Plantar Fasciitis: The Best Treatment Approach

Does foot pain have you limping every time you get out of bed? Do you find yourself constantly rolling your arch with a water bottle every day with zero relief? If you are dealing with plantar fasciitis, as I have for years, it can be an extremely frustrating condition. Unfortunately this particular foot condition can take a while to get under control, but if you are diligent about management techniques, you can limit the effects plantar fasciitis has on your training program and daily life. What has worked for me may not work for everyone, but there are several tried and true methods that are worth the investment in money and time.

Treat the Cause

To understand how to treat your plantar fasciitis, it is important to know the cause, since treating symptoms will only lead to temporary results. This condition can arise from many different problems, and many are issues that are easily corrected.

Improper shoes: Since foot form and landing style can vary from person to person, the style of shoes you wear for every day use and running will largely impact the wear and tear on your feet. Runners who consistently train in low drop shoes are constantly stretching out the Achilles tendon. This undue strain leads to heel pain since the Achilles attaches to the area where the plantar fascia attaches. Since runners also use the calf muscles with every push-off in the running cycle, the calves tend to get overused and tight. Wearing shoes with a higher heel drop decreases the stress to the Achilles, therefore less strain on the bottom of the foot. All of my running shoes have an 8mm or larger drop, and I always rotate between several different pairs at once to give the different muscles of the foot a break at times.

Muscle Tightness: As explained above, tight calves can lead to heel pain. The lack of flexibility causes tugging on the attachment point at the heel where the plantar fascia attaches. Those who suffer from pain right at the base of the heel versus the arch can have success at relieving their issue by simply adding in more flexibility exercises to their program. Stretching the calves in standing both with the knee straight and bent is necessary in order to stretch all of the muscles that attach to the Achilles tendon. Daily post-run foam rolling is also beneficial for breaking up adhesions in the muscles that are causing the lack of flexibility.

Weakness: There are 26 bones in the foot, which means that many muscle attachments and more. The foot is commonly ignored when strength training, but it is the most important body part for runners since the feet carry our entire body weight through miles and miles. The small intrinsic muscles that control toe strength, stability, and range of motion for the feet and lower legs are constantly contracting and if there is any weakness, you can guarantee that much of the pressure gets applied to the fascia at the insertion points of the balls of the feet and heel, as well as in the center at the arch. Exercises such as the well-known “calf raises” (which is better referred to as ‘heel raises’) strengthen the push-off muscles, but it is important for runners to be incorporating toe raises as well in order to strengthen the shin muscles. To work the tiny muscles of the toes, a great exercise can be done in the sitting position: Place a small towel on the floor under the foot and curl the toes as if trying to pick up the towel. Repeat this motion for 2-3 sets of 10 repetitions a few times per week and you’ve hit the toe flexor muscles and stabilizers of the foot. Stabilizing the foot also involves strength from the inverter and everter muscles, which are basically in charge of controlling lateral movements (think rolling your ankle).

Foot Type:Any foot deformity such as bunions, hammertoe, low arches, or flat feet can greatly impact the pressure through the plantar fascia. Particularly having low arches or flat feet is the most concerning as this causes the fascia to be on a stretch at all times. The best relief for this cause is to make sure to wear the proper running shoes, which help supinate the foot, or lift the inner part of the foot to mimic having an arch. There are many insoles created for this purpose. My favorites are by Profoot, which you can find here. Runners with flat feet should also incorporate more hip external rotation and abduction exercises to help keep the hip, knee, and ankle aligned. Good choices to add into your routine are clamshells, banded lateral leg lifts, and hip hiking off of a step.

Personal Relief Strategies

I have dealt with plantar fasciitis for at least 8 years. I used to try to ignore it as much as possible and I got used to always waking up with heel pain and stiffness and it relieving after a few steps. When it would get bad to the point that it would bother me several times a day I would just stretch my toes sometimes and ice my feet when I wasn’t too lazy. All I was doing was controlling the symptoms at the time. Over the years I have developed a routine of different treatment tactics that have gotten me to the point of being pain-free at least 95% of the time. Here’s what has worked for me:

• Using Normatec Compression boots for 45-60 minutes at least 4 times per week—this has helped with my lower leg circulation and relieves general tightness and soreness.

• Rolling my foot with a spike ball every night for a few minutes—breaks up tightness and adhesions in the fascia.

• Wearing insoles for both running and walking most days—Profoot Plantar Fasciitis have been the best! I also use the toe separators every night for just 5 minutes, which helps stretch all of those intrinsic muscles I was referring to.

• Rotating between 5 pairs of shoes for running—currently I use Nike Pegasus Turbo for long runs, Nike Zoom Fly for speed and track sessions, and Saucony Guide Iso 2, Nike Epic React, and Adidas Ultraboost 19 for easy runs.

• Leg strengthening: from the hips all the way down to those small toe muscles—I work them all twice per week!

This is a combination of strategies that has helped me personally, which all have treated different sources of my pain. These may not work for everyone, but I will emphasize that you MUST first figure out what is causing your plantar fasciitis in order to find the right treatment for you! Get advice from an orthopedic specialist or physical therapist to evaluate your issue. Not taking care of plantar fasciitis can lead to many problems from ankle injuries to hip and low back pain, which will only keep you from running you best.

Vitamins: Do Athletes Really Need More?

