Low mood, irritability and mood swings are a common peri-menopausal symptom, and this is where running really comes into its own, offering a natural way to boost mood, release tension and deliver a sense of wellbeing (see here). It can improve concentration, focus and sleep too, so running is a really useful tool for managing the mental health effects of the menopause.
Real-life runners
I started running in my early 50s after discovering the positive impact exercise had on my perimenopause. It has really helped my increased anxiety, sleep problems and self-confidence. Running has brought me joy, friendship and a sense of purpose.
Jo, mum of two grown up sons, lives on the edge of the Yorkshire Dales
Top tips for a healthy runner’s reproductive system
• Attend screenings such as cervical and antenatal screenings.
• Perform regular self-examination, for example on breasts and testicles.
• Visit a sexual health clinic for a screen for sexually transmitted diseases if you have any symptoms you’re worried about or for reassurance if you have ever had unprotected sex.
• Practise safe sex.
• Report any unusual bleeding, lumps or other changes to your GP.
• Lead a healthy lifestyle. Don’t smoke, maintain a healthy weight and eat a healthy diet full of fresh fruit and vegetables. Keep exercising regularly.
• Take your time returning to running after childbirth. Follow a core and pelvic floor rehabilitation programme and then build up slowly from walking.
• Consider tracking your menstrual cycle if you want to identify any effects on your training.
Further help and advice
Menopause Matters: www.menopausematters.co.uk
The Miscarriage Association: www.miscarriageassociation.org.uk
Male cancer – Orchid: www.orchid-cancer.org.uk
Relate: www.relate.org.uk
Sexual Advice Association: www.sexualadviceassociation.co.uk
Cervical cancer – Jo’s Trust: www.jostrust.org.uk
Gynaecological cancers – Eve Appeal: www.eveappeal.org.uk
Chapter 7
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The Musculoskeletal System
The musculoskeletal system is made up of bones, joints, muscles, tendons, ligaments and more, all of which give our body structure and shape. The system from our toes to our finger tips is truly an incredible feat of engineering. It allows us to perform large movements, such as running and jumping and tiny, intricate movements, such as threading a needle. Force, tension and pressure are applied in multiple directions at once, but our body structure is light enough for us to move around freely. What’s even more amazing is that the body has its own systems to repair and strengthen any weaknesses so it can perform even better the next time. So is the act of running good or bad for the musculoskeletal system and what can we do to keep it in optimum condition?
Public Health England report that every year 20 per cent of people see their GP about a musculoskeletal problem and over 17 million people in the UK are affected by musculoskeletal conditions. Of course, doing exercise puts you at risk of injury and might lead to you having to use the health service, but the evidence is overwhelming that keeping physically active is good for your health. Not only will you live longer, but you’ll lower your risk of disability from osteoarthritis, falls and hip fractures, and increase the likelihood that you can remain living independently and pain free.
All the elements of the musculoskeletal system are living. Our bones, far from being the inert, hollow structure you may visualise, are in fact alive. Bones are constantly being broken down (to release minerals such as calcium) and reformed to keep them strong. They’re also filled with bone marrow, which makes new blood cells. Nerves and blood vessels run through and over bones to nourish them, so they’re far from static. Muscles are made up of cells called myocytes that are arranged into long strands of muscle fibres. Myocytes are packed with mitochondria, which are the power packs supplying energy to the cells. With incredible endurance and strength potential we need to take care of our muscles and do what we can to preserve their integrity and mass, especially as we age. Tendons are what anchor muscles to bones. They’re formed from the tough outer coating of muscles. When the muscle contracts, the tendon pulls on the bone and the bone moves. Ligaments are tough fibrous bands which attach bones to bones and their role is to stabilise joints. For example, in the knee there are ligaments to stop the knee slipping sideways, forwards and backwards. If a joint dislocates then the ligament hasn’t done its job and has overstretched or torn, allowing the bones to slip out of place.
Running certainly stresses the musculoskeletal system, but stress isn’t necessarily a bad thing, because it’s only by stressing something that it’s made stronger. However, stresses in the wrong direction and inadequate time for recovery can lead to a breakdown of the system. As runners we need to respect our musculoskeletal system and do what we can to ensure we’re giving it all it needs to function at its best. Let’s start with muscles, move on to bones and joints, and then look more specifically at knees, feet, ankles, hips and the spine. There is quite a bit of crossover in all these sections so read the whole chapter rather than just one section.
Muscles
Q Why do my muscles hurt so much the day after a long run, and how can I ease the pain and stiffness?
A You may have heard the term DOMS. This stands for Delayed Onset Muscle Soreness and the typical picture is of a runner standing at the top of a set of stairs the day after a marathon and wondering how on earth they’re going to get down them! Any time you push your muscles to their limits, whether through endurance or strength workouts, you’ll probably feel some DOMS. We used to think that the pain was due to a build-up of lactic acid in muscles, but we now know that this usually clears within a couple of hours of stopping exercise. Instead, we think DOMS is due to micro-tears in muscle fibres – tiny rips that happen during intense exercise. As the body heals the tears, muscles become a little inflamed and swollen, making them stiff, sore and tender. It’s important to prioritise recovery, to allow muscles to repair and strengthen themselves for your next run.
