Gary’s Fitness Blog

I have now watched the NOVA - Marathon Challenge program twice.  My personal opinion is that the documentary is way better than the Spirit of the Marathon Documentary that was done about the Chicago Marathon trainees.

That may be due to the face that I’m a little bit of a science freak when it comes to the training involved in  marathon training.  The NOVA special doesn’t go into a lot of detail, but they do address certain training issues:  injuries, VO2 Max, Body Composition and a little about nutrition during long runs.

Here are some key take home messages that I’d like to point out and my view:

1.  Long Runs

I’ve discussed this many times in the past.  I recently wrote an article that I called, “A look at the long run and marathon training.”  And my first podcast, “The long run in a marathon program.  The double long strategy,” addresses my thoughts on how to approach a long run.

One of the interesting discussions was when the exercise physiologist and nutritionist from Tufts said that by the time you get to the “long” runs you have already developed the physiological changes and the soft tissue changes, the long runs are primarily beneficial for the psychological outcomes.

That is a point that I like to make and my point-of-view is that the downside of injury (for most runners) is greater than the psychological uplift a person may generate.

Just a reminder that there is no magic to a 20 mile run.

2.  Weight Loss / Body Composition

They analyzed the body composition of the runners before and after their marathon training programs.  What they found was that only one of the runners changed their body weight or body composition during the program.

This is hard to believe for many people, especially when you consider the amount of exercise they added to their lifestyles.  The take home message (which they made) is that we often over-estimate the caloric expenditure of the activity we participate in.

Thus, if we want to get into a weight management situation or lose some weight, nutrition is a very important (if not the most important) variable in that program.  This can be hard for an exercise physiologist and personal trainer to admit because I want to believe that exercise is the most important key to any lifestyle… but there are limitations.

A better message is that there needs to be a combination of exercise and non-disordered-eating.  One thing that I see often (and see in myself), is a belief that with all the exercise that comes with running a marathon or training for an Ironman, a person can eat whatever they want.  That mentality leads to disordered eating.

Exercise Session –> Eat what mind wants –> Non-Optimal Food Choices

This is one thing that I am currently working on.  I know that when I’m in full capacity training I have little mental energy and strength to combat poor nutritional habits.  Last summer it got a little crazy as I trained for Ironman Wisconsin.  Now that I’m not in full capacity training, I see myself being able to change some of those habits.  Still more changes that need be made.

3.  The other side of body composition.
The other side to their body composition discovery was that the one person that did have changes also included a bootcamp training program in addition to their marathon program.

This is a good lesson because it helps us realize that even within an exercise program, there needs to be a balance between strength training, flexibility training, and cardiovascular training.  Many endurance athletes can become addicted to the “runner’s high” and neglect other aspects that would benefit their health (again, I am as guilty as anyone).

4.  The injury issues:

There seemed to be a lot of injury issues that the runners were dealing with.  One of the most important lessons that I’m continually learning is the value of specific strength training and flexibility training as a hedge against injury in a beginner / novice marathon program.

You can go back and read the posts I’ve had on strength training and patellofemoral pain.  Many lessons learned there.

The long run is usually viewed as the center piece of a marathon training program. In the current pop running culture, this means that most marathon training programs work towards the “20 miler”.

This is a topic that I have discussed many times in the past, with many different people, and I thought now was the time to get all my ideas out there to share with fellow runners.

Why I don’t like the “20 mile” Destination for marathon training:

1. I don’t like the concept of placing so much importance on a single 20 mile run. Why? In many running programs that I see, runners end up putting so much value on the long run that it ends up taking away from the value and training stimulus they could get by having a solid week of running. (Which means running regularly throughout the week too.)

This doesn’t mean that every runner using these programs puts too much emphasis on the long run, but psychologically it can become a trap. If you decide that the weekend long run is the most important workout of the week, it can be tempting when “life happens” to justify missing a couple runs during the week, as long as you “accomplished” the long run.

