Return to Routine

January is my least favorite month. (February is a close second, but the proliferation of chocolate around the 14th and the fact that February is short and sweet—literally—gives January the edge in awfulness.) My favorite months are fall months—ideal marathoning season—which transition pleasantly into the joys of the holiday season, which drops you horribly and suddenly into cold, dark January.

The only redeeming qualities of January are the fresh start and the return to routine. The whirlwind of holiday festivities and obligations are gone and there’s a comfortable return to normalcy: regular workweeks, being able to predictably fit in runs, an easier time eating healthy instead of stuffing yourself with endless appetizers at holiday parties. As much as I cherish the lazy gluttony of holidays and vacations, it can be nice to get back to the good habits of an active lifestyle.

The January return to routine conveniently coincides with the beginning of spring marathon training and the runner’s life once again becomes a continuous succession of eating, running, and sleeping. (And, of course, working. Gotta pay those race entrance fees somehow!)

Fortunately, I too am back to running, more than a few minutes, more than a few days a week, and more than a few miles. (In a telling move, I’m back to counting miles, not minutes.) I am not where I was last year at this time or where I’d like to be, but I’m running and that is a major (shuffled/marathoner-type) step in the right direction.

Before the holidays, the prospect of Boston still seemed far-fetched. I was running, but not often and not for long. Around the New Year, though, as life shifted back to normalcy, running clicked back into place as well. My daily routine began to resemble my old life, with a time every morning clearly carved out for running. And I began actually using that time for running more and more as the torturous bike started collecting dust. The road to Boston again seems possible, although daunting as always. It will be my shortest buildup, but there is enough time for things to come together.

But still, the fear and doubt accumulated over the last few months have perhaps made me underestimate what I’m able to do. In an effort to come back carefully, my first runs were snail’s-pace slow, and I cut myself lots of slack. Having not run since August, I was sure I wouldn’t be able to keep any semblance of a good pace and didn’t want to risk anything trying. Even now, as I am getting back into real shape, I remain convinced that slow is all I can do. Serendipitously, on a “long” run last week (my longest run in six months, but what I would have referred to then as a medium-length run), I saw a teammate up ahead. Having not been able to run with any teammates since my injury, I excitedly picked up the pace to catch her. Of course B was running much faster than my woe-is-me-I’ve-been-hurt shuffle, so catching up and staying with her was a challenge. But we ran together for a few miles, and, although our pace was not lightening fast (B was in fact just doing her warm-up for a tempo run), I was still impressed I could stay with her. I had incorrectly convinced myself otherwise, and it was a nice reminder that I can still run at my old (warm-up) pace. I may not be as far behind as I think.

Of course, afterwards I was completely zonked and collapsed on the couch in a post-Sunday-long-run heap. Ahhh, back to routine.

Dream big,
Teal

Science Friday: A Good Night's Sleep

Exercise helps you sleep—that's not particularly shocking. And most runners aren't surprised to hear of its role in stress relief. So it stands to reason that when you're so stressed out that you're tossing and turning at night, going for a run could provide a double benefit: less stress and more sleep.

Monika Fleshner's group presented data at the Society for Neuroscience Conference in San Diego (a great place for a run—stressed or not) that investigated, in a number of ways, the relationship between exercise, sleep, and stress. One study, led by Robert Thompson, a PhD student at University of Colorado-Boulder, asked if exercise could help stressed rats sleep better. Half of the rats were able to run on a wheel, while the other half remained sedentary. (The rats weren’t forced to run, but were given access to running wheels in their cages and could run as they pleased. Rats voluntarily run about 5K each night.) After six weeks, the rats were stressed with shocks to their tails. Their sleep/wake cycles were studied both before and after the stress.

Before stress, exercised rats spent more of their time in REM sleep—the stage of sleep when dreams occur—compared to non-exercising rats. Directly after the stress, all the rats had a rough time sleeping—they got the same amount of REM sleep whether it was day or night. But by the very next day, the running rats were able to recover their sleeping habits. The sedentary rats struggled for a few more days.