Diet and exercise go hand in hand these days. Most people change their diets when they begin an exercise program, or at the least, they become more mindful of what they eat and drink. Whether you are exercising to lose weight, gain muscle, train for a marathon, or simply to maintain a healthy heart, diet will play a big role in the outcomes. Many active people include supplements in their diet to get more nutrients that may be missing in their regular diets or for the sake of enhancing their performance or recovery. The best approach to nutrition is to eat a well-balanced diet from every food group, making sure to include all vitamins and minerals your body needs. For the majority of people who live a busy lifestyle, this may not always be possible.

In any popluation many factors can affect what the body needs such as illness and disease, regular diet, activity level, genetics, and even the amount of time we spend indoors versus outdoors! People who lower their food intake to lose weight end up lacking necessary nutrients the body needs. On the other spectrum, high intensity athletes, especially marathoners, tend to lose nutrients and not replace them sufficiently due to their higher metabolic rates. Both of these categories require a certain amount of nutrients, including vitamins and minerals in order for the body to perform at any state and maintain proper organ function.

Since many vitamin and mineral supplement bottles are labeled with a notice that states they are not FDA approved, many people are opposed to taking them. It isn’t until they develop a symptom or certain results from routine blood work that they pay more attention to taking the essential missing nutrients. It would be helpful to get evaluated by your doctor and get routine blood work done before any negative symptoms or illness develop, since it is possible that a body can naturally not produce or absorb certain nutrients even when given a wholesome diet. If you are trying to lose weight and know that you are cutting out certain food groups, or are an athlete performing at higher intensity levels or for long durations, you may want to consider including proper supplementation to keep your body going.

Calcium and Vitamin D

Bone health is a popular topic throughout life. Most children are brought up learning to drink calcium-rich milk every day to make and keep bones strong. Besides being a bone-strengthener, calcium is also in charge of other vital roles in our bodies such as nerve conduction, muscle contraction, and aiding in blood clotting. Many food sources are rich in calcium besides milk, including almonds, kale, broccoli, yogurt, and most other dairy products. Sufficient amounts of Vitamin D should also be included as it is responsible for the calcium absorption, as well as other functions such as helping reduce inflammation in the body and for immune health. More recent studies have shown that insufficient Vitamin D intake may lead to more incidences of stress fractures and decreased performance levels. Foods high in Vitamin D include milk, mushrooms, eggs, and most seafood. The easiest way to increase vitamin D intake is to spend an extra ten minutes in the sunlight!

Iron and Vitamin C

The most important role iron plays in the body is to transport oxygen in the blood to the tissues, basically ensuring proper muscle function. This is a major factor for athletes who want to perform at their best. During recovery from strenuous exercise, such as long distance running, iron helps produce new cells and repair our damaged muscles. It is important for high intensity and endurance athletes to include the recommended amount of iron in their diets. Women in particular should be aware that their requirements are higher than for men. Iron deficiency can be caused by blood loss, poor absorption, or inadequate intake through diet. The antioxidant Vitamin C plays a role in the proper absorption of iron, as long as it is ingested at the same time. Vitamin C is also vital for the repair of damaged tissue and immune health.

B Vitamins

For active individuals who train at high intensities or for prolonged periods, it is essential to include the recommended amount of B-vitamins in order to be able to perform at their best. This important group of substances is in charge of the proper metabolism of macronutrients—carbohydrates, proteins, and fats. Some B-vitamins help our bodies rely on carbohydrates for energy, which may assist in delaying the glycogen depletion process. This is desirable for a marathon runner who wants sustained energy for as long as possible. These vitamins are abundant in many food sources, so it is not difficult to ensure adequate intake. Fortified cereals, vegetables, lentils, animal products, and nuts are all rich in most B-vitamins.

Magnesium

Many vitamins, minerals, and antioxidants aide in the metabolism of macronutrients, including magnesium, which is essential for muscle health. Its role in protein synthesis is especially important for the recovery process when muscle tissue is broken down during exercise. Magnesium also plays a role in oxygen uptake, therefore making it beneficial for high intensity and prolonged exercise, since there is a need for higher oxygen requirements. During activities that result in increased sweat loss, magnesium is known to be one of the electrolytes lost during the process, which will decline exercise performance if not replaced. Good high-magnesium food sources include seeds, legumes, bananas, avocados, and dark chocolate.

Upper Intake Level

Although dietary requirements of vitamins and minerals vary from one individual to another, it is important to note that there is a maximum. Many studies have shown there are benefits to including the proper amount of vitamins in an athlete’s diet, but going beyond the maximum level will not enhance performance further. There are harmful effects of ingesting too much of any nutrient, such as increased risk of toxicity, interference in absorption of other medications and nutrients, immunosuppression and oxidative damage. As mentioned earlier, it is best to include a balanced diet of all food groups in your daily diet with plenty of fruits, vegetables, and other fortified sources before opting for supplementation. If your diet is lacking in a particular food group, such as in a vegan or vegetarian diet, or a low calorie diet used for weight loss, and it is difficult to include a variety of vitamin-rich food sources, supplementation may be necessary. Many health conditions and diseases can alter the amount of nutrients and vitamins our bodies require, which is why it is always best to consult a medical professional before modifying your diet.

