Good Enough

Thank you so much to Lacy over at Running Limit-less for the feature today! Click over to read about how I run without limits…and a colon ;)

I consider myself a fairly rational individual. I say “fairly” because I am also crazy, just ask my husband. But by and large, I’m even-keeled and lean toward the middle of the road on most things.

Except pie. I believe in eating all the pie. And cake.

Except pie. I believe in eating all the pie. Apple and cherry pie. And cake. But only vanilla/vanilla cake.

But when it comes to running and training, I am as Type A as they come. Too often I hear from runners who are injured or disappointed in their performance that they “did everything right”, only to find out that they were woefully misinformed by someone and were, in fact, doing most things wrong or merely halfway.

The simple fact of the matter is that our bodies are not symmetrical. And we are not the .0001% of the population with ridiculous athletic genes. And you can’t drink 8-10 glasses of booze and eat a half doze cookies on your “cheat day” and be race ready.

Good enough is not enough.

You gotta dig deeper for those results to shine through.

You gotta dig deeper for those results to shine through.

What do I mean by not good enough? Well, here are a few examples and how to tackle the problem of training better than “good enough”:

  • You’re not seeing improvements in your pace after training for 3 months

Problem: Your training schedule and/or effort are sub-par

Fix: Gut check. Are you really putting the work in during your runs? Are you really hitting that max effort? We are all guilty of dogging it in a track workout every now and then. A great way to ensure you leave it all out there during your workouts is to get with a buddy or a group and do it together. Accountability helps!

My accountability buddy is MUCH faster than me. So happy to have her by my side for many, many vomit-inducing track workouts!

My accountability buddy is MUCH faster than me. So happy to have her by my side for many, many vomit-inducing track workouts!

  • You keep getting overuse injuries

Problem: Your training schedule is too intense, doesn’t include the right (or any at all) strengthening exercises, or you’re not getting enough rest between workouts and/or training cycles.

Fix: The simplest fix for this may just be to take a break, see a Physical Therapist, and start over. Or fire your coach. Or both. Here’s the thing: the body, as a moving entity, is not rocket science. When you get hurt there’s a reason, asymmetry and weakness being two of the biggest culprits.

And if your coach is having you push through or ignore injury instead of addressing it, fire them. Or maybe you’re not listening to your coach…or your body?

Hmmmm...

Hmmmm…

  • You keep getting the same injury

Problem: The injury has never really healed from last time or your strength training routine isn’t specific enough

Fix: It’s sooooo easy to ramp things up to 11 once you are pain-free post-injury. The problem is, once you’ve sustained an injury, you will always be more susceptible to re-injury. Doing your home exercises, adhering to your strength training program, and taking adequate rest are life-long steps to avoiding the IR list.

And sometimes it's sitting this race out in favor of coming back stronger for the next one.

And sometimes it’s sitting this race out in favor of coming back stronger for the next one.

  • You work out at 10/10 effort, but just can’t seem to get your times down

Problem: Your workout schedule is too heavy, your rest days are inadequate, and/or your diet stinks

Fix: Rest more. Rest often. Eat real food. Prioritize the really important runs and workouts and take a break from the extraneous ones. Recovery time is just as important as strength and endurance. Without rest, your body will never be able to work at its maximum potential.

All are equally important.

All are equally important.

Start by being honest with yourself. Then enlist the help of experts–actual experts, for training and rehab, if need be. Be patient, work hard, and be honest with yourself and your team about what you are doing and not doing. 

I promise this will make a world of difference.

Now go out and run!

Foam Roller ≠ Doctor

I love that people are taking their {running} health seriously by stretching, cross training, yoga-ing, foam rolling and being generally awesome, responsible runners.

You go.

CT  CTH rollerfit.jpg

Pink devil.

I’m proud of all of you.

But we need to talk about something. Like, how the foam roller isn’t a doctor. I know all the articles are telling you that if you foam roll til you can’t walk anymore and stretch all day every day that your IT Band syndrome will miraculously disappear.

Wrong.

Just…wrong.

But why? Well, because injuries are complicated. It’s not just confused, pissed off muscle fibers that tangle up for no reason. There are lots of reasons.

Like opposing muscle weakness.

Like funky foot patterns.

Like terrible running form.

Like tightness somewhere seemingly unrelated (but it IS related ‘cuz everything’s related!)

Like misaligned structures in your foot…

…or hips…

…or head or neck or ribcage or scapula.

You get the picture, right? There is no amount of foam rolling and stretching and icing that can realign your pelvis by joint manipulation of your hip flexors and activation of your glutes.

See? That’s a lot for someone who’s NOT a physical therapist to diagnose and do. First of all, you can’t manipulate most of your own joints. It’s just not happening. Second, you can’t watch yourself run from all angles to diagnose imbalances. And third, you can’t treat yourself.

Just 'cuz I wear the scrubs doesn't mean I treat myself. I have a whole list of professionals I see for my bod.

Just ‘cuz I wear the scrubs doesn’t mean I treat myself. I have a whole list of professionals I see for my bod.