This is a trap that often leads to, in the worst case - injury, in the best case - less developed fitness due to less overall training stimulus.

This idea becomes even more magnified if a training program leads towards the 20 miler and a runner develops the belief that they are ready to run the marathon, using the 20 miler accomplishment as their only indicator.

I’m not the only one who takes this approach. Jack Daniels, in his book, Daniels’ Running Formula suggests that the longest run you do be under 2.5 hours. The risk-to-reward ratio (injury risk/physiological reward) beyond that point is often not worth it. I remember Bobby McGee taking a similar stance.

Solution: as a runner begins a marathon training program, set the initial goal to accomplish “x” number of weeks running 3 days and building to 5 days a week before taking on any run over 2 hours. “x” depends on your timeframe, but a typical 18 or 20 week program should give you at least 6 weeks to build up to 4 runs at 40mins+ or 5 runs at 30mins+.

2. Does it pass the common sense test to do more than 50% of your running in one day? It doesn’t, but many marathon runners that I see or read about do just that.

When a runner is doing less than 40 miles per week, that is what they are doing when they build to a 20 mile long run.

Again in Daniel’s book he suggests that the long run be no more than 25% of your total weekly mileage. Therefore to have a long run of 20 miles, a runner must be doing a minimum of 80 miles a week. That kind of mileage is not all that common for the average age-grouper hoping to finish a marathon.

An approach that I have reviewed several times that I like a lot (probably because it is how I like to train people too) is the way the the Hansons train their runners (their age-groupers, not their elite… that would destroy all of us).

In their approach, the longest run that a beginner or advanced runner does is 16 miles. (I know your are screaming in revolt as you just read that.) The advanced runner will see more training stimulus throughout the program, but the longest run distances are the same.

What a refreshing display of understanding an average runners needs and ability. Someday I would love to get some closer looks and discussions with the Hanson-Brooks guys, but from the outside looking in, I like what I see.

Solution:

So you are freaking out about not running longer than 16 miles prior to your marathon day - that’s normal. But it is normal due to the fact that the 20 miler has become ingrained into every running groups mindset around this country, not because there is a physiological or training stimulus significance to that distance.

I personally don’t have a 16 mile limit in many of the programs I help with, I schedule the longest run at 2.5 hours and allow a little more if the runner is running well, consistent and injury free.

So how do we address the psychology behind “being ready”?

The Double Long Run Weekends.

I have to admit this is not my idea originally. It was a style of training that a professor I had at UNL (Nebraska-Lincoln) put me through (in late 2000) when I went to her for a solution to my 2 previous failed attempts at running a quality marathon.

The basic Idea: is to alternate weekends, doing a longer run on week one, then two medium long runs on Saturday / Sunday of week two. Then repeat that pattern throughout your training program. An example might look like this:

week 1 - Saturday: 12 miles / rest
week 2 - Saturday: 8 miles / Sunday: 8 miles
week 3 - Saturday: 14 miles / rest
week 4 - Saturday: 10 miles / Sunday: 10 miles

That is a basic example, it would be changed based upon athlete, scheduling, along with other variables that could impact the schedule, such as races. I personally prefer to use time goals than mileage goals, but the same pattern would apply with either method.

What I found was that this pattern allowed me to be incredibly more consistent in my running. I would spend less time recovering from the mega long runs. I also found I could easily handle more total running stimulus in a week compared to situations when I was trying to stay fresh for the weekend long run.

Those two things improved my running greatly - consistency and greater overall training stimulus.

How to approach the Double Long Weekend?

These weekends can be tough sometimes, but they can also provide a great deal of training stimulus and self-confidence. Here are some tips that I like to share about those weekends:

1. Saturday’s run should be relaxed and comfortable. I rarely get excited about how fast or slow the runs are, because the main goal is to feel strong. Many times the Saturday run will be finished with the runner feeling a little anxious about not having done enough. Especially when they have reached a point where 10 mile runs could be done each day they run.