Sources

Melvin H. Williams, Dietary Supplements and Sports Performance: Introduction and Vitamins, Journal, Nov 03, 2017

John Eric W. Smith, Megan E. Holmes, Matthew J. McAllister, Nutritional Considerations for Performance in Young Athletes, Journal, Nov 03, 2017

Kathleen Woolf, Melinda M. Manore, B-vitamins and Exercise: Does Exercise Alter Requirements?, Journal, Nov 03, 2017

Forrest H. Nielsen and Henry C. Lukaski, Update on the Relationship Between Magnesium and Exercise, Journal, Nov 03, 2017

Running with IBS

Stomach problems are a common complaint among runners. It only makes sense since our intestines are jumping up and down for a long period of time, sometimes for hours. Unfortunately a more serious intestinal issue affects a smaller percentage of runners and can interfere with daily training and racing. Irritable Bowl Syndrome, or IBS, is poorly understood and does not have a specific diet or medication that can cure it. This can be extremely frustrating for runners since the symptoms can get in the way of performance. The best thing one can do is to learn how to control the symptoms, but this is highly individualized.

Causes & Symptoms

The actual cause of IBS is unknown and experiences can vary from person to person. It is important for runners, and anyone else living with this condition, to understand what triggers their own symptoms and alter their lifestyle based on those factors. IBS can cause stomach and bowel sensitivity, gas, bloating, cramping, constipation, and difficulty controlling bowel movements. It is shown that different foods and psychological disturbances such as anxiety or a stressful event can cause these symptoms to heighten.

Does Running Make Things Worse?

Unfortunately yes, it does, but not in every case. If what is causing your symptoms is stress, then running can actually make it better. Studies show that exercise is a key method to relieving stress. If your IBS causes constipation rather than diarrhea, then running can also help by relaxing the intestines and promoting more regular bowel movements. For those suffering from the opposite symptoms, running will usually make it worse and cause you to have to stop mid-run for a toilet break. During exercise, especially at a higher intensity, such as running, the blood is circulated to the muscles and away from the intestines. This lack of oxygen in the area is the cause of cramping.

Controlling Symptoms

As mentioned above, runners should first figure out what triggers their symptoms if they want to be able to run without worry. A proper diet has been shown to be a critical method for controlling symptoms, but requires a great deal of trial and error. Some foods that have been shown to exacerbate symptoms are refined and processed foods (since they require more work for the body to break down), high fiber foods, dairy products, and beverages with caffeine (I know, coffee is a must for so many of us morning runners!). 

It is best to not go into a complete diet overhaul and eliminate everything. You may only have one food group that your IBS is sensitive to so avoiding everything is unnecessary. The number one place to start is by eliminating one food at a time and tracking your intake and body responses with a food diary. Cutting out dairy as a first option has been shown to have positive results in controlling symptoms. This food group is not digested very well in general in any body, so when combined with lactic acid buildup during exercise, it can disrupt the stomach for most people anyway, so it’s an even worse situation for those who suffer from IBS.

Tips for Easing Symptoms

·     Never introduce a new food/food group right before a race! Practice keeping a steady diet for at least 1-2 weeks before the event.

·     Stick with natural mid-run fuel. Gels and sports drinks can be highly concentrated and if you do not have enough water after taking them, it can cause bloating and cramping soon after.

·     Dehydration causes nausea in general so staying hydrated before, during, and after runs is important. The best approach is to practice being hydrated ALL THE TIME.

·     Avoid foods high in protein and fat before running. Actually, it is best to give at least 2 hours for a meal/snack to digest before heading out.

·     Research shows that symptoms are not only worse just after a meal, but in the morning hours as well. Opting to run later in the day may be ideal, but most races are scheduled in the early AM, so morning runs are beneficial to train the body for race day.

Once you have an idea of what your triggers are, training will be much more comfortable. For those of you who race, be careful with the “carb-loading” leading up to the event. Instead of taking in a large amount of carbs the couple of days leading to a race, it is best to start the loading about a week before and spread the quantity over the day. It may take much more time out of your schedule and weeks or even months to really figure out what is causing your symptoms, but in order to train comfortably with IBS and avoid taking medications, which are usually antidepressants, this trial and error process is worth it.

Finding the Right Running Shoe for You

Finding the right running shoe can get tricky. We all want to go for the most stylish pair with attractive colors and designs, but many times these nice-looking kicks end up destroying our feet. As a runner and physical therapist I have learned along the way that the single most important gear to be picky about for running (or really any activity that has you standing or walking for long periods of time) are shoes. If you are an occasional runner who gets in a few miles every week just to stay active, one pair at a time is sufficient. But runners training for a distance event, especially those who incorporate different types of runs require a couple of pairs to rotate through. And it involves more than just “cushioned” or “light” when shopping around. 

Know Your Foot Type

The first thing every runner should do when selecting shoes is figure out their foot type. Are you a pronator? Do you excessively supinate when you land? Do you have high arches? What does this all mean anyway?!

Pronator: This is when you land on the inner part of your foot when running. Most of the time runners initially land on the outer border of the foot, but quickly roll inward excessively. Those with low arches usually fall in this category.

Supinator: This is when you land on the outer border of the foot and remain with the majority of the pressure on this area throughout the midstance and even into the push-off phase of running. Those with high arches will fall into this category.