But rats are rats, what about people?

Most of the studies on people (described here, here, and here) don't look at stress, but agree that running helps sleep in general. In contrast to rats, however, exercise decreases REM sleep in humans, while increasing non-REM sleep (including deep sleep). When looking at people who have trouble sleeping, like insomniacs, exercise takes longer to have an effect. But the moral of the story is the same: exercise will eventually help you sleep, no matter how stressed.

Another interesting story from the Society for Neuroscience conference: When asked if mental games (like crosswords) or exercise is better for brain health, scientists agreed that the jocks win. So put your crossword down and go for a run! If nothing else, maybe you’ll get a better night's sleep instead of tossing and turning over the answer to 7 Down.

Dream big and sleep well, 

Teal

Five minutes

On Tuesday, I ran for five minutes.

It was exactly five minutes longer than I've gone in over six weeks. I haven't been running seriously in over two months.

To clarify, it was actually a ten minute "workout," alternating between one minute of walking and one minute of running. So I have yet to even run two minutes consecutively. This is a precipitous drop from eighty mile weeks of the past.

When my physical therapist told me last week I could attempt running this week--and then revealed my plan--I was simultaneously overjoyed and disappointed. At my first appointment, the prognosis was that I'd be running again within 4 weeks. (I was even told I could still compete in the Philadelphia Marathon, but I abandoned that idea.) The four week deadline came and went. The appointment the week before was bleak: I was to tack on additional appointments and running still wasn't on the radar. But armed with new exercises, I seemed to make a turnaround. I could run.

Back in five... 

But five minutes? Really? I didn't know I would be starting so slowly. In the past, no matter my fitness, I have always assumed a baseline of four miles. I can not workout for months (namely in college), but I can always struggle through and make it four miles. But this isn't a problem with my fitness. This is a very real injury, and caution is key.

And so, I embarked on my Big Run:

Minute 1: Sheer bliss. It may seem like an exaggeration to be so enamored by running that one minute can transform you, but that is how addicted I am. Just speeding up from a walking pace to a slow jog felt amazing. Damn, I've missed this. I knew I did, but this reminds me how much.

Minute 2: Still feeling great, the morning is just breaking. The weather is perfect autumn, shorts and long sleeve tee weather. I make it to the trail, there are leaves underfoot, pure joy.

Minute 3: Geez, it's already time to turn around. Oh wait, what's that? My hip?! I feel it, working. It doesn't feel like sharp pains like it used to, but I feel something, and I'd really rather feel nothing at all.

Minute 4: My hip feels like it does when I'm doing my exercises. Maybe it's just out of shape and/or tired? After all, that's the point of the exercises, to get it working again. In the old days, it was letting the surrounding muscles (quads, hamstrings) do the work and that was the beginning of the problem. It doesn't feel like it did when I first realized I was injured, so that must be progress, right?

Minute 5: Almost done. The hip feels as it did in minutes 3 and 4, no better but no worse. I'm still loving the running, as the early minutes, but the carefree attitude is gone. Everyone told me that coming back from injury would be filled with paranoia (among other not-so-pleasant emotions), and they were right. It's starting.

My physical therapist was clearly right to be so cautious, if a quick five minutes can begin to trigger something. It was certainly a mixed bag of emotions and a reminder--as if I needed one--of a long road ahead. But overall, it does seem like I covered all the bases of a solid run: both pure joy and discomfort, both moments of doubt and moments of triumph. Okay, no triumph with that run, but maybe when I tackle ten minutes.

Dream big,
Teal

Science Friday: The Ten Percent Rule

As I recover from an injury the questions loom: What caused this? Will I make the same mistake again? Was  "too much, too soon" to blame? I've admitted before that I sometimes break the ten percent rule. Is that where I went wrong?