2. Make sure you allow your legs to recover after Saturday’s run. Proper post run nutrition, stretching, cold baths are all good ideas.

3. Sunday’s run should be done at an intensity slightly higher than Saturday’s run (but much less than the Tuesday,Thursday runs during the week.) Ideally, the runs would be completed at a pace that is 45 seconds to 1:15 per mile slower than the goal marathon pace.

This depends upon the runner’s current fitness though! Don’t run those times if they are picked out of the air, know that your fitness is prepared for them.*

4. Make the back half of the Sunday run the most intense of all the weekends efforts. Often this will happen naturally as the legs fatigue, but a very fit runner may need to push that portion of the run in order get the training effort up. (Still should be around 45 seconds off marathon pace.)

Using these double long runs in this manner, especially approaching the Sunday run this way should give the runner confidence in their ability to run the marathon’s 26.2 mile distance. It can also be a huge learning experience to feel the legs achy and tired prior to Sunday’s run and still being able to finish the distance or duration.

As mentioned, this structure also allows recovery to occur faster and decreases the risk of injury when compared to the single long run days.

Expanding this concept (even to triathlon).

This idea can be taken one step further for the more advanced runner. An example that I can share is my approach to our (Nikki and my) run programs leading up to Ironman Wisconsin last September.

Knowing that putting in a long run didn’t fit the schedule or our ability to maintain regular workouts in the other sports, we built up to a “broken marathon”. This was different for the two of us as we were different in our running needs.

My program built to this series: 12.6 am run / 6.8 pm run (included some tempo) / 6.4 am run. That got me to 25.8 miles with a little tempo built into it within a 30 hour period.

Nikki’s program built to this series: day 1: 10miles, day 2: 10miles, day 3: 6miles. That got her to 26 miles within a 48ish hour time period as the day one run was an evening run and the day 3 run was a morning run.

Keep in mind that this isn’t a prescription to copy, just an example as to how the idea of stacking runs in a 24/36/48 hour time period could be done. This method was easy enough on my body that I was able to get in an hour recovery swim during the evening of the second day.

(As a sidenote, the longest run I did in the Ironman build was 15 miles.)

Final Thoughts on Approaching your Long Run.

The long run is an important piece to any marathon program, but don’t be fooled into the dogma that the long run has to follow the staircase to 20 miles. It might just be the worst thing you could do for your training, because training and racing become difficult if not impossible when you are nursing an injury.

Try a double long weekend… you just might see your running improve like I did.

* This deserves another post that I hope to get to soon, but for now you can read Daniels’ Running Formula or search google for “VDot running”.

I am currently dealing with the results of not following my own advice. It happens to all of us at times. Here’s my quick story:

The entire year of 2008 I have made a decision to remain consistent in my training, but to not train for any specific race. I have followed through, but got the idea to sign up for an ultra marathon a couple weeks before the race. I ended up turning up the mileage on my legs pretty quickly (like doubled in the couple weeks). I didn’t have any troubles at first, but then….

I started having some hip problems. Issues that have lead to this, in my view: Running too many miles way too quick. Dropping strength training and yoga in order to get in the extra runs.

The worst part of the situation is that I always have runners that I coach and mentor focus on “leg durability” as the main goal for the first phase of their training programs. This almost always means running multiple days before running a certain mileage or duration. I fell into the trap of feeling unprepared, thus jumping into something my legs were not ready for.

As an example of what I often preach, here is a note I sent to a group I trained for the Rock N Roll Marathon back in January.

So often a new runner is concered about how far they are running or how fast they run, but one thing a new runner should be concerned about is how durable their legs are. If a person hasn’t developed the right amount of durability, then when they run “far enough” or “fast enough” to make them happy, they commonly are in a position that their legs can not hold up. Things like injury and soreness creep in and their running becomes less consistent, exactly the opposite of what they might need to produce better durability in their legs.