There are several running shoe stores that offer a gait analysis that can give you an idea of your foot type, but the best analysis would be by a podiatrist or sports medicine professional that specializes in gait and has access to the technology. A great way to analyze your foot type that can be done at home is checking the wear on your current or an old pair of running shoes. If you notice the wearing is excessive on the outer border, you can assume you are a supinator and you underpronate when you land. A pronator would have excessive wear on the inner border. If your shoes have even wear, you most likely have a neutral arch and pronate a normal amount.

Next Step: Shoe Type

Cushioned: Supinators should opt for cushioned shoes (at least for the majority of their runs). They provide optimal comfort (cushioning) with the least amount of firmness in order to promote a bit more pronation when landing. Cushioned shoes are made to be more flexible, but not all flexible shoes are cushioned! Some cushioned shoe examples are New Balance Fresh Foam, Brooks Adrenaline, and Saucony Omni.

Motion Control: This shoe type is made with more rigid materials in order to control the foot from rolling inward too much. Overpronators or runners with flat feet will benefit from motion control shoes since they include a more dense midsole, which helps raise the arch of the foot. Saucony Kinvara, New Balance 1540, and Brooks Ravena are all great shoes for low arches.

Stability: If you are a neutral runner, then stability shoes are your go-to. Most will have a firm rear and flexible forefoot with a moderate amount of cushioning. Some examples are the Saucony Guide Iso 2 (one of my favorites!), Adidas Ultraboost, and Nike Air Zoom Pegasus. 

Shoe Rotation

If you are an everyday runner, alternating between faster paced running, track sessions, and easy runs, it is best to rotate between two or three pairs. Opting for lightweight, flexible shoes are best for speed sessions. Shoes made for the track or even most “racing” shoes such as the Nike Vaporfly 4%, generally do not have much cushioning. As long as you limit the use of this type of shoe to short track repeats and racing, your feet won’t be affected too much. For the majority of your weekly runs (which should be at a conversational/easy pace), it is ideal to use the shoes that are best for your foot type as explained above.

Everyone has different feet and running form varies greatly, so what works for one person may not work for another. Just because you see a “fast” runner using a pair of the brand new Nikes does not mean you should go out and spend the money to use the same style. Well, first of all, a shoe does not necessarily make you faster. If you find you run faster in a given pair of shoes it is your better foot mechanics that are making you faster, not the actual shoe. The best advice if you are having any foot, knee, hip, or back pain during or after running, is to definitely evaluate your running mechanics and foot type. Switching to the right shoe for you can be a simple fix to a nagging problem.

A Stronger Upper Body for Better Running

The upper body plays an important role in our everyday activities. We would not be able to perform tasks such as reaching, pushing, lifting, pulling, and grasping objects without sufficient upper body strength. During walking and running, our arms help propel us forward by the act of swinging in coordination with the opposite lower limb. The arm swing is what aids in controlling the upward force developed by the leg swing, keeping us moving horizontally, either forward or backward.

The arm swing in running is driven by the shoulder muscles. Even when we try to restrict our arms from swinging, our shoulder muscles are still contracting. While our legs swing during this motion, our torso rotates. The remainder of our upper body muscles, including the abdominals, entire back and chest, and even the neck muscles, control this rotation.

Weak Arms = Fatigue

Runners with poor upper body strength will fatigue much quicker in longer runs. As mentioned above, the biomechanics of running involve the entire body working together to create the running movements of leg and arm swing, pelvic stabilization, and torso rotation. Since the arms contain smaller muscle groups than most of the rest of the body, if they do not have sufficient strength to begin with, once they tire during running, the other muscle groups must begin to work harder throughout the remainder of the run. The shoulder muscles will need to work harder to continue propelling the weak arms, which will cause them to fatigue and then limit the amount of arm motion. At this point the core and torso muscles will need to create a stronger rotation to counteract the leg swing. The pattern will continue the fatigue downwards to the legs. In this case, for whole body endurance purposes, having a stronger upper body will help a runner last much longer.

The Purpose of Good Posture

A component to proper running form is good posture. Running with a forward head posture or rounded shoulders will make it more difficult to swing the arms and rotate the torso efficiently. This may lead to similar fatigue as described above or even injury to other joints below and most likely back pain. 

• Run Tall Proper posture begins with making sure to run tall—basically keeping the head facing forward with the chin parallel to the ground and keeping the shoulders back. This will help open up the chest and ensure more efficient breathing, improving endurance. Keeping the head in the appropriate position and shoulders back to create this tall posture requires strong upper back muscles. These muscles will pull the shoulders back by squeezing the shoulder blades together. Effective exercises to help achieve this strength are upper back rowing and reverse fly exercises. It is important to also include stretching for the chest and shoulder muscles, as having tightness in these areas will contribute to rounding out the shoulders and preventing a tall posture.

• Arm Swing Overall shoulder strength is beneficial since the shoulders are the driving force to the arm swing. Deltoid exercises such as straight-elbow forward and side raises are examples of simple strengthening exercises. Proper running form also includes elbows bent as close to a 90-degree angle as possible and limiting the arms and hands from angling in front of the body. This bent position is the job of the bicep muscles; therefore adding in a few variations of arm curls will help achieve this strength. Another effective way to strengthen all components of the arm swing is mimicking this motion with a pair of light dumbbells while performing a leg exercise such as walking lunges or step-ups.