What can help the pain of DOMS? Time is the biggest factor. It’s usually gone within three to five days. There’s no evidence that warming up or stretching will reduce DOMS happening, but being well trained to run the selected distance certainly will, so following a gradually increasing training plan is the best preventative. Ice baths straight after exercise might be beneficial and so might a post-race massage, but the evidence is mixed. If you have DOMS, try light exercise, warm baths, ice packs, gentle massage, compression wear and paracetamol to get you through the worst days and return slowly to running when you’re ready.
Q I’m running my first marathon and don’t want to be one of those runners you see at the side of the course with bad muscle cramp. Why does it happen and how can I prevent it?
A Muscle fibres contract (shorten) and relax (lengthen) in turn when a muscle is used. Sometimes the muscle gets stuck in a contracted state and that’s when you get the excruciating pain of cramp. It’s a pain that’s impossible to ignore, as demonstrated by runners having to stop when they’d otherwise just tough it out. There are multiple causes of cramps, including dehydration, low mineral levels (sodium, potassium, calcium and magnesium) and poor circulation. Cramps can sometimes be due to underlying medical conditions such as diabetes, thyroid disorders and medications, and they’re also more common in pregnancy.
But what causes a cramp in an otherwise well runner who has kept hydrated, replaced their electrolytes and doesn’t have any medical conditions? The answer seems to lie in the theory of altered neuromuscular control and there is a growing acceptance of this explanation for exercise-associated muscle cramps (EAMC). Muscles contain stretch receptors called muscle spindles which detect muscle length, relay that information to the brain and spinal cord, and activate muscle contraction. At the same time, structures c
alled the Golgi tendon organs detect tension in muscles and tendons (which attach muscle to bone), and prevent too much loading by inhibiting muscle activation. When there is an imbalance in these messages and the muscle spindle messages overwhelm the Golgi tendon organ ones, then involuntary muscle contractions occur. This imbalance can happen in fatigued muscles, is probably exacerbated by heat and is more likely in undertrained runners.
If you get cramp the best thing to do is to stop and passively stretch the affected muscle. Passive stretching means the muscle itself is not doing the work. The easiest way to passively stretch your hamstring is to lie down, and get someone else to lift your leg off the ground and raise it towards your head. You can passively stretch your own calf by taking hold of your foot and flexing it. Drink fluids to negate any dehydration and let your body temperature slowly return to normal. Most importantly, prevent cramp by training sensibly and gradually for your marathon, practising your fuelling and adjusting your expectations according to the weather conditions on the day.
Did you know?
Leg cramps in the evening and at night can be part of Restless Leg Syndrome, a frustrating condition when the sufferer has the overriding desire to move their legs around. Aching, itching, jerking and tingling can all be present. The cause is unclear, although sometimes there’s an underlying medical condition such as an underactive thyroid, iron deficiency or diabetes. Runners can experience restless legs after a particularly long, hard run.
Q Why am I better at running slower over long distances than I am at sprinting short ones?
A Muscles contain two different types of muscle fibres: slow-twitch fibres and fast-twitch fibres. The slow-twitch fibres, also known as type 1 or red fibres, contract slowly, don’t fatigue easily and are used in endurance exercise. Fast-twitch fibres, also called type 2 or white fibres, contract quickly, tire rapidly and are designed for explosive movements like jumping and sprinting. We’re born with a certain amount of each, usually around half and half, but the ratio of each is largely what determines our strongest events when it comes to running. If your muscles are packed with fast-twitch fibres (think Usain Bolt) then sprinting is probably your niche. If, however, you have a higher percentage of slow-twitch muscle fibres (think Paula Radcliffe), then you may be more suited to marathon distance. Genetics have a large role to play in this, but you can’t ignore the environmental factors and your ability to target training at the different fibres. The evidence is mixed as to whether you can convert one fibre into another, but you can certainly work and train with what you have.
As we age, we naturally lose muscle mass and this seems to be predominantly a reduction in size of the type 2, fast-twitch fibres. This explains why we get slower with age and highlights the need to include strength training, particularly in later life, to negate this loss. Interestingly, a study in Finland in 2000 found that an aptitude for endurance events (with a higher percentage of slow-twitch fibres) and continuing that activity through life gave some protection against coronary heart disease that was not seen in those who had an aptitude for power speed events. It seems our muscle fibres may influence more than which events we sign up for.
Q I’m confused about stretching! Should I do it before running, after running or not even bother?
A It’s easy to get confused when the advice we’re given keeps changing! This topic is quite controversial, but we seem to have settled into an acceptance that traditional static stretching isn’t beneficial before a run, but might be afterwards. Stretching cold muscles before you run won’t increase your performance or reduce your risk of injury. Warming up rather than stretching should be your priority before a run (see here). Brisk walking and slow running is enough and you can add what we call dynamic stretches to prepare your muscles and joints for running. A dynamic stretch is a stretch that’s done in a controlled way while a muscle is in motion and takes a joint through its full range of movement. Dynamic stretches for runners include arm swings, hip swings and lunges. Traditional static stretches can be done after your run when muscles are warm and pliable, to lengthen muscles, particularly if you have a known tightness. Stretching out your calves, quads and hamstrings can improve flexibility. Again, there’s still some uncertainty as to how crucial this is in terms of recovery or injury prevention, but it does at least provide some social time at the end of a group run!