The ten percent rule--that the safe, injury free way to increase mileage is by ten percent each week--is repeated often by running experts and in training books. It's simple, concise, and easy to remember. But is it true? What does the science say?

Unfortunately for ten percent rule advocates, the science isn't on their side. There aren't many studies that examine the rule, and, to date, none that agree with it. The study that is often mentioned as the best test of the rule was published in 2008 by a group in the Netherlands. 

The participants in the study were 532 novice runners that signed up for a four mile race. The researchers divided the runners into two groups, carefully accounting for past history of sports and previous injuries. The control group was assigned a "frequently used beginners training program" that was 8 weeks long, with an average weekly increase of 23%. (The increases each week varied greatly and included a down week.) The intervention group was assigned a more gradual program that was 13 weeks long, and carefully increased the time spent running by ten percent each week. (One week had only a 2% increase but the rest were pretty consistent.) Both groups were to run three times a week.

The injury rates were shockingly similar. In the control group, 20.3% of runners became injured. In the intervention group, 20.8% were injured. A gentle ten percent increase didn't help.

(Not entirely relevant but interesting: They followed up their work with another study looking specifically at a preconditioning program. Prior research suggested that people who participate in sports that involve jumping and pounding to the joints (soccer, basketball, or volleyball) get injured less often when they start to run than those who participate in sports with less pounding (swimmers and cyclists.) They designed a four week program that simply included a few sessions of hopping mixed with walking. The preconditioning/hopping program was completed before the running program began. The hopping had no effect on running injuries, however, as the control group and the hopping group were injured just as often.)

Recently, a smaller study was published using GPS watches to track increases in mileage. The authors wanted to do away with the subjectivity of subjects self-reporting how far and fast they ran, so they gave them Garmins (Forerunner 110s), asked them to run for ten weeks, and tracked their injury rates. The Garmins couldn't lie: runners who became injured tended to have a greater weekly increase in mileage. But the increases--for healthy and injured--were higher than ten percent; injured runners increased mileage an average of 32% while runners who remained healthy increased mileage by 22%. The difference between the two groups' mileage wasn't quite statistically significant, however, which means that while it's interesting, it's not quite enough to make sweeping generalizations. They also calculated that injured runners had a large (and significant) jump in their mileage the week before symptom onset, with an average increase of 86%*. It may be surprising to the ten percent folks that people can get away with greater than 20 percent increases and remain injury free, but injury following an 86% increase isn't terribly shocking.

The authors of the GPS study summarize nicely: "No clear evidence for safe progression of weekly volume exists." The ten percent rule may be convenient, but it's not accurate. In fact, some people can safely increase weekly mileage over 20 percent and remain healthy. But others (1 in 5 in the first study) get injured even with an increase of just 10 percent. It seems like it's up to you to know your body and what it can handle, which unfortunately is learned by trial and error (and injury.) It's probably best to err on the side of caution, and maybe not try to bump up by 86% in one week. 

Dream big, 

Teal

*It should be noted that the number of participants in this study was small, and the number of injured was even smaller, only 13. So while this may seem like a high number, it's probably because of the small number of people. 

Injury Is A Pain In The Butt

Fall is my favorite season, mostly for the perfect running weather. Yes, the overabundance of all things pumpkin flavored is delicious, but it's that other smell in the air that is so inspiring. It smells of cross-country season, of marathon season, of running season. 

But, for me, it's biking indoors season. My hip is not yet healed enough to run, and although I am still thrilled I don't need surgery and thankful it isn't a worse injury, I'm not exactly enjoying my time away from running. I try to keep my head up and continue to look forward, but I do have some observations to share. Okay, they are mostly complaints, but perhaps other injured runners can share in my misery. 