• Stable hips The rest of the upper body, from the mid-back to the lower abdominals, is the main component for the torso rotation and pelvic stabilization in running. The torso should mostly be kept as stable as possible with a rotation that flows with the amount of leg swing. Deep core muscles that connect to the spine are in charge of keeping this stability. Most abdominal exercises such as leg raises, crunches, and planks, should be performed with the pelvis rotated slightly backward as to limit arching the back. This posterior pelvic position will contract these deep core muscles. 

• Trunk Rotation Rotation is achieved mostly by the obliques in the core, which can be strengthened by floor exercises such as the dead bug and Russian twist exercises. Performing walking lunges with a torso twist to the side of the stepping leg is a great combination exercise for the obliques, as well.

If you are looking to improve running form, endurance, or even set a PR, consider including several exercises for the upper body. Although this means you have to set aside a bit more time for exercise, it will be well worth it. A stronger upper body means more efficient breathing, better posture, and improved biomechanics with every step of running. All of these outcomes will lead to lasting longer while running and decreasing your risk of injury and pain along the way.

Sources

Beattie, Kris, et al, The Effect of Strength Training on Performance Indicators... : The Journal of Strength & Conditioning Research, Online, Aug 19, 2019

Pontzer, H., et al, Control and Function of Arm Swing in Human Walking and Running, Online, Aug 19, 2019

My Current Training Schedule & Fall Race Plans

My decision to take a long break from racing has made my training schedule a bit foggy this summer. Since I haven’t yet decided on whether I will race anything more than a 10k this fall, I have been taking it easy, not worrying about skipping some days or not pushing myself as much. The fall is quickly approaching, though, so if I do decide to race a half or full marathon, I want to be ready to finish strong with a PR or at least a very good workout!  The last couple of weeks I have started a new, and steadier schedule, which I hope to keep for another month or two until my “real” training starts.

Strength Training

This is something I have been extremely strict about since my last race. I have always made time for the gym, but was doing pretty much the same workouts most weeks. I started heavier lifting this summer, splitting up body parts most days. Now I have been making sure to stick to four days of strength training, mixing up my routine every week. At least three of these days are at the gym using machines and dumbbells, and I’ll squeeze in another day of 30-40 minutes of resistance band and bodyweight exercises. Most of my workouts are my own, but I do get loads of inspiration from fellow Instagram fitness buffs! Consistent strength training has been what has kept my joints healthy and free from injury. If you normally experience back or knee pain, I suggest you start hitting the weights! It will make a huge difference if you want to keep up your running routine. 

My current training plan looks like this: 

Monday         AM: 10 miles (either with 3-4x1 mile hard OR 5-6 miles at tempo pace)

                       PM: 45-60 minute gym session – legs/biceps/shoulders/abs circuit

Tuesday         AM: 8-10 miles easy

                        PM: 3-5 miles easy

Wednesday    AM: 8-10 miles – 3 miles easy + 8x200m uphill/downhill repeats + 3 miles easy

                         PM: 45 min gym session – chest/triceps/back/abs circuit

Thursday        AM: 8-10 miles easy

                         PM: 3-5 miles easy

Friday              AM: 8-10 miles easy + 30-40 mins band/bodyweight legs/abs circuit

Saturday         AM: 13-16 mile long run + 30 mins full body gym session + lots of stretching

Sunday             OFF 

Of course, depending on my schedule I will have to switch things around at times. If I have less time one morning, I will run shorter and increase the miles on another day if I feel good. If I have somewhere to be on Saturday morning, I will do my long run on Friday. I am fortunate to have a flexible schedule, so I can get my training done without excuses!

Potential Fall Racing Plans

Since I have never raced a 5k (I know, crazy!), I am thinking of signing up for the Turkey Trot this year and have that race be my debut. I did not have a great 10k last year, so the short distance makes me more nervous than racing a full marathon! I am looking to stay local for any other race I plan, so my options will most likely be a half in Ft. Lauderdale in mid-November or West Palm Beach in December. These will be great workouts to prep for February’s Miami Marathon, which is where I plan on having an extra large PR. I do not want to get too comfortable going too many months without any races on the schedule, and I know signing up for races is a huge motivator to train hard, so I will most likely decide what I am doing within the next month or so. Stay tuned!

Mind + Body Reset: Taking a Break from Racing

Racing season is the most exciting time of the year for runners. As nervous as we get at the start line, we are anxious to sign up for another race just seconds after crossing the finish line. At least that’s what happens to me! I spent the last three years training my butt off to PR at every race I signed up for. I had an incredible start after beginning a serious training program in 2016. I dropped 31 minutes off of my previous PR in the 2017 Miami Marathon and 11 minutes off my Miami Beach Half—both within one year. I was itching for more, so I added miles to my training, switched up my speed work and strengthening program, upped my recovery game, and trained my mind at the same time. I rang in 2018 with another 16 minute drop in my marathon time and 5 more minutes off of my half.

Of course, this success comes with so much sacrifice, but the feeling of reaching goals gets addicting and I just kept wanting more! The issue I did not see coming was that I was about to have a “down” season, which is actually pretty normal in a runner’s world. I used to blame it on my DNF at the 2018 Boston Marathon, where the brutal weather conditions got the best of me and made it a difficult and slow process to get back in shape. Since i was not seeing progress in a short time like I was used to, I ended up hiring a coach, thinking my self-coaching abilities were limited. I trained hard for another PR at the Sydney Marathon (which happened to have the most perfect running weather!), but it just didn’t happen. I was close—two minutes slower than my previous PR, but not good enough for me. The rest of 2018 was miserable—my entire training program was completely different than what I was doing, which I thought was a good thing, but it only got me out of shape and ultimately discouraged me.