Two things about the program that you can pay attention to is this:

1. Are you completing all the runs during the week?
2. Are your legs recovering from the Sunday runs?

Your answers to those questions will lead to your answer of this question; “How durable are my legs?”

It’s so important that you develop an adequate durability before you start doing the typical “long runs”. I like to see people run at least 4 days a week at 40 minutes per run before they do anything that resembles a long run.

The athletes that I help become used to the “double long” weekends very quickly. What a great way to turn around your running… those runs build durability, they also allow people to get in more training than when they spend all day Sunday recovering from the weekends “mega long run”.

Guess it is time to take my own advice! As I can not run consistently right now, I’ll be cycling and swimming (and yes, getting back to strength training and yoga).

For now, I’ll keep sharing the message. Think Bobby McGee said it this way, “strong before long.”

If you have read some of my blog posts lately than you have seen that I have been digesting some research articles related to patellofemoral pain and strength training.

One question that could be asked is; Why patellofemoral pain? Here are two answers:

1. If you read my review of the article that discussed the benefits of physical therapy then you would know that patellofemoral pain is also known by many other names, such as, chondromalacia patellae, anterior knee pain, patellar malalignment, and patellofemoral arthralgia. Therefore it may seem that the name is a very narrow issue, but it is not.

2. These issues seem to be very common set backs that runners deal with from my experience. While I used to believe that these knee issues (runner’s knee even) were more prevalent with new runners, I am not sure that I can make that general observation anymore. I feel like I get these questions all the time lately, from all sizes, shapes, gender and experience of runners.

The previous two articles have been a review of: a - suggestions to sports physicians on how to address and manage pfp and b - the role that physical therapy interventions have, especially strength exercises.

The article that I reviewed today discussed the question from another angle, Is there a difference in hip strength in females that have patellofemoral pain versus those that don’t?

Here’s the article source:

Ireland ML, Wilson JD, Ballantyne BT and Davis IM. (2003). Hip strength in females with and without patellofemoral pain. Journal of Orthopaedic and Sports Physical Therapy. Vol. 33, No. 11, Pgs. 671 - 676.

The basics of the study is that they matched 15 females subjects with patellofemoral pain to 15 female subjects without patellofemoral pain. They then tested both hip abduction (moving your leg away from your body) and external rotation (rotating your foot in).

They had some interesting findings:

1. isometric hip abduction was 26% weaker in the females with patellofemoral pain
2. external rotation was 36% weaker in females with patellofemoral pain

They do point out in their discussion that b/c of the study design it is not possible to determine a cause/effect relationship, but they do make some observations that I felt were worth mentioning:

1. the results of this study, along with previous studies show that proximal stabilization programs (this means proximal to the knee… thus the stabilization at the hip) may be beneficial for those with patellofemoral pain.

2. strengthening of the hip abduction and external rotators may benefit those with patellofemoral pain (they mention other studies that have focused on strengthening the gluteus medius)

My thoughts:

This observation is essential to my understanding of the patellofemoral pain issue and helping runners. Why? Because most of the articles that I’ve read and found deal with the issue of patellofemoral pain treatment. Which is not what I would ultimately like to do. The desire is to find characteristics of the problem and correct them before they become an injury that needs treatment.

Again, this article does not show a cause / effect relationship. I could not promise someone that if they increased their strength for hip abduction and external rotation, they would not ever develop knee pain. The injury is multifactoral, therefore that idea is too simplistic in my point-of-view.

But it does point to a possible factor that we can control by including some appropriate strength training exercises.

One of the biggest revelations that I’ve had lately is just how oblivious I have been to this issue in the past. I have always had personal training clients strengthen their hips in the different planes, but I have seen the hip abduction weakness and hip stability (glut med) weakness a lot recently. Even in my own hips, which has created other problems (tight psoas muscle and back pain).

Does this mean that doing a hip strengthening routine is appropriate for everyone? I am not sure I can answer that, but I will say that my belief now is that it can’t hurt (while knee pain can), especially for those who are beginning a running/cycling program or are in a period where they are increasing their activity levels by a large percentage.

