A Bony Issue

Are you a habitual loser? Do you constantly find yourself losing things and desperately searching every nook and cranny of your surroundings? On several occasions, I've lost a contact in the process of putting it in my eye, scrambling nearly blindly on the ground to find the transparent little bugger. Perhaps you've lost your keys, or even the T.V. remote, on numerous occasions. Next time this happens, remember that things could be much worse. You could lose your bone mass.

Main Entry: os·te·o·po·ro·sis
Pronunciation: \ˌäs-tē-ō-pə-ˈrō-səs\
Function: noun
Inflected Form(s): plural os·te·o·po·ro·ses \-ˌsēz\
: a condition that affects especially older women and is characterized by decrease in bone mass with decreased density and enlargement of bone spaces producing porosity and fragility

According to the National Osteoporosis Foundation, osteoporosis affects more than 200 million individuals across the globe. Many know that running, which is high-impact, can help increase bone-density as the bones respond to the great stress under which they are placed. However, one important study (in the British Journal of Medicine), performed on 52 female runners who ran a great range of weekly distances, found the women who ran the most to have the lowest bone density. While it is true that osteoporosis is often associated with older women, this research done on female distance runners has proven that this problem is not solely a condition of old age. Being one who truly puts the "long" in long-distance running, this certainly caught my attention.

What was the reason for this result, seemingly counter to the very physiological principles of increased work load and response? It was found that many of the women who had higher training volumes were not eating adequately to fuel the expected bone response to such mileage. Of course, a lower bone-density makes much more likely the possibility of stress fractures and/or osteoporosis, even when safely bumping up training at the 10% per week rule-of-thumb. Thus, maintaining a balanced diet that provides enough energy to sustain physical activity, with adequate calories to promote the building of muscle and bone, is of great importance.

Another possible reason for these findings is the fact that estrogen, a hormone that has a great impact on bone health, is typically lower in female athletes who participate in vigorous exercise like running.

Additionally, if you are guilty of commonly skipping other upper-body resistance exercise (like weight lifting), bone-density in these areas will be unaffected by concentrated efforts in the predominantly lower-body sport of running. Therefore, even though a runner may harbor doubts as to whether or not weight lifting and other such workouts will help cut a 5k time, said exercises would certainly be in the best interests of bone health.

Weight lifting isn't just for meat-heads, as everyone who wants to show some love to their bones should give it a try. You don't have to bench-press 100+ lbs. to achieve better bone density or become a better runner; rather, 2-3 sessions of moderate weight lifting per week will suffice.

And lastly, I will remind all my fellow runners to eat up and fuel well! It's not one's outer "bony" that matters - it's the inner "bony" that counts.

Res(pec)t Your Body

Of course, no elite distance runner reaches the olympic marathon trials by laying around on the couch all day. However, rest does play a very underestimated role in improvement, especially as your training volume and intensity increase. If you don't already, incorporating one day of rest (or at least very low-impact exercise) per week would be a good idea. Not only would it aid in recovery and hence, performance, but it would also reduce the risk of injury and overtraining.

In our sport, approximately sixty-five percent of runners are injured annually as the prevalence of injuries is about 1 per 100 workouts ('Incidence and Severity of Injury Following Aerobic Training Programs Emphasising Running, Racewalking, or Step Aerobics,' Medicine and Science in Sports and Exercise, vol. 25(5), p. S81, 1993). It is estimated that runners are forced to sit out of 5-10% of their workouts as a result of an injury, which is a rather large amount of time spent out of commission.

Anybody who wants to miss out on 5-10% of their workouts, raise your hand at the keyboard. Anyone? Anyone? It's true that no dedicated athlete wants to sit out on the sidelines, counting down the seconds until they can rejoin the sport they once knew and loved. But rest days and recovery, which should become more numerous as you pass the age of forty, can help keep your body healthy. When you run every consecutive day, you risk being forced to discontinue activity for an even greater period of time than you would have spent cumulatively over your rest days. And rest days aren't just for the recreational runner - even the Kenyan elites take them!

Sometimes, even if one is not "scheduled" to rest on any given day, a day off to recover from the demands of exercise and life in general can be very beneficial. According to the Runner's World website, you can gauge when to rest based on your pulse. First you must know what your "average" pulse is. Then you can find your pulse before getting out of bed in the morning, and if it's 20% higher than normal, your body is telling you it needs a break.