One unsurprising discovery is my jealousy when I see other runners running. They don't know how good they have it as they trudge up that giant hill, red faced, struggling in sheer desperation to get to the top. Oh how I miss that agonizing delight. I want to jump in and jog alongside them while raving, "Isn't this wonderful?" (The irony is that this does not mean I don't want to go to races. When invited to cheer on friends in a November half marathon—the same weekend that I was to run my marathon—I couldn't say yes fast enough. If I can't race myself, there's no place I'd rather be than cheering others as they race, even despite my jealousy.) 

What was unexpected—to me, at least—was how much seeing my running routes would make me jealous. I run some of the same paths all the time, to the point of monotony. But now, I'll drive past one, and the grass has never looked greener, the path never more inviting. That cross-country/marathon season smell wafts in through the window, teasing me. I want to be out there! 

Since I'm biking to stay in running shape, I use very low resistance and very high RPM. Most experts would say that's a dangerous recipe for runners (i.e. inexperienced bikers) to get seriously hurt on the roads. So I'm stuck indoors, watching terrible television and cursing the inefficiency of biking. To get a similar workout to running, you have to bike about 1.5 times longer. But it's awful, particularly because it's incredibly boring and early morning television is the worst. I can't watch the Kardashian sisters fight over something blown out of proportion one more time. (Oh, but there's a marathon on, with new episodes? Okay, then, well I just want to see what happens with Khloe and Lamar...)

Fortunately I have a wonderful husband who listens to my complaints,
and, instead of getting annoyed by them, draws motivational pictures.

And dieting, forget it. There are many reasons I run and one of them is I really love cupcakes. Biking doesn't allow me the same gluttony. (That'd be too many Kardashian episodes to handle.) But despite working out at a fraction of what I'm used to, I still want to eat everything in sight. What do you mean I don't deserve a large stack of syrup covered pumpkin pancakes?! I ran a twenty miler six months ago, that doesn't still count?

Even chores are harder. Living in the city, sometimes it's just easier to run somewhere. On weekends I run to work or to do errands. But now I take some combination of buses and subways and can't help but calculate how much faster it would be to run, and how much more enjoyable. 

But the most tangible problem with biking is the bike seat. The bikes at the gym have wide, cushioned seats; although they aren't exactly Lazy Boys, they are much more comfortable than what true cyclists use. But thanks to kind triathlete family and friends, I currently have a real cyclist's bike with a real cyclist's seat set up in my living room. The first day wasn't so bad. This is so convenient! The second day, if I even tried to shift one inch, a wave of pain went through my butt, punishing me for anything anti-biking I've ever said. If this is some cruel torture device to force me to have more respect for cyclists and triathletes, congratulations, it worked. (Thank you family and friends??)

Of course, there are psychological struggles, too: the questions of getting back to where I was, how far behind I'll be when I can run, if the injury will return, how the recovery seems to be taking longer than originally anticipated. But it's simpler and easier to repress those worries and to focus my anger on that bike seat, because it's a serious pain in the butt. 

Dream big, 
Teal

Science Friday: Diagnoses and Discoveries About Hips

Note: This is not a typical Science Friday, but Part 2 in the unexpected series identifying what is wrong with RunnerTeal.  (Let’s hope for no Part 3 anytime soon.) 

Last week I told you about my not-so-hip hip and my upcoming doctor’s appointment.  Everyone’s well wishes and thoughts paid off, as I do not have a surgery-requiring labral tear, but tendonitis in my hip flexor instead. (Yippee!!) Tendonitis means no running for a few more weeks, being forced to confront my hatred for biking, and no fall marathon. (The Philadelphia Marathon has now stolen my money for the last two years. I’ll get you back some day, Philly…) But, it isn’t surgery, and that is a huge relief that indisputably makes a few run-less weeks and hours of boring biking seem like a blessing.

Given the crash course I’ve had the last few weeks, I thought it might be nice to share some of the things I’ve learned about hips, both their tears and tendons.*

The hip is a ball and socket joint, like the shoulder, where the head of the femur (the ball) sits in the pocket (called the acetabulum, the socket) of the pelvic bone. This allows for motion in almost all directions and allows us to walk, jump, and of course, run. It absorbs a lot of forces; when we run, the forces are many times our body weight. The hip is the superstar of joints.