Mind Over Body

Disappointed with so many failed attempts at hitting my goals, my mind went into a negative state, and this was when I realized how much the mind can control. I switched courses during this year’s Miami Full Marathon to the half when so many things went wrong from the start, including the fact that my head was not into it this time around. After my short-lived tantrum about my running abilities was over, I realized that getting a coach was not a good idea. It’s true when they say “if it ain’t broke, don’t fix it”. Coaching myself was actually going so well. Why did I feel I needed to change that so badly? It was at this moment I decided to take a break from racing (after I ran the last two Spring races I was signed up for—the Miami Beach half and the Boston Marathon). It was the best decision for me to not set any specific goal for a while and just focus on my weaknesses.

During these last few months I have dedicated my time to coaching my own athletes, which I have grown to love! I also have been focusing on rebuilding the training program I once had that I know gave me the best results. Although the Summer heat has been brutal lately, making me feel like I am getting nowhere, I’m making sure this does not get the best of my mind this time around.

A Learning Process

My intention for this detailed rant is to show how any runner can have a “down” season—this even happens to the elites! I have a passion for inspiring others to stick to their programs no matter how many times you fail. We learn so much from these times..I certainly did! I learned to believe in myself. Now I make sure to evaluate situations and make changes where it’s needed and not touch what’s actually going right. I feel extremely proud of myself for always staying dedicated to my goals and more confident in myself as a coach. If you are considering working with a coach for your upcoming races, don’t hesitate to reach out! If you are doing just fine on your own, do not change a thing!

Hypothermia in Runners is a Thing: This is What You Need to Know

Since the Boston Marathon is quickly approaching, many runners are being reminded of the tortuous weather from the 2018 race, where hypothermia struck a great deal of racers. Most research emphasizes the importance of understanding how to deal with running in warm weather and the detrimental effects heat illness has on the body. Although it seems it is more common to suffer from dehydration and a heat stroke, the opposite is also quite often experienced in runners. Hypothermia occurs when the body temperature drops to below normal levels, which is about 98.6 degrees, and the body is unable to produce heat at a faster rate than it is losing it. The reason it may be less common for hypothermia to occur in runners is because our bodies naturally produce heat while in motion. This does not mean that outside factors cannot contribute to causing more heat loss while we are running.

Year-round many races are scheduled far away from the hot summer months to avoid heat illness, but what about the races that fall during drastically cold temperatures? Many runners who train up north may get used to running in cold temperatures but will often skip running outside when temperatures drop too low or during rain or snow. The worst cases of hypothermia occur with a mixture of temperatures below 50 degrees, wet conditions, and significant wind. Although your body is producing heat while running, the mixture of these cold and wet conditions will eventually cool the body down at a fast rate, especially during long races such as marathons.

Symptoms of Hypothermia

Mild Hypothermia

During hypothermic states, when the temperature drops below 95 degrees, symptoms experienced can include shivering, slurred speech, loss of coordination, fatigue, and pale skin. During the start of decreasing body temperature runners may simply feel shivering which normally creates body heat along with goosebumps from heat loss in the skin.

Moderate Hypothermia

Once a runner begins to experience numbness and fatigue, hypothermia is continuing to advance. The fatigue that sets in causes one’s pace to slow which will end up generating even less heat in the body. Even worse is if the fatigue causes a runner to slow to the point of walking or stopping altogether, even if just at the aid stations. This will eventually lead to a severe sensation of cold deep to the core of the body and result in chattering of teeth and uncontrollable shaking that although produces heat will only cause more loss of energy.

Severe Hypothermia

When body temperature drops into the 80s and no medical treatment has been sought, one may develop a significantly low pulse and breathing rate and eventually end up unconscious.

Preparing for Cold Weather Running

Of course, the first piece of advice given to runners is to layer their clothes according to the weather. Since hypothermia is more common during cold AND wet conditions the best layers are those that are thin and waterproof, although this may not even help you during a torrential downpour. The idea is to not wear too much clothes thinking it will keep you warm as all the constant rain will do is weigh you down and end up slowing your pace as well as keeping you cold. Besides opting for the most waterproof and windproof clothes, below are other tips for preparation.

▪  Wear several extra layers before the start of the race to ensure to retain as much heat in your core as possible. Once you start running you can begin to shed these items as you go. If the start of the race is going to be a wet one, wearing an old pair of socks and shoes is best. Change into your race shoes and one or two thin layers of socks before heading to the start line.

▪  Wear proper gloves and a hat or two. The areas of the body where heat is more easily lost are the head and hands so keeping those areas covered is important. Just as with waterproof clothes, having a waterproof hat is ideal. It is important to try an keep gloves as dry as possible, so reaching for drinks at aid stations should be done carefully as to not spill liquids onto the gloves.

▪  Use hand and toe warmers. These nifty sacks are great to stuff into your gloves, hat, and shoes for extra warmth. Taking your own bottle of fluids on race day may be a better option if you have the hand warmers as it will keep your fluids at a warmer temperature. This is ideal since chugging the water or electrolyte drinks at aid stations may be too cold and cause a faster drop in body temperature.

