When Inspiration Can Turn Into Desperation

We all can name a few people who inspire us - those that push their limits and accomplish great things not just day after day, but year after year.  Whether you’ve been running one year, 10 years or many decades, we all have our running heroes. Those we admire in the running community may be big names - the closest we’ll ever get to them is following them on Strava.  Sometimes those we admire most are people right in our own community, or even our best friends.

With the explosion of running participation worldwide, more and more people are either taking up running for the first time or setting new goals for themselves.  Regular 5K runners are reaching for that 10K, half marathoners are doing their first marathon, and marathoners are going for a BQ or even jumping into the ultra running scene.  This is amazingly awesome and nothing makes me happier than seeing someone set and achieve new goals, especially in running.

However, there is a dark side.  Unfortunately, I am bearing witness to it more and more in my line of work as a physiotherapist who treats primarily runners.  The number one cause of running injuries is training error, particularly increasing mileage too much too soon. The incidence of stress fractures is disturbingly on the rise, and I am finding myself spending more and more time coaching runners on periodization and proper recovery techniques as a way to prevent or treat chronic injuries.  Social media and apps like Strava can provide us with a running community and motivate us to perform, while at the same time can make each run a competition and lead us to compare ourselves to others who may have vastly different running experience or daily family and work demands.

I recently was asked to consult with a male runner in his 40’s whose chief complaint was fatigue.  He had been battling injuries for several months and with the help of one of our therapists was finally running “injury-free.”  At the same time, he admitted to feeling constantly exhausted and stressed.  He was an experienced half marathon runner but this year, inspired by some leaders in his running community and a few close friends, he ran his first marathon, his first ultra, and had 2 more ultra marathons planned for the season. He had a high-stress job and admitted to not sleeping as much as he should.  His training was not producing the gains he wanted, and as he sat before me I could see his eyes fill up as he admitted to dreading his runs now rather than looking forward to them.

My heart went out to this man.  He had obviously been motivated to set some big goals for himself early in the year.  No one sets goals to break themselves down.  We set goals because we need to build ourselves up - to give us a sense of purpose, direction and satisfaction when we accomplish them.  He was trying his best to do what he thought he should with the inspiration of his running community as fuel.  I couldn’t help but think that we had failed him.  This man was obviously deep in overtraining syndrome and possible adrenal fatigue and was still convinced that he needed to do a 50K training run before his upcoming second 50K race.  Overtraining syndrome is serious, can take months if not years to recover from, and doesn’t just affect elite runners.

After a long discussion on everything from his training plan to recovery techniques and diet, I prescribed him at least one week off running, cycling for cross-training, and asked him to seriously reassess his goals for the year.  I didn’t ask him to stop running long term, just to give his body the time it needed to adapt to the incredible stress that he was placing on it.  This was not what he wanted to hear, but it was what he needed to hear.

I can’t help but wonder…can inspiring someone also be inadvertently harming them?  Do we have a responsibility not only to inspire each other but to take care of each other? In a world where we present filtered snapshots of ourselves on social media, do we have a responsibility to ensure that those who are watching us are witnessing our authentic journey?

As an ultra runner, I believe strongly in setting BIG goals and doing the work to achieve them.  Personally, I hope that I inspire people to believe in themselves and to set gigantic goals as well.  However, this also gives me a big responsibility to ensure they understand the process and the patience involved in reaching those goals.  We are all coaches to a certain extent.  As a running community, it is important not only to inspire each other but to take care of each other.  More experienced runners have a responsibility to mentor those following in their footsteps with the wisdom they have gained.  Less experienced runners have a responsibility to reach out to those who may have something to say that they need to know.

Achieving big goals in running is a process, not an event. After the completion of my last 100 mile footrace, I was frequency asked the question, “how long does it take you to train for a 100 miler?”

My answer? “My whole life.”

My challenge to our incredibly awesome Winnipeg running community is this:  Speak up when you need help.  Speak up when you see someone in need of help.  Be inspiring, but be authentic.   Let’s help each other to shine brightly for a long time, not just a short time.

Bounce strong my friends.

Onward and Upward

Today I had a celebration of sorts.  A little personal victory party.  After spending the latter half of 2016 dealing with a stress reaction in my foot, I can comfortably say I am not injured anymore!  As a physio, I often advise my patients to mindfully avoid falling into a long term "disability mentality" when they are injured.  There comes a point when your body is healed, but it's easy to still think of yourself as "damaged," and remain fearful of moving normally, living normally.  Although it's still healthy and wise to be cautious post injury, consciously leaving that "injured runner" mentality behind is necessary and so liberating!

Today I completed my first 4 week training block after coming out of my boot.  I started slowly, so slowly, painfully slowly.  First I started replacing some of my bike time with walking on the treadmill.  Then I started moving into run:walk intervals, and then finally short steady runs.  Once I was able to run 4 miles with no walk breaks I moved outside, because I was then moving enough not to freeze to death!  My mileage has slowly increased and I'm feeling the need to hold back to stay in zone 1, which is a great sign. Finally.

All along the way, I gave my body small tests I strongly felt that I could pass. I was not interested in self-sabotaging this whole process and wasting all that valuable healing time I had spent resting. This is the criteria I give my patients, and I made sure to apply it to myself each and every day.

Before Running:
Pain-free walking before running. My personal test was 60 min on the treadmill.