The acetabular labrum is the cartilage that surrounds the socket, helping to keep the femur securely in place. Running repeatedly over years and years (as marathoners are wont to do) can cause the labrum to wear thin and tear. (This can also occur more instantaneously in contact sports or accidents.) The pain occurs on the inside of the hip and it may present as stiffness and tightness or it may feel like it’s clicking or catching. The latter is the symptom that had me (and Dr. #1) convinced I had a tear. If the tear is bad enough, arthroscopic surgery may be required, where the torn portion is cut out. After seeing my x-ray and hearing my description—when the pain was worst, what time of day it hurt, etc.—my doctor was less than convinced that I had a labral tear, and did an ultrasound to check. If I had a tear big enough to need surgery, he’d see it on the ultrasound. Fortunately, he found a healthy looking labrum! He diagnosed me with tendonitis of the hip flexor instead.

The hip flexors are a collection of muscles that mainly function to pull the leg and knee upward, towards the body. Two of these muscles, the iliacus and the psoas major (together referred to as the iliopsoas), are the most susceptible to hip flexor injuries, and tendonitis can occur in the tendons associated with these muscles. (Tendons attach muscles to bones.) When under repeated stress, tendons can degenerate and become inflamed. (The suffix “-itis” means inflammation.) The stress could come from doing too much too soon or from overuse, pushing too hard for too long—again as marathoners are wont to do. If the tendons are inflamed or aggravated, most likely the surrounding muscles are as well. During my appointment, the tightness and stress on these muscles was obvious. The psoas major connects the lumbar part of the spine (the lower back) to the front of the pelvis. When my doctor pressed on my lower back, I could feel pain in the front of my hip—a strange sensation that convinced me he knew what he was talking about. (An interesting side note: only about 50% of people have a psoas minor. It seems not to matter whether you do or do not have this weak muscle.)

Treatment for tendonitis includes anti-inflammatories, physical therapy, massage, and, of course, the most hated treatment: a break from running. The tendon is able to heal itself; the purpose of the initial inflammatory process is to promote healing. As with all injuries, the trick is patience: let your body work its magic (and have a really good PT to help coax it along.)

Here’s a quick run down of other hip issues that affect runners:

Bursitis:

Bursae are lubricating sacs that cushion areas where muscles and tendons slide against bone; bursitis is an inflammation of these sacs. Trochanteric bursitis will cause a dull ache or rubbing on the outside of the hip. Again, the treatment includes rest and ice/anti-inflammatories.

Stress fracture:

In the hip region, the most common place for a stress fracture is the neck of the femur. A stress fracture causes a throbbing pain that gets worse with more running and will probably leave you limping. If you can’t hop on the affected leg, a stress fracture is probably the issue, and you should immediately stop hopping and stop running. Here the treatment is 6-8 weeks of no running.

Iliotibial (IT) band syndrome:

This can present as a jabbing pain on the outside of the knee, but it starts up in the hips. IT band syndrome is from irritation of the ligament that runs along the outside of the thigh from the hip to the shin. You can get it from doing too much too soon (always trouble!) or even from running the same direction on the track (too many left turns!) IT band syndrome can be helped with rest, ice/anti-inflammatories, and massage before starting a program that strengthens the surrounding muscles.

Piriformis syndrome:

This is literally a pain in the butt, as pain shoots from the butt down the back of the leg. It can be treated with massage and physical therapy.

Staring at images of skeletons, muscles, and joints and learning all the things that can go wrong makes me appreciate how amazing it is that, most of the time, things work smoothly to allow us to move around. And, someday soon, to run again.

*Note: I am not a doctor, just a scientist who likes to teach herself things. You should see an actual doctor if you’re having hip trouble.

Dream big, 

Teal 

Broken

I have never been injured. 