▪  Wear a neck gaiter or scarf to cover your face. In cold, windy races the constant breathing in of that cold air may cool the body down even faster and cause abnormal breathing throughout the race. This is especially important for those with asthma.

▪  Hydrate as needed. As mentioned, the fluids at the aid stations may be cold but turning them down at every stop may not be a good idea. You can still develop dehydration when in a hypothermic state. Our bodies actually require more energy and electrolytes in order to keep warm and running.

Treatment

If you develop any moderate or severe symptoms of hypothermia during a race or other training run, seek medical attention as soon as possible. During these severe conditions, the medical teams are all prepared to assist athletes and bring their body temperatures back up. Once in the warmer medical tents, the first thing that should be done is shedding of all of the wet clothes immediately and get wrapped in warming blankets and hot packs. Temperature should be taken frequently, and if body temperature does not begin to rise within 20 minutes, the athlete should be transported to a medical facility. Treatment will also include drinking hot fluids to get the core warm more quickly.

It is important to understand the symptoms of hypothermia and when it is safe to run. If you develop any of the initial symptoms of a significant drop in body temperature and quickening your pace or ingesting warm fluids while running is not getting you warm, it is imperative to stop running and head indoors or to the medical tents if racing. Although it is easier to warm yourself back up than it is too cool yourself down if experiencing heat illness, it is not a reason to ignore the symptoms of hypothermia. Doing so will lead to serious health risks.

Sources:

Jessie Fudge, MD, Exercise in the Cold: Preventing and Managing Hypothermia and Frostbite Injury, Journal, May 21, 2018

Achilles Issues & How to Fix Them

Some muscles work harder than others during running. One of these star players is the calves. Well, they pretty much work during every movement we do. Crossing both the ankle joint and knee joint, the calf is involved with any activity that requires us to push off of our toes. Not only that but they are also highly active when trying to control our descent during downhill running or walking. Since they play key roles during every part of running, we should be taking very good care of them every day. Strengthening and stretching the calves on a regular basis is an important part of training.

Having limited strength and flexibility in the calves leads to numerous injuries and pain including shin splints, plantar fasciitis, tendonitis, knee issues, and even hip and back issues over time. One common injury experienced by runners and many other athletes is Achilles’ tendinitis. The Achilles tendon is a thick band that connects the calf muscles to the heel of the foot. It is a prominent tendon in most people. All of the forces generated during running, especially during the push-off phase, are transmitted to the Achilles’ tendon. Faster running usually transmits more forces leading to injuries in the area.

What is Achilles’ Tendinitis?

When there is increased strain to the Achilles’ tendon, inflammation, irritation, and degeneration occur. The overworking of the tendon creates tiny microtears that weaken over time and can eventually lead to larger tears and ruptures. The most notable symptoms of Achilles’ tendinitis is visible swelling in the tendon, tenderness, and pain when first getting in up in the morning and when trying to stand on toes. Once it is warmed up the pain will usually subside and runners are able to run through it. As the condition worsens, the pain will gradually reappear and eventually limit the volume and speed of running. Tendon tears and ruptures will either have a visible bump over the area and commonly a gap where the tendon is ruptured.

Biomechanics

Although high volume training, speed training, and lack of strength are all causes of Achilles’ tendon issues, many physiological and biomechanical factors can increase the strain on the tendon and risk developing these problems.

Foot Strike

You have probably heard about how terrible heel striking is for runners. Well, the truth is that the research is inconclusive and heel striking actually works for some people. The reason this type of foot strike is related to Achilles’ tendon pain is that it involves increased stretching of the tendon. So if you already have tight calves to begin with, then the constant pulling during heel striking can lead to overstretching. The opposite type of foot strike, forefoot striking, actually creates a worse strain on the Achilles’ tendon. With this motion, you are basically landing on the toes and pushing off for the next stride all without giving the calves a break.

Pronation

Foot form is different for everyone. Flat-footed people or those with pronated feet (foot is turned inward when standing) will have a more strained Achilles’ tendon, as well as impeded blood flow to the area. There is already an area with limited blood supply, termed the “watershed area”, where the majority of tendon ruptures occur. This area is located about 4cm above the end point of the tendon on the heel. Limiting blood flow further as in the case of pronation will increase the risk of damage and slow healing on the tendon. Using supinated running shoes or inserts to decrease the amount of pronation is a treatment strategy.

Treatment & Prevention

Runners should focus on incorporating calf strengthening a couple of times every week, especially during their training seasons. Heel raises in all planes—toes pointed straight, toes pointed inward, and toes pointed outward are the main exercise for the calves. Seated heel raises or while in a squat position will help strengthen the soleus muscle, which is a muscle found deep under the gastrocs, the main calf muscles, that also connects to the Achilles’ tendon. Eccentric heel raises are the best way to strengthen the calf muscles as this will prepare the tendon for activities in which it is required to control the descent from extreme positions. To perform eccentric heel raises follow these steps:

1. Stand on a step with both heels hanging off.

2.  Lift both heels together.

3. Once completely on toes, shift all weight to only one leg and slowly lower the heel to just below the edge of the step.

4. Repeat 10-20 times on one leg, then repeat the same with the other leg.

Essentially this exercise will create a type of damage in the tendon, which strips away the previously damaged fibers and encourages the development of new fibers as a form of healing.