Hopefully I can find an article that discusses these weakness issues and interventions related to prevention. If I can, that will be the next patellofemoral pain article I review.

Until then… happy abductions.

In my last post I discussed the topic of Patellofemoral Pain and Tendionopathy. Specifically, I mentioned the special communication that was put out in the November, 2007 issue of Medicine and Science in Sports and Exercise.

Over the past year, I have been collecting articles, reading and researching this topic of injury prevention for runners and strength training. The special communication has once again peaked my interest and I thought I’d share a brief synopsis of a few articles that I have reviewed lately.

The next few posts will all be short reviews of articles discussing Patellofemoral Pain. Here’s the first article:

Source:

Crossley, K, Bennell, K, Green, S, et. al. (2002). Physical therapy for patellofemoral pain. A randomized, double-blinded, placebo-controlled trial. The American Journal of Sports Medicine, Vol. 30, No. 6. Pgs 857-865.

1. One of the first things I found interesting was that in the introduction they say that patellofemoral pain is the most common diagnosis cited by many authors. And that while it is a common issue to be seen and treated, the “pathologic origin of this disorder is not clearly understood.”

2. The jargon is wide ranging describing this issue. Patellofemoral Pain, Chondromalacia Patellae, Anterior Knee Pain, Patellar Malalignment, and Patellofemoral Arthralgia have all been used synonymously.

3. “The rationale behind the use of physical therapy for alleviation of patellofemoral pain includes restoration of patellar alignment through active or passive interventions, including quadriceps muscle-strengthening exercises, stretching, patellar taping or bracing, biofeedback, and use of corrective foot orthoses.”

4. The purpose of the trial was to find out if physical therapy was effective in managing and treating patellofemoral pain in comparison to a placebo group.

5. The physcial therapy used consisted of: patellar taping, biofeedback of vastus medialis oblique (VMO, which is the quad muscle on the inside of your leg), gluteal muscle strengthening exercises and stretching.

The exercises that they uses were the following:

• isometric VMO contraction at 90 degrees — basically a leg extension done isometrically at 90 degrees
• squats to 40 degrees with isometric gluteal muscle contraction (4 sets of 10 reps)
• isometic hip abduction standing against a wall (4 sets of 15 seconds)

added exercise after 2 weeks:

• step downs — stand on step and slowly lower leg in front (3 sets of 5 or 10)
• increase the hip abduction to 30 seconds.

6. They were instructed to do these exercises 2x a day while in the program.

7. They concluded that there was a significant difference between the two groups in three measurements: worst pain, usual pain and anterior knee pain scale. But there was no difference between groups in the functional index questionnaire.

My thoughts:

As many of the articles that I find, this article discusses the rehabilitation of knee pain not the prevention of knee pain. But there are some interesting insights that I feel I can pull from this article:

The exercises that they chose strengthened the gluts and hip abduction. This is a common theme that I have seen in runners that end up developing the worst knee issues - they have weak glut and hip abduction.

One easy way to see how stong and stable your hips are (those two mucles groups involved) is to stand on one leg and try to do a 2 or 3 inch squat. Make sure you are not holding onto any table, chair or wall for balance. Can you do it? Does your knee try to cave in towards your other leg or push out away from you midline?

If it appears that you can’t balance or do the squat, it might be that you are a little weak.

Now relate this to running. Each gait cycle you have to do a very small version of the single leg squat. You flex and extend at the hip, your knee flexes and extends, your foot dorsiflexes and then you plantar flex to toe off. What happens if each time you go through this cycle your leg isn’t strong enough to carry through the movement and your hip or knee has to adapt?

Let’s do a quick calculation: Let’s say each leg goes through this cycle 90 times a minute (the 90 rpm cycle many coaches suggest today), you run for 1 hour (60 minutes). That equals 5,400 times each leg will make that movement. Now go run a marathon!