Let me ask you a question? Did you go to school for an extra 2-4 years of grad school and get licensed by the state and are you considered an expert in the field of musculoskelatal movement? No? Oh.

THEN WHY ARE YOU DIAGNOSING AND TREATING YOUR INJURIES?????

I get it. You know a lot about your body and running. You’ve maybe “fixed” this problem before (but did you if it came right back when you ramped up your mileage?).

But you’re not an expert. You’re not a doctor.

Yo. Bad form.

Yo. Bad form.

If you have a problem, see a doctor. Most physical therapists these days are doctors of physical therapy. They are experts. This is their thing. Go see them.

The foam roller is not a doctor, nor is it a cure-all for running injuries. Get it taken care of before it keeps you from your next PR.

Now go out and run.

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IT Band Research

A few weeks ago, I had to write a short paper about a common lower limb injury and provide the mechanism for injury, muscles involved, treatment, and rehabilitation for the injury.

Below is the paper with the scientific resources to back up the paper. These resources came exclusively from peer-reviewed articles. So, if you were interested in knowing more about your favorite lateral fascia, here you go! It’s science.

(Image courtesy of Anaerobic.net)

(Image courtesy of Anaerobic.net)

(If you copy or quote any portion of this paper, you must cite me as a source and/or the sources cited within the paper and notated below)

Illiotibial band syndrome

By Abigail Bales

Illiotibial band syndrome (ITBS) is responsible for approximately 22% of lower extremity injuries.(5) It is especially prevelant in the growing number of both professional and amateur long-distance runners due to repetitive nature of the movement of the knee, specifically the flexion of the knee.(3) It is the most common lower-limb injury in long-distance runners. The illiotibial band is a thick fascia that extends from the muscle fibers of the gluteus maximus and medius as well as the tensor of fascia latae, over the lateral femoral condyle of the knee, and attaching to the infracondylar tubercle of the tibia.(2) The causes of the injury are multi-faceted, though most recent studies focus on hip adduction, knee internal rotation, hip flexion, and overall kinematics of the individual. Training factors and terrain can also contribute to cases of ITBS. All, in part, seem to be to blame. This suggests that weak hip abductors and glutes, improper form, and speed of the movement are the root causes of the injury.(1,3)

Athletes experiencing ITBS often complain of knee pain located near and around the lateral condyle of the femur and/or hip pain localized near or around the greater trochanter of the affected leg. In mild cases of ITBS, symptoms may come and go during various activities, dissipate during exercise, and become aggravated on certain terrains or during rest.(4) In its most severe form, many athletes will find the pain so severe that they are unable to participate in running or cycling activities entirely.

Surgery is rarely necessary and is not recommended as a treatment for ITBS. Common treatments include rest, reevaluation of training and mileage, strengthening exercises, stretching, and myofascial release techniques. There are conflicting theories about the role played by the hip abductors, and subsequent strengthening of them, in ITBS. While studies point more to over all body mechanics and running form as the root cause of the syndrome, including over-adduction of the hip, hip abductor strengthening is routinely part of the rehabilitative process prescribed by physical therapists.(1)

Dr. Michael Fredericson, a professor at Stanford University who has done extensive research on ITBS, found in his 2000 study that, “Long distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners” and found that “after 6 weeks of rehabilitation, 22 of 24 athletes were pain free with all exercises and able to return to running, and at 6-months follow-up there were no reports of recurrence.”(2) This study focused on improving gluteus medius and minimus strength (hip abductors) and stretching as a treatment for ITBS in males and females from the Stanford University Cross-Country and Track teams.

The literature calls for abductor strengthening exercises, such as side-lying lateral leg raises with ankle weights, side-stepping straight leg walking with resistance bands, in addition to foam rolling, stretching, and massage as the best and most common forms of treatment for ITBS. In addition to treatment, complete rest from hip flexion activities would be prescribed, with return to small amounts of activity over time, so long as symptoms did not return.(2) Gait analysis and speed of running are also to be considered as a part of the rehabilitation and preventative process since ITBS occurs less in faster runners,(3) presumably because their form is better than that of slower runners.

References

1. Ferber, Reed, PhD, CAT(C), ATC, et. al. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic and Sports Physical Therapy. February 2010. Vol 40 No. 2. 52-58.

2. Fredericson, Michael, M.D., et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine. July 2000. Vol 3. 169-175. PMID: 10959926. http://www.ncbi.nlm.nih.gov/pubmed/10959926

3. Fredericson, Michael, M.D. Illiotibial band syndrome in runners: innovations in treatment. Sports Medicine. 2005. Vol 5. 451-459. PMID: 15896092. http://www.ncbi.nlm.nih.gov/pubmed/15896092

4. Khaund, Razib M.D. Flynn, Sharon H., M.D. Iliotibial Band Syndrome: A Common Source of Knee Pain. American Family Physician. April 2005. Vol 8.1545-1550.

5. Linenger JMCC. Is iliotibial band syndrome overlooked? Physicians and Sports Medicine. 1992. Vol 20. 98–108.

Now go out and run!