When I admit this to someone, it is not to brag. Rather, I confess it sheepishly, full of guilt, fully aware that I don't deserve to be an injury-free runner, fully aware of all those runners who have been frustrated by injury for years. (My sister, who will always be a far superior runner to myself in my eyes, has been hit with one too many injuries. Why can I run and she can't? It isn’t fair.) 

In high school I had a problem in my foot that flared up a few years later while training for my first marathon. Before my first Boston, my Achilles started acting up. In these cases, the remedy was a few days off and then carefully resuming running. I've never been to the doctor for these minor glitches. 

When asked how I remain injury free, I list the usual reasons: I watch my mileage and have built it up slowly over years. I take careful inventory of what hurts and stretch/ice/rest when anything feels off. I know what works for me and what my body can handle. But honestly, I'm just lucky. I've broken the ten percent rule. I've gone weeks without a day off and felt a sense of pride about it. Busy mornings mean skipped stretching and icing. The injured runners reading this now hate me. Don't worry. Karma will get me soon. Maybe it already has. 

While training for this spring's Boston, my hip acted up a bit. Some days it would feel tight and go away, some days it would be a quick pang of pain, and then disappear. Looking over my log, there is one day it bothered me enough to cut a workout short. Instead of logging 15, I cut it to 9. Still, I ran 9 miles; I wasn’t debilitated. I worried about it a bit, but it wasn't serious enough to slow me too much. 

After Boston, I took off more time than usual. I did a short test run; the hip was still tight, so I took some more days off, and repeated this process a few times. By June, I was aching to run and getting out of shape. I started slowly and built back my mileage. My hip made its presence known a few times, but nothing to sideline me. I religiously did hip exercises and iced it. It seemed to be going away. Three weeks ago, I did a tempo run that wasn't a complete disaster. I was coming back. 

The next day, while visiting Brother in Philly, he took me on a run along the river, following the same course the marathon would. It was a gorgeous day, the kind of beautiful morning that makes you glad to be a runner. My hip was tight in the beginning, but loosened up. I hit a pretty decent pace, and felt happy with it. Afterwards, I did my stretches, grabbed some ice and hopped in the car for a wedding in the Hamptons. 

On the drive the hip stiffened and throbbed. But after we got out of the car, it felt fine. We danced and celebrated, all fine. The next day, Husband and I tried to go for an easy run. It tightened immediately. “Maybe it will loosen up like it usually does,” Husband said. But I couldn't even make it two steps to try and see. I was hurt.

I took a few days off before testing it again with an easy jog. After five minutes of pain-free running, it tightened. I could have pushed it to see if it would stretch out like I have in the past. But remembering not being able to take two strides a few days before made me realize it wasn't worth it. At that moment I switched from someone who defied injury to someone who was injured, and accepted it. Time to see the doctor.

I called the best hip doctor around, as recommended by a teammate. I couldn’t get an appointment for three weeks. Three weeks? That seemed like an eternity. I am supposed to be training, what the heck do I do with myself?

After the aborted test run, I cross-trained to maintain sanity. On Friday (day 7 of no running), I saw my doctor to get a referral to Dr. Hip Specialist. She thinks it may be a labral tear, to be confirmed by the specialist with an MRI. She warned me a tear could require surgery, although it may be possible to rehab it with physical therapy. She also said I can run in the meantime, provided I decrease mileage and avoid hills. I can run? This happy news clouded the rest of the appointment. But as I walked away, the reality of what else she said dawned on me. Possible surgery!?

I was able to run for five pain-free, glorious days before the tightness was back and I was sidelined again. Tomorrow I have my appointment; the three weeks of waiting are over. I’m eager to get a real diagnosis: will I need surgery? Is cross-training aggravating it? When and how can I get back to running? I’ve come to accept my immediate goals may need to change, but I want to get started fixing this as soon as possible, so my long term ones don’t need to.

Dream big,

Teal