My thoughts are obviously an attempt to make a somewhat educated discussion based upon my experience and the knowledge gained from this article. As I continue to be aware of the issue of injury in runners, I continue to be more convinced that some runners will benefit by including strength training in there regular programs. For no other reason then they will be able to handle more miles without injury.

One of the biggest questions becomes, What exercises should I do? One place to start would be with a post I wrote some time ago called, Improve Muscle Imbalances with Strength Training - Hip Stabilizers. I plan to update that post soon, but I still believe it is a good starting place.

Next Post:

I plan on looking at an article called “Hip Strength in Females With and Without Patellofemoral Pain.”

** Below is a copy of an email I sent to a few runners I’m currently coaching**

I was reading through the latest issue of the Medicine and Science in Sports and Exercise yesterday and found a special communications from the organization (American College of Sports Medicine) to team physicians. In that communication they gave suggestions to physicians about “selected issues in injury and illness prevention”.

The one injury area that I thought was relevant to us runners was their thoughts around Patellofemoral Pain and Tendinopathy.

Risk Factors they associated with this are:

1. muscle weakness and imbalance and inflexibility including quadriceps shortening
2. trauma, overuse, training errors or previous injury
3. patellar hypermobility
4. hip muscle weakness

Prevention Interventions Include:

1. implement sport / activity conditioning program with periodization emphasizing the proven interventions of quadriceps strengthening and increasing hamstring flexibility

2. other interventions may include core / lower extremity strengthening, hip abductor and external rotator strengthening, improving motor control.

My thoughts:

I come across a lot of issues in runners and general population with weak hip stabilizors and pelvic mobility/control. Incorporating some adductor exercises / abductor exercises have seem beneficial (I’ve especially seen this in a cyclist that I’ve worked 2 years with). The other thing that they talk about is “motor control” … I’ve recently seen a need to incorporate some balance training (single leg balance exercises) to help develop the hips / lower leg stability so that it can properly move through the gait cycle.

Some beginning exercises that can help in these two areas can be found at this link: http://familydoctor.org/online/famdocen/home/healthy/physical/injuries/479.html

One thing to remember is that when running your body can’t rely on a machine for stability or movement patterns, so when incorporating a strength, stability and balance program… don’t use machines.

Last thought:

Everytime you run, your body has to work to strengthen itself and adapt to the workout. If the first law of training is “specificity” (which it is one of the first four by the way) then we should appreciate that regular running is likely the best way to strengthen our body to run. In other words…

… if you are not running regularly, it doesn’t matter how many single leg squats you do on a balance pad, your long run is going to likely cause injury…..

…. But if you have been running regularly, these exercises are a great addition to help boost your body’s ability to handle your runs…

…. In other words - these exercises are In Addition To, not In Place Of your running …

…. unless you are already dealing with an injury, which changes the entire ball game …

**** End of Email ****

Those are some thoughts that I felt were worth sharing with everyone. Since that email, I’ve come across a couple situations that have driven home the importance of these injury prevention interventions even more.

When motivation is high, which often is the case in an individual taking on a marathon for the first time, there can often be a disconnect between what is “optimal” and what is “practical”.

I put “optimal” in quotes because there are a lot of people out there willing to give advice about the proper way to train for a marathon. But the question we always have to ask ourselves is this: Is it the proper way to train for me? The truth is that there are many ways to get to the finish line of a marathon (or triathlon), choosing the best path for you is the key.

Someone who has run 10 (or 50) marathons may have a program that works well for them, but may not necessarily be proper for you. Do they have the same biomechanics as you? What was their history with running before they began?

There are so many variables. The interventions listed above are a good starting place if you are starting to see some patellofemoral pain during or post running workouts. They are also a good hedge against injury development if you have poor biomechanics or running form.

If you feel like you need more individual guidance, look me up and I’ll try to help if I can. My email is garyditsch at gmail dot com.