where I only walked about 2-3 min.  Those 2-3 min though I thought it was going to strain again.  I felt good every where else.  FINALLY a run.

Saturday-While I had to turndown 400 m repeats with the "bog boys" as he said, I was happy to go for a while.  I thought if I get to 30 and I can go to 45 I will go.  If I get to 45 and I feel good I will go to 60 min.  Well I went 70 min.  I didn't have any pain, just slight tightness and I felt ready to go.  Even felt ok as far as pace/fitness goes.  Today, no soreness.   Cautiously optimistic about my chances of getting off the ground before surf city.

The other days were res/rehab and getting this calf ready to run.

I would like to send a big shout out to a stud of a runner who ran the Arizona Rock n Roll half marathon.  She was told she would never run more than 5 miles after her gnarly back injury.  She ran the half with no signs or symptoms and not just that ran a 1:46.  Atta girl Michelle, YOU ROCK.

Recovering

well now that this is going on the 3rd week of no real running and rehab only, I do not know what I am going to do with this season.  I think with schedule about to heat up at track and my recent troubles I am going to dial down the training the next few months.  I am going to get this tendon issue resolved and get the effects of the injury fixed and then plug away.  I am going insane for sure not able to run.  I did get a 1/2 mile before I had to turn around this week.  Better than 0.1.  Keep plugging away.  The good news is I have not gained one pound through the month of december or now.  I feel like my fitness is far away though.  It is an awful feeling.  Thanks for the words of encouragement.  I will get this fixed here soon.

Happy new year( kinda)

I'm such a bad patient.  I hate being hurt.  I am so bored and I just want to run.  The end to 2011 was so abrupt.  I am starting off 2012 with no real plans.  The full at surf city is at serious risk.  I'm not sure.  December was definitely a down month.  No good runs during the whole month.  I have to figure things out here soon.