One must also make the important distinction between a "rest" versus an "easy" day. A rest day entails little to no exercise, stretching, upper body weight lifting, and/or low-impact activities such as swimming, walking, or yoga. For runners especially, it is important to give the legs time to recover from the training demanded of them the other 6 days of the week. Easy days, on the other hand, are days in which a runner does a lower intensity, less demanding workout, typically following a day of a hard training session such as speedwork. In essence, an easy day allows the body to repair muscle tissue on the microscopic level, whereas rest days give the muscles a chance to more fully repair themselves from larger-scale damage.

There is no need to worry about losing fitness over the course of one, two, or even three days off. The world will not stop turning, fall off its axis, and drift off into outer space. Although, much more than that - which injuries usually require to completely heal - will unfortunately be detrimental to your performance. For every week of no exercise, it takes approximately two weeks of training to make up for lost fitness.

Injury prevention is key. But when the ten-percent-increase-per-week rule and proper athletic footwear fail, giving way to an injury despite all proactive measures, rest is crucial. Sometimes we runners can be rather stupid - yes, including myself - by trying to train through an injury or skimp on complete injury recovery time for fear of losing the the fitness for which we give our blood, sweat, and tears. Interestingly, 50% of injuries are of the recurring variety; that is, those that were not properly taken care of and fully healed. The voice inside us, that source of great success, can also become the source of great harm if left uncontrolled. I highly disagree with the phrase, "No pain, no gain," when it comes to injuries. Instead, refrain from pain.

The moral of the story? R-E-S-P-E-C-T your body, and it will do so in return.

That's How We Roll

When one hears the word "cross-training," several others may come to mind, like "swimming," "biking," or "elliptical." If you're injured and looking for alternatives to running, or even just bored with your exercise routine, try adding this word into your cross-training vocabulary: "rollerblading."

How Did Rollerblades Originate?

Despite the associates many people have with rollerskating and the disco-ful seventies, in-line skates were first produced by a Dutchman in the early 1700s who attached wooden spools to strips of wood and nailed them to his shoes. How did he devise this strange plan? Who knows. Nevertheless, after the prototype of this seemingly odd man followed a more modern version of rollerblades in 1863.

Physical Benefits of the Sport

Although the scene of someone trudging through snow in a pair of rollerblades adorned with icicles is not one you're apt to experience, rollerblading is a great spring, summer, and fall sport. Of course, the sport is less aerobically demanding than running, but it is more so than that of biking due to the lesser amount of time spent coasting. To receive a more equivalent aerobic workout to running, multiply the time you would plan to run by approximately one-point-five. Rollerblading is certainly no walk in the park, and can be made more difficult by blading uphill or in intervals alternating between a fast pace in the tuck position and a slower, recovery pace in an upright position.

On the other hand, despite its inferiority to running's aerobic potential, rollerblading has been shown to have more anaerobic benefits than either running or biking. It's a good method of developing one's glutes and hamstrings, as well as muscles of the hips and thighs that running largely doesn't employ.

Pros of Rollerblading

• Low-impact (causing roughly 50% less impact to joints in comparison to running, according to a study conducted by the University of Massachusetts)
• Great aerobic and anaerobic exercise
• Alternative to running when cross-training or injured
• Like running, it can be performed with Fido alongside
• Enjoyable
• Moving quickly through the air, acting as a natural "air conditioner"

Cons of Rollerblading

• Seasonally- and weather-limited
• Somewhat motion-restrictive gear

As wonderful as rollerblading is, precautions should be taken and proper equipment worn to ensure one's safety. I highly recommend the following, even though skating is fairly safe for decently balanced and coordinated individuals who do not model their technique after Chazz Michael Michaels (AKA Will Farrell) in Blades of Glory. And remember, such gear is obviously not intended to make a fashion statement! It may feel excessive or "dumb," but you'll feel much dumber if you're scraped up like a zested lemon because of an overly self-conscious attitude.

Rollerblading Equipment

• Helmet
• Knee, elbow, and/or wrist pads
• Properly fitted skates (Note: Aim for a mid-priced pair, as cheap, poorly-fitted skates could cause discomfort, rubbing, and blisters, making the experience much less enjoyable. Also, look for skates that include plastic molding support for your ankle.)
• An even, smooth surface for skating
• 76-78 mm wheels on the rollerblades

Keep in mind, if rollerblading becomes a regular exercise habit, it is recommended that you rotate the wheels on your skates every so often, clean and lubricate the wheel bearings, and check and tighten the wheel nuts as needed.

