If you are suffering from a running-related pain, the joints—indeed, all parts of the body—generally benefit from movement of the affected area, not immobilization. Running (and walking) the right way is an excellent treatment for degenerative injuries sustained from running the wrong way. In my practice, I continually witness the body’s remarkable ability to heal itself and restore itself to its natural position—while people remain active—if the causative issues are addressed and the right signals are sent.
Mistakenly, many of us are “rehabbing” basic movements and skills out of ourselves by focusing on an isolated exercise. Imagine seeking guidance from six golf swing coaches—a backswing coach, a stance coach, a strategist, and so on. You might succeed in improving the movement of a single specific muscle group, yet you’d still have a dysfunctional swing.
AS YOGI BERRA MIGHT HAVE SAID, HALF THE PAIN WE FEEL IS 90 PERCENT MENTAL
Pain management is a persistent challenge in the treatment of running injuries. And one of pain’s enduring mysteries is the manner in which we anticipate it. (Note that it’s the brain and nervous system that register and process pain, not the injured part.) Experiments have looked at how people respond to a painful stimulus applied to someone else’s limb, or to a sham limb, that is placed in a position where it appears to be one’s own. (See Dr. Lorimer Moseley’s TED talk, “Why Things Hurt,” linked on the videos page of runforyourlifebook.com.) PET scans show that subjects can experience genuine, objectively measurable pain—from a physical stimulus that doesn’t exist.
Why do we feel pain in the first place? For one thing, it’s a signal telling us that we need to protect tissue that is harmed or at risk. To the extent that it correctly alerts us to the problem, pain can protect us from further damage. But the signal can have a lag time, or come from an area that isn’t the actual source of stress.
In other words, the patient and the doctor can misinterpret the signaled pain. Even worse, when doctors offer symptomatic treatment (the easy, billable solution), they leave the root cause of the pain unattended and untreated. The simple binomial that pain is bad and relieving pain is good is a simplistic response that seldom translates into appropriate medical treatment. Indeed, this approach has guided us directly into the current opioid addiction crisis.
When it comes to running, changing your mental approach can do wonders. Running coach Elinor Fish urges that simply shifting your mind-set from running causes injury and pain to running makes me injury-resistant will reduce your chances of developing an overuse injury. “With a positive mind-set,” Elinor says, “you set the stage for establishing new habits that support running as a lifelong practice. While it’s easy to view running as the cause of your injury, it’s more likely that running is just making you aware of a preexisting problem. For example, sitting all day long causes chronic shortened hip flexors and underdeveloped glutes, both of which make running more difficult.” The pain and stiffness and sensitivity arise when you are out running, so we don’t automatically make the connection to the real cause: sitting.
AN EXPERIMENT OF ONE
Ultimately, a doctor or physical therapist can’t know you intimately, and you need to rely on yourself as diagnostician and medical researcher—with yourself as the patient and experimental subject. Each of us responds differently to exercise, to physical stress, to the numerous insults that our bodies face as we move across the surface of the earth and interact with the objects on it. Ultimately, your personal experiment should seek one important outcome: to avoid injury. Do not put pain into your body. In place of the aphorism No pain, no gain, we should approach our activity with the conviction No pain, thank you.
DRILLS
Evaluating someone standing in a rested state provides a physical therapist with only part of a picture. The therapist—you, in this case, examining yourself—needs to see what happens under load, and especially in a fatigued state. Take a look at a sequence of pictures of yourself in a race: you look pretty good in the early images. By the end it’s a different story. As you fatigue, your posture and form change—almost never for the better.
A high-speed smartphone camera can reveal a lot. Try video recording the following:
A single-leg step down from a low platform. Watch what is happening at the foot, the knee, and the hip. If the knee collapses inward, try to notice what gives out first. Is it the foot or the hip?
Ten hops on a single leg. This shows what happens under a bit of load. Then magnify the response and fatigue yourself by doing three or four minutes of shuttle runs, a few burpees, some jumps, and a few sprints. Then do the single-leg step down and single-leg hop tests again. Notice the difference? Even elite athletes will show weaknesses. (Do this fatigue test cautiously, and only if not injured.)
Identify and correct any “pathokinematic” (dysfunctional) movement pattern before you train for your next marathon. Build strength and follow gait cues. Don’t overstride. From the frontal view, land with each foot directly under the hip (as if ascending stairs). Think of running on a line, with each foot landing on either side of the line, never touching it.
My foot lands directly under my hip, as if stomping grapes.
Inure yourself to injuries
The objective of the following drills is to protect yourself from injury and pain. Here are some simple ways to short-circuit the repetitive stress and high impact that typically result in injuries.
Rather than run the same route each time you go out, alter the path you take. Changing up your route lets your body adapt to different environments. Trail running, for instance, improves balance and muscle strength (though it comes with the risks of unpredictable terrain). Soft grass or sand offers a cushioned landing for runners, but requires more muscle use, because there is less energy returned when your foot strikes the ground. Mix it up. Throw in some new challenges, and enjoy—but make the changes gradually.