Did Not Fail

Ahhhhhh, Fall! For most of us runners, Fall = running season. Cooler mornings, a race every single weekend until Christmas, and the threat of holiday weight gain urging us to employ our running shoes more frequently.

For many runners, it also means having our sights set on the finish line at some marathon or another.

NYC Marathon Finish Line. Mecca, for a lot of us.

16 weeks of training (or more), weekend after weekend of long runs, the shame of having to wear compression socks to the grocery store on Saturday afternoons, and more attention to our glutes than most of us like to admit culminates with 26.2 miles of foot-stomping fun.

But sometimes it doesn’t.

Sometimes a runner’s dream is dashed only weeks before the Big Race. Tendonitis, pulled muscles, stress fractures, catch-all joint syndromes, and mystery pains can keep the most seasoned marathoner from toeing the line this Fall. The dreaded DNF.

DNF usually stands for Did Not Finish. I hate this acronym. There’s an innate sense of failure in the wording that brings about feelings of deep shame to the individual whose name bears these three little letters on the runner roster.

But DNF doesn’t tell the whole story, nor is it the final chapter in your running book.

It takes courage to defer or call it a day. When you know your body can’t take any more, that running further or for more weeks would only be detrimental to your long term health, DNF-ing or deferring is SMART. In fact, it takes a smarter, more seasoned runner who knows their limits to call it a day.

The smart runner knows when it’s over.

The smart runner knows that one race does not define them.

The smart runner knows there will be more.

The smart runner knows when to ask for help.

The smart runner knows the difference between good pain and bad pain.

The smart runner pushes the limits and is ok when, occasionally, they fail.

The stupid ones (yes, I called you stupid) push through the bad pain and force themselves on the course simply for their own ego. You know where ego gets you? The orthopedic surgeon’s office and then the PT’s clinic for months and months in excruciating pain. Sounds fun, right?

To all of you who have called it a season, despite having paid for a marathon entry this Fall, I salute you. You are smart and brave and I applaud you for taking care of yourself, knowing there will be other races for you to rock.

Have you ever deferred or had to DNF? How did you feel then? How do you feel now? Are you considering a deferment this year? Share with us!

Now go out and run!

Why You’re Injured

So, I’ve been a runner for going on 22 years. I started off running in 5th grade track and graduated to a full mile in 6th grade during my first cross country season. The next year is was 1.5 miles and by 8th grade, I was running 2 mile races. High school cross country introduced me to the 5K and freshman year of college was my first 10K (Bolder Boulder, baby!).

I was always very active. Not fashionable, mind you, but active. I never did learn how to stop properly in my roller skates. I always just ran into the grass.

It was a very slow progression. From 1-6.2 miles in 8 years. From there I started running LONG distances and ran my first marathon in 2003. I have run 9 marathons in 9 years.

And I’ve only missed one month of running due to an overuse injury.

One month.

It was an overused/underdeveloped left side gluteus medius and one month off of running + 3 months of rehab got me to my fastest marathon to date (3:46).

Post-injury Marine Corps Marathon. PR!

One month.

Why? Because it took me 8 years to get to 6.2 miles and 11 years til I ran my first marathon. That’s why.

If you understand connective tissue, you’ll understand why so many people experience overuse injuries when they decide to just “pick up” marathon running as a hobby in their 20s and 30s. Ladies, you have a huge strike against you. Estrogen contributes to the break down of connective tissue. Yay for being a woman. So, on top of all the repetitive movements that are making your newfound hobby hurt a little more than you expected, your hormones are actually working against you.

Ugh. The “why me?” of being injured is probably the most frustrating thing that I hear from newbie runners. Why you? I’ll tell you why:

  1. Because you did too much too soon.
  2. Because you didn’t rest and recover from your last marathon/half marathon/longest race.
  3. Because you don’t lift weights.
  4. Because you don’t take rest days.
  5. Because you don’t run enough for your body to get used to it.

If you go from 0 to 26.2 in a year, I guarantee you will have an overuse injury by the time that year is out. You may not even make it to your marathon because you will develop ITB syndrome, tendonitis or some other overuse injury. Promise. The odds that you will develop an injury can go up considerably when you look at your weight, diet and gait.

How do you get around this? Easy. Don’t go crazy.

Yes, it would be cool to run the New York City Marathon this year. You will not be ready by November. Try for next year. BETTER YET, try for 2 years from now and build up gradually. Sure, a half marathon in August may not kill you, but it will definitely not make you stronger. Why not shoot for a 10K instead?

Race For the Cure 5Ks are all over the country–and for a good cause! Lots of t-shirts with “boobies” written on them. Pretty sure you’re not gonna see that in Boston.

Don’t drop all of your other fitness habits just because you want to run. I still spin 2-3 days a week during first half of marathon training season. I also lift throughout the entire year to keep my muscles strong and to increase the density of my connective tissue, which is a very slow process.

Don’t go crazy. Take your time. If you do it right, you can start running now and be able to run for the rest of your life. If you do it wrong, this might be the only race you ever run.

Your choice. Run forever or run for now?

Tell me about your injury. When did you finally seek treatment? Share with us so we might learn from you!

Now go out and run.