Runners should also incorporate stretching after every run and activity that highly involves the Achilles’ tendon such as hiking and climbing stairs. Stretching with both the knee straight and bent is important in order to include both the gastric and soleus muscles. Foam rolling is also helpful to break up any adhesions and extreme tightness in the muscles. Although strength training is time-consuming during training season, it is very important in order to prevent injuries. Achilles’ tendon injuries can be frustrating as they are frequently overlooked since the initial stages involve pain-free running. Taking care of Achilles’ issues from the start will involve a short rehab time while waiting until the pain is unbearable and affecting your running can leave you out of the sport for several months.

Sources:

Răzvan Aniţaş And Dan Lucaciu, A Study Of The Achilles Tendon While Running, Journal, Sep 07, 2018

What is Macro Tracking and How Does it Help With Your Goals?

Many of us have been dieting, or at least trying to, for years. The ultimate consensus to lose weight has been to burn more calories than you eat. Although this may make sense, it takes much more input than that. Consuming 500 calories of chocolate cake does not treat the body the same as 500 calories of broccoli. Due to the different reactions of the macronutrients—carbs, protein, and fat, calories are not all created equal. It may seem time-consuming to not only count your calories, but also every single gram of the macros, but it will end up being extremely useful if you are looking to lose weight or improve your fitness.

Athletes especially are one group who will benefit the most from counting their macronutrients, as the amount of protein and carbs significantly impacts their performance and recovery. Endurance athletes are at the greatest risk of injury and burnout if they do not consume enough carbs and protein at specific times surrounding their workouts. Proteins are known to be the building blocks of muscle, so it is obvious why those who exercise should consume a sufficient amount. High protein diets have been studied and seem to be the way to go for weight loss as well. In order to understand what ratio of macronutrients you should be eating you need to take a look at your goals.

Weight Loss

As mentioned, weight loss comes from eating less than you burn. Of course, a mixture of cutting calories and exercising more is the ideal plan, but most people have the hardest time with the diet part. When trying to lower calorie intake enough to make a difference, many dieters become irritable, develop uncontrollable cravings, and end up with barely any energy to get them through a workout. These are reasons why many people cannot stick to a strict diet.

When incorporating macro tracking into a weight loss diet, you can be sure your body is getting all of the nutrients it needs. Keeping protein high means you will stay full for a longer period of time. Enough carbs should keep your energy levels up. Some dieters get used to trying to cut out carbs completely and end up getting scared to add them back into their routines. Keeping tabs on macros shows how a higher carb diet than what you are used to, say 40-50% carbs, will not contribute to weight gain. This is because you will be more aware of what you are putting into your body. Remember, a 1200 calorie-a-day diet of just bacon and eggs will not let you reach your goals like 1200 calories of lean meats, low-glycemic carbs, and healthy fats will.

Gaining Muscle

When trying to get stronger and leaner, putting the time in the weight room is generally the way to go. In reality, if you do not eat a proper diet for this specific goal than gaining muscle will either be almost impossible or take a very long time. Macronutrient ratios will be different if your goal is to gain muscle rather than to lose weight. Protein intake must be higher as this macronutrient is the building block of muscle. But keeping carbs high is also important, as your body will require sufficient energy levels for weightlifting.

Now, gaining muscle and losing fat at the same time (which is most people’s dream!) can be tricky. Thankfully with a macronutrient tracking diet, you can achieve this goal. The key here is to be in a calorie deficit but not too drastic, in order to keep up with muscle building. A deficit of 10% is a good place to start but must be adjusted along the way. It is especially important to look at your protein ratios to make sure the building of muscle outweighs protein breakdown. Being in a calorie deficit with not enough protein will lead to dropping pounds but losing muscle.

Improving Fitness Performance

Runners, particularly those who race, are vulnerable to becoming “skinny fat”. This means they easily lose weight but all of the running basically eats away at their muscle. This means their macronutrients are out of order. Runners must make sure to be consuming enough carbs, around 60% of total calories, to fuel their bodies for endurance training. Keeping protein at a higher ratio is useful to maintain as much of their muscle as possible. The stronger the body, the faster the paces! Fats also have to be accounted for as they help regulate hormones and keep us feeling full throughout the day. A good ratio of macros for a marathon runner is 60% carbs, 25% protein, and 15% fats.

Although this sounds like extra work besides counting calories, it easily becomes habitual. When you realize how well your body responds by keeping within these ratios, you will want to stick with it. Of course, consuming quality foods as the majority of your diet is most beneficial, but macronutrient dieting allows you more freedom and flexibility. As long as you stick to your carb/protein/fat ratios you can feel free to enjoy foods that you love more often and will not feel guilty when cheating a bit. This type of macro diet is popularly known as the “IIFYM” (If it fits your macros) diet. To make things easier there are plenty of applications for macro tracking, such as Macrostax, that allow you to just plug in the meals you eat and it will show you whether those meals fall within your ratios. Once you see quicker results from macro dieting, you won’t go back to your old ways!

Sources:

Anne-Claire Vergnaud, Teresa Norat, Traci Mouw, et al, Macronutrient Composition of the Diet and Prospective Weight Change in Participants of the EPIC-PANACEA Study, Journal, Jul 13, 2018