Transition—again, gradually—from a heavily cushioned and supportive shoe with an elevated heel to a minimal shoe that is flatter, lighter, thinner, wider, and more flexible. Your freed-up feet will thank you.
Listen to your body. Don’t mask discomfort with pain medication or anti-inflammatories. Slow down, add gentle and progressive stress, and recover. Then notice what you’re no longer noticing: pain, soreness, and stiffness.
Along with the TrueForm Runner (a remarkably useful tool for gait retraining and injury prevention), try the Zero Runner. This no-impact trainer allows for full range of motion in the hips, and variability of movement. (An elliptical trainer or Stairmaster, by contrast, dictates your movement.) If you are recovering from a stress fracture, joint replacement, or other mechanical stress or overload-related injury, the Zero Runner (which is great fun) can get you back in the game.
PART III
Running Is for Everyone
CHAPTER 15
Women Are Pulling Away from the Pack
If you want to become the best runner you can be, start now. Don’t spend the rest of your life wondering if you can do it.
—PRISCILLA WELCH, winner of the New York Marathon, at age forty-three
Leave your watch on the kitchen table and go—freely, like a child.
—CLAIRE KOWALCHIK, The Complete Book of Running for Women
MYTH: Running is mainly for men.
FACT: Today there are more women runners than men runners.
MYTH: Women shouldn’t run when they are pregnant.
FACT: Women have run safely during pregnancy for as long as humans have been on the earth.
MYTH: Women should not run if they have osteoporosis.
FACT: For osteoporosis, consistent, gradual exercise helps build bone strength and the balance that is needed to prevent falling.
This book is intended for everyone—men, women, and kids; young and old. But there are some issues outline
d in this chapter that are specific to women.
One of the wildest tales of fiction, resulting in decades of lost opportunity for women in running, was the media coverage of the women’s 800-meter race in the 1928 Olympics. “Below us on the cinder path were 11 wretched women,” wrote John Tunis of the New York Evening Post, “5 of whom dropped out before the finish, while 5 collapsed after reaching the tape.” His and other accounts described a “terrible exhaustion,” which was widely accepted as an accurate depiction. As a result, the 800-meter distance for women was dropped from the Olympics until 1960.
The true story of 1928 is quite different, as shown in the film coverage linked on the book website’s videos page. In those pre-television and -Internet days, this footage would have been scarcely viewed. As is evident, only nine runners ran the race, and only one fell at the finish, then arose quickly. In this single event, several of them broke the existing women’s 800-meter world record. They ran with grace and relaxation, and there were plenty of smiles at the finish.
For women, the 1,500-meter distance (just short of a mile) was included in the Olympics only in 1972, and the first women’s marathon was run in 1984. The 10,000-meter race was added in 1988, the 5,000 meters in 1996, and the 3,000-meter steeplechase in 2008.
In 1966, female runner Bobbi Gibb petitioned to become an official entrant in the Boston Marathon. Race director Will Cloney responded with, “This is an AAU Men’s Division race only…Women aren’t allowed, and furthermore are not physiologically able.”
Bobbi Gibb ran anyway.
The larger women’s running movement, and the many changes made to racing rules, were driven primarily by brave women who simply desired to run, and to challenge themselves. Why obstruct anyone who seeks the pleasure, freedom, and health of running? By the 1980s, women posted times that would have beat or equaled the top male Olympians of a generation earlier.
This doesn’t surprise me, especially after I had a chance, in 2001, to study the form of multiple world champion and Boston Marathon winner Catherine “the Great” Ndereba as I ran alongside her at the Boston Marathon. Until she pulled away, that is. I was with her group when we hit the halfway point in 1:14, and her light, springy stride and total relaxation seemed to propel her. In contrast, the body language and heavier breathing of those she left behind exposed their wasted energy. Catherine stayed relaxed on the long downhill, then tightened the screws and hugely accelerated over the Newton hills, running the final ten miles in 50 minutes, finishing in 2:24. Catherine helped my day. By cueing off her pacing and relaxation, I finished in 2:29—faster than I had expected, considering the surgery on my feet a year earlier.
IN IT TOGETHER
When friend and author Christopher McDougall came to Shepherdstown for a run and a talk over coffee, he described how 1992 Olympic gold medalist Derartu Tulu, of Ethiopia—at age thirty-seven, after childbirth and without having run a marathon in five years—returned to the endurance running circuit and ran the 2009 New York Marathon. From the start, she boldly took a position in the lead pack. As usual, the pack began dwindling as they entered Manhattan and ran up First Avenue. When they crossed over to the Bronx at Mile 20, the few who were able to stay with the lead pack appeared to struggle. That’s when Derartu slowed down and encouraged them to keep up. After assisting and coaxing as much as she could, she pulled ahead and won the race.