If you're looking for a good way to cross-train and want to have some fun while you're at it, try rollerblading! There's no need to disco; it's the 21st century and time to rock and roll!

To Stretch or Not to Stretch? That is the Question.

If you were once involved in high school athletics, chances are you received the old school schpeel about static stretching (the task of maintaining a stretch for 10-20 seconds) and how it "prevents injury." Memories of a chorus of my teammates counting down from 10, stretching in unison while gathered in a circle, still echo in my mind. In fact, for some coaches, static stretching is the very pinnacle upon which a thorough warm-up rests. I, myself, truly detest taking time to stretch before workouts, which is likely why I often end up skipping it altogether. But with recent research searching for the science backing this claim, static stretching is no longer thought to be beneficial, but rather detrimental, to ensuing athletic performance. Fellow stretching-haters, rejoice! (insert Hallelujah chorus)
Perhaps I celebrated too soon. Although studies show static stretching pre-workout negatively affects actions such as jumping, sprinting, reaction time, balance, muscle strength (reducing it by as much as 30%), neuromuscular response, and strength endurance, researchers are now promoting the art of dynamic stretching, found to be exponentially more effective in a true warm-up.

What is Dynamic Stretching?

Dynamic stretching is the act of loosening the muscles and tendons, expanding the joints' ranges of motion, and increasing blood flow. There are a number of exercises that accomplish this task, some of which include straight-leg march, handwalks (informally known as inch-worms), forward lunges, backward lunges, arm circles, squats, heel walking, forward inverted hamstring, vertical power skip, and carioca.

Why is Static Stretching Detrimental to Performance?

Static Stretching, although it elongates the muscle, actually weakens it. It also causes a "neuromuscular inhibitory response," meaning the stretched muscle(s) become(s) less responsive, being counterproductive to the main purpose of a warm-up. This effect lasts for around 30 minutes post-stretching. One may perceive an increased readiness for athletic performance as they can stretch farther and farther as they hold the stretch, but in reality this is merely their increased mental tolerance for the discomfort.

Although the benefits of dynamic stretching put somewhat of a damper on my celebration, as I am impatient and will have trouble incorporating it into my training, I can certainly find happiness in laying to rest pre-workout static stretching.

Is There a Time and Place for Static Stretching?

Although static stretching prior to a training run or race is not recommended, there is something to be said about performing such exercises post-workout. One shoudn't entirely forego static stretching, as it may indeed help prevent injuries when performed after exercise. Of course, it also increases flexibility and range of motion.

In essence, if you haven't already, try incorporating dynamic stretching pre-workout and static stretching post-workout for optimal effects - even if you're a self-proclaimed stretching-hater such as myself.

"Nobody Makes Me Bleed My Own Blood!" -White Goodman, Dodgeball

If you can dodge a wrench, you can dodge an injury. Or, maybe not. Unfortunately, the movie Dodgeball's philosophy does not necessarily apply to us runners, for whom no amount of pointlessly dodging wrenches will lessen the chance of injury.

Those of you who have had or are currently dealing with a debilitating injury know how frustrating it is, waiting and cross-training with your fingers crossed, wishing you could will the body's seemingly never-ending healing time to speed up. If you've been running for very long, it is likely you've had experience with a number of injuries. As I was, you may be excited to hear of a treatment called platelet-rich plasma (PRP) therapy that could potentially revolutionize sports medicine.

What is Platelet-Rich Plasma Therapy?

PRP therapy essentially involves extracting the patients blood, placing it in a centrifuge to isolate the platelets (microscopic image shown at left) in a concentration 3 to 10 times that of normal blood, and injecting around 1 to 2 teaspoons of the substance into the injured area. Because of its high platelet concentration, it has the ability to spur the production of new bone cells or soft tissue. Also, the clotting that platelets are known for does not occur in areas like ligaments in tendons because these structures are not well-vascularized, or not accustomed to receiving blood otherwise.