Did you know?
You use 200 muscles when you take a single step forwards.
Q Do runners really need to do strength and conditioning?
A I think the majority of runners feel a bit guilty, because they know they probably should do some muscle strength and conditioning work, but prefer to just go for a run instead. It’s easy to think it’s unnecessary and that running is enough, but there are many benefits to doing strength and conditioning. Having strong muscles helps you to run with good technique – more efficiently with increased power and less risk of injury. No runner is going to turn those benefits down.
A strong core will hold you upright, allowing you to fully expand your lungs, keep your pelvis and hips stable for ideal running technique, and fire up the often lazy and weak gluteus maximus muscles. Strong arm muscles will help power your sprint finish and drive you up hills. Strong muscles around a joint such as the knee will help to take the impact off the cartilage and bones in the joint. Having a regular strength and conditioning routine will allow you to focus on individual muscle groups and work them against resistance. That may simply be your own bodyweight, increased resistance from a band or a weight.
Take the glute muscles, for example. If you spend a lot of your day sitting, then it’s likely that you have weak glutes. When muscles aren’t used, the nerve pathways that stimulate them switch off. When you then run, the glute muscles don’t fire and you’re missing out on the power of the biggest muscles in the body. Spending some time re-igniting those pathways, learning to use your glutes and strengthening them with the addition of weights will lead to rewards in your running.
It’s important to work all the major muscle groups so you have balance on the front and back of your body and limbs. If you work your back then you need to work your abdominals. If you work your glutes then you need to work your quads (quadriceps or front of thigh muscles) etc. You only need to do it once or twice a week and there’s no need to join a gym. Runners can have a perfectly good work out at home with little or no equipment. There’s evidence that heavy resistance training is more effective than low resistance with lots of repetitions, so don’t be afraid to go short and heavy.
We also know that both muscle and bone mass decrease with age, and regular muscle-strengthening work will help to counteract both of these and keep you running fit for the future as well as the present.
Q Foam rolling hurts so much. Can it really be good for me?
A Is it possible that the pain of what genuinely feels like torture from a roll of hard foam will help your running? Should it be an established part of caring for your muscles or is it just a popular trend without good evidence of benefit? In summary, there’s no clear answer. Foam rolling may well help to ease sore, tired muscles and increase their flexibility, but there’s not sufficient evidence yet to say exactly when and for how long we should foam roll to make a difference to our recovery and performance. So, like many of these techniques, if it seems to help you, then carry on doing it, but don’t rely on it to knock time off your PB.
Foam rolling is effectively a type of deep tissue massage. Fascia is the fibrous tissue that encloses and lies between bundles of muscle fibres (you will have seen this slightly shiny sheet of strong tissue if you’re used to preparing the Sunday roast). It’s thought that with repetitive movements such as running, the fascia can thicken and stick to the underlying muscle, which restricts its movement. When you foam roll you compress your muscle against the roller using your body weight. This is said to free up those sticky areas, make the fascia more pliable, and allow the fascia and muscles to glide freely against each other again. The me
dical term for this is myofascial release.
In addition, foam rolling may warm up muscles before a work-out by causing friction and after a run it may speed up recovery by increasing blood flow. There’s also a theory that the benefits aren’t just due to myofascial release and may be in part or fully attributable to the effect that rolling has on pain receptors. Information is transmitted to the brain when the nerves are stimulated due to temporarily increased pain. Messages then come back to the nervous system to relax the muscles and that feeling of release is felt. Some therapists argue that foam rolling should not be painful and that if it is then you’re doing it wrong. They advise not rolling directly over ligaments, joints and bones and sticking to more gentle rolling over large muscles groups, such as the glutes and hamstrings. This means that rolling up and down directly over that IT band isn’t a good idea. There’s so much we still don’t know about foam rolling and its popularity has spread faster than the evidence for it.
Bones and joints
Q Will running damage my knees?
A The million-dollar question and the reason many people give for not wanting to run! To answer it in one sentence: a recreational runner of a healthy weight, who trains sensibly, allows adequate recovery, runs with good biomechanics and isn’t pre-disposed to osteoarthritis does not need to worry about damaging their knees.
Knees are cleverly designed to absorb impact, keep moving smoothly and to repair any stresses or damage that comes their way. Bones respond well to impact and weight-bearing exercise can increase bone strength. Maintaining a healthy weight (and running can help you achieve that) will mean that the load placed on the knee joint isn’t excessive. Training sensibly and building up your running miles gradually will make sure the joint and the muscles around it have time to strengthen and adapt. Ensuring you have rest days and time for recovery will allow for joint repair processes. As you get older, you’ll need to prioritise more time for recovery because repair processes slow with age.
Run Well Page 13