South Africans often use the word Ubuntu, which translates as “I am because of you.” In my experience, it is this quality that is central to the women’s running movement.
TALKIN’ ‘BOUT THEIR GENERATION…
A new generation of women has become running’s leading force, and more than 40 percent of marathon finishers are women. The half marathon is the fastest-growing competitive distance, and more than 60 percent of recent years’ entrants are women—up from only 20 percent in 1985. Not only have their numbers increased, but their fastest times have improved at a faster rate than have men’s times: the women’s marathon record has dropped by 46 minutes since the first sanctioned women’s marathon, in 1972. Men’s fastest marathon finishes have improved by less than 30 minutes over the past century.
In 1995, Oprah Winfrey entered, and handily completed, the Marine Corps Marathon. Pre-Oprah, races were for speedy folks. She proved that anyone—and women in particular—can go out and run. She characterized it correctly not as a sport but as a “healthy activity.”
Of the millions of women who have taken up running, few have quit. Nudged along by the inevitable release of endorphins, most women run in a relaxed, contented style, less aggressively than men, with more consistent pacing. It’s self-perpetuating: the act of running reinforces the desire to go out and do it again. For many mothers and other working women, running or exercising outdoors is the highlight of a busy day.
THE TORTOISES RELIABLY BEAT THE HARES
Men have a larger muscle mass—their testosterone advantage—meaning that they have a higher strength-to-weight ratio, and tend to be faster than women at short distances. But the performance gap between men and women diminishes in longer-distance events. A woman who equals a man at shorter distances will likely run as fast as, and often surpass, the same man when running longer distances. In ultra races, such as fifty miles and above, women in the 50th percentile of the women’s results reliably outpace the men in their 50th percentile. Healthy women, with their higher natural percentage of body fat, can readily adapt to burn fat—the fuel that is needed for longer distances.
EAT (DIFFERENTLY) TO BE FIT
So, what are the specific medical issues that physically active women should be aware of?
A woman’s hormonal changes through life (and a man’s, to a lesser degree) include the upregulation of insulin resistance/carbohydrate intolerance. This means that many women can’t get away with the same eating patterns when they enter their forties and fifties (and during pregnancy) as they did when they were younger and during preadolescence. Avoiding metabolic syndrome is of key importance as women age. It’s not possible to outrun a bad diet.
Although obesity and diabetes are overwhelming health crises, and are likely to continue for some time, sports doctors see another, not uncommon condition in the form of what is called relative energy deficiency in sport, or RED-S (an emerging, broader term for what has long been called the female athlete triad).
This deficiency, or syndrome, is a cluster of symptoms and disorders that, when taken together, can result in poor health and adverse outcomes. It is seen most commonly among high-performing athletes, although symptoms and risk factors can be identified as early as middle school. RED-S tends to occur when three circumstances converge:
Nutritional imbalance or insufficiency. This isn’t necessarily an eating disorder. Gymnasts, ballet dancers—and long-distance runners—may sometimes appear unnaturally thin. Basically, they are struggling with an energy imbalance that develops when there is an energy or nutritional mismatch between the nutrients going in and what the sport and their bodies demand. For optimal bone and tissue growth, women require not only adequate calories but a well-balanced diet of essential fatty acids, essential amino acids, and the other nutrients that are obtained from real food.
The body fat of a healthy female (with the capacity to have normal cycles and sustain a normal pregnancy) must be at least 20 percent of overall weight. Ballerinas, gymnasts, and elite runners often have body-fat levels well below this, sometimes dipping into the single digits. They are fit, but not always healthy. Our culture idealizes women who are ultra-thin, too, which likely contributes to the tendency toward nutritional imbalance.
Low bone density. We lay down most of our bone matrix by the end of our teens. After that, bone cells (known as osteoclasts and osteoblasts) are broken down and rebuilt every day through a process of “remodeling,” which is acutely affected by the amount of impact loading. Impact and load-bearing sports, which help build and protect bone
mineral density, are necessary and good—up to a point. Overloading causes more breakdown than buildup.
Low bone density, or osteopenia, can lead to increased risk of stress fractures, and is a precursor to osteoporosis. Osteopenia is seen more commonly among postmenopausal women as their estrogen levels naturally decline, and (of surprise to many) in swimmers, cyclists, and others engaging in non-weight-bearing activities.
Vitamin D (which is more of a hormone than a vitamin) also plays a role, as it is essential for building bone strength. Yet a study of women college athletes found that nearly a third of them were deficient in it. In addition, 30 percent of Division 1 female athletes were found to be iron deficient.
Menstrual dysregulation, or irregular ovulation. A regular menstrual cycle works as a regulator for normal metabolism and growth, and an environment of good nutrition and health is necessary to maintain this. With a regular cycle, the body produces the right hormones, in the correct amounts. When not regular, or in amenorrhea, the body is in a state of hormonal imbalance. Elite sports or dance performance, if requiring body fat below 20 percent, may be a mismatch for health.
Run for Your Life Page 21