Pros and Cons of PRP

The treatment is not appropriate in all cases, but it is a good non-surgical alternative to "problems that don't have a great solution," according to assistant professor of orthopedics at Stanford University Medical Center, Dr. Allan Mishra. In addition, the procedure costs $2,000 - a seemingly staggering amount, until one compares this figure to the typically $15,000 or more of surgery. It is also possible that, once the therapy has become more commonplace, insurance companies would cover PRP and make it a first course of treatment.

Also on the positive side, the non-surgical PRP is much less likely to cause infection, doesn't cause scarring, has a shorter recovery time than surgery, and takes a mere 20 minutes.

But, hold your horses ladies and gentlemen, because like everything, this procedure does have a down-side. Unfortunately, despite the great optimism with which the orthopedic community views the treatment, in an estimated 20% to 40% of cases, PRP is ineffective in treating the injury.

Although still in an experimental phase, as it's not yet fully available in clinical settings per patient request, it implies great prospects for athletes who find themselves hindered by stubborn, nagging injuries. Introduced in the 1970's, platelet-rich plasma therapy only recently began to receive media attention in light of new technological advances, as well as Pittsburgh Steelers players Hines Ward and Troy Polamalu finding great success with treatment two weeks prior to their Super Bowl game. Their stories truly illustrate the promises PRP makes for many athletes sidelined by an injury.

Ward, having a medial collateral knee ligament tear (which has a roughly 4-6 week healing time) treated with a combination of PRP, intense rehabilitation, and hyperbaric oxygen therapy, was able to make two catches in the big game. Ward's teammate Polamalu had a strained calf and was also treated with PRP. Polamalu was deemed well enough to play in the Super Bowl, in which he intercepted and returned the football for a 40-yard touchdown.

What Does This Mean For Runners?

Many runners have a hard time relating their own sport to that of football, but PRP's application promises a method of rehabilitation that reaches across the expanse of many sport-related injuries. This therapy is music to my ears after having endured my fair share of injuries, most notable of which was a metatarsal stress fracture that lingered for several months. I know that now, if someone gave me the opportunity to have PRP therapy and "bleed my own blood" (according to White Goodman from Dodgeball) in the midst of a nasty injury, I'd put my fear of needles aside for my love of running.

The Running Gods Are Smiting Me

crap [krap]
noun
1. vulgar : nonsense, rubbish

This was my first thought yesterday as, half-way through my 8-mile planned run, I began to feel pain directly below the site of my outer ankle. Or, what foot physicians refer to as peroneal tendonitis.

It began as an ache, really, that grew progressively worse over the course of several days. I, of course being the stupid individual that I am, blew it off as a minor thing that might accompany the stress of the 50+ miles a week I regularly run.

I was very wrong.

I've gone through injuries before, most noteably last summer. I was inflicted by tendonitis near the inner ankle, followed by two weeks off from running. A week later, I got a repetitive stress injury that came frighteningly close to a stress fracture. Thus, 6 weeks of no running was in my future, which meant 6 weeks of intense training on the stationary bike. Because I went back to running too soon, with the permission of my far-from-knowledgable-about-running podiatrist, this stress injury plagued me for many months after its onset.

This spring, it fully healed and I was running with an attitude of iron. Or perhaps of titanium alloy. You see, I was the "bionic woman," training as hard as ever. No injury could even catch me.

Unfortunately, yesterday was the moment of brutal realization: I am as susceptible to injuries. My bionic facade has been crushed, and my far-from-machine-like body has brought me to remember the physical and mental anguish of injury.

Today is a scheduled rest day, making it mentally easier to not run, but what about the day after that? And the day after that? I will evaluate my situation on a day-to-day basis, but in the face of denial, I realize deep inside that this may require a week or more to heal.

Perhaps not running as a result of injury should be dealt with the same mental strength as running. Instead of putting my energy towards running, I must temporarily direct it towards cross-training (i.e. biking) and healing.

There will be ups and downs along the way - times when I want so dearly to succumb to my running addiction - but for the betterment of my training, it is a duration as necessary to my training as a long run.

I may come back to read my own writing tomorrow, the next day...however many days I am out of commission. I need to take my own advice and put aside the hardcore runner within me until my peroneal tendons decide to cooperate.

Regardless of how I'm talking tomorrow, ranting on about my anger towards the running gods who seem to have so quickly turned on me, I will accept my fate as an oppurtunity to grow. Ironically, I posted a while ago about the meaning of patience. Looks like this is my chance to practice some.