During Running:
1) No obsessing about your injury. If you are aware of your problem with each step and you can't relax and forget about it for whatever reason, that's a sign that maybe you shouldn't be running that day.
2) No limping or altered gait allowed.  I constantly monitored my gait with the metrics from my Garmin, which meant wearing my HRM for all runs.  If my ground contact time R/L balance spread by more than 2% over the course of a run (L 51% R 49%) then I knew I needed to adjust my plan for the next few days.

After Running:
1) No lasting discomfort > 2 hours.
2) No increased morning stiffness or discomfort the next day.
3) Overall healing trend - each week is better than the last.

I just had a 3D Gait Running Assessment completed where I work at The Running & Gait Centre.  I can happily say there is nothing  biomechanically precluding me from running - no red flags.  In fact, my gait is better than it was last year! I'd highly recommend any recovered runner consider having one of our assessments done before starting to increase mileage, if for nothing else than peace of mind.  I'd be lying if I said that I am 100% pain free, but the vast majority of the time I am and each week is better than the last.

So it's time to leave that injured runner mindset behind and move on towards my next race goal.  I am finally confident enough to say that I'll still be toeing the line at the Zion 100 in April.  Very excited. Onward and Upward!

VO2 Max and Lactate Threshold Testing

Last week I had my first VO2 max and blood lactate testing done at the Pan Am Clinic where I work.  I was so excited. Despite being able to do field tests and now having a ridiculously complex and expensive Garmin that predicts such numbers from heart rate and running data, blood lactate testing and actual VO2 max testing is still considered more accurate and the gold standard of measure for aerobic fitness. So I booked myself in!

I have some big goals for 2016 and although it's getting late in the season to be having such testing done, I really wanted a snapshot of my current aerobic fitness profile in order to train more specifically throughout the rest of the year.

What is VO2 max?  It is a value given to the maximal rate at which oxygen can be taken in, transported and utilized by working muscle.  The higher your VO2 max, the better is your ability to use oxygen during muscular work.  It is often expressed in the relative score (ml/kg/min).  This is important for athletes that must move their bodies against the force of gravity (runner, X-C skiers) and for comparing individuals of different body sizes.  The absolute (L/min) value is important for sports where body weight is supported (cycling, rowing) and is a value that is only meaningful to the individual - there is no point comparing this number to others.

Here is one example of a normative data chart.  There are many and they all vary slightly.

Here is another one:

Elite runners and athletes are reported to have VO2 max values in the 70s and 80s.  The world record is reportedly held by a cyclist from Noway named Oskar Svendsen (97.5).  There is debate as to how relevant VO2 max really is in predicting performance, as athletes with lesser scores can beat those with higher scores.  Hence the whole mind over matter debate...which is best saved for another post.


Lactate threshold (LT) is used to signify your anaerobic threshold which is the shift from the energy supply primarily from aerobic to anaerobic.  Blood lactate is a measure of the lactic acid that appears in the blood as a result of anaerobic metabolism when oxygen delivery to the tissues is insufficient to support normal metabolic demands. LT is indicated by the sudden rise in the lactate when the anaerobic energy system (without oxygen) becomes the primary contributor to exercise.
Athletes all want to stay out of the anaerobic zone as much as possible and having a high LT enables them to perform to a higher level without those dreaded burnings legs. Here is a great article on LT.

Here are some pictures of my testing:

Nose clamped, breathing into a tube, heart rate monitor on

It was hard to see where I was on the treadmill with all that gear - I kept bumping into the front

This is how the test worked: After I had changed and put on the heart rate monitor, I warmed up on the treadmill at a very easy pace for 15 min.  This allowed my heart rate to stabilize, as it spikes all over the place during the first 10-15 min of any run.  Then I put on the head gear, clamped my nose shut, sealed my lips around the mouth piece, and hopped back on the treadmill.  Dean pricked my finger and took a blood sample (in the same way as a diabetic will do a blood sugar test) to determine my baseline blood lactate.  Then I started running on the treadmill.  Every 3 minutes I hopped to the side to allow Dean to take another blood sample.  Then Richard bumped the speed up by 0.5 mph and I ran for another 3 min.  We repeated this cycle several times, while Dean monitored all sorts of information on his computer and reported the blood lactate levels to Richard.  We started at 5.5 mph and by the time we reached 8.0 mph I was starting to wonder when this test would be over.  After running at 8.5 mph for 3 min, my blood lactate finally jumped from the low 3 mmol/L to 4.8 mmol/L (if my memory is correct).  At this point, we had our LT reading, but I still needed my VO2 max scores.  Richard then started to increase the incline on the treadmill by 2% grade every minute, while I was still running at 8.5mph.  It didn't take me long, and after 2 min I called it quits at 4% grade. I'm not sure if I could have gone more, but I thought I was maxed at the time.

Richard and Dean

The whole test took about 45 min on the treadmill, and I had my results within another 15 min.  Dean and Richard were amazing and very good at explaining the whole process and interpreting my results.  I have debated as to whether I should share my results publicly, but I'm no elite athlete and this is a form of journal for me, so I will use my real numbers to help explain what it all means.

Absolute VO2 max: 3.4 L/min
Relative VO2 max: 53.1 ml/kg/min
Maximum heart rate: 184 bpm
Lactate threshold: 3.1 L/min
HR at LT: 172 bpm
LT as a % of VO2 max: 91%

Interestingly, Dean asked me what I thought my LT was before he told me.  He said that people who regularly monitor their HR can usually tell when they reach it just by the burn in their legs.  I told him 170-173 bpm.  I was bang on.  So what do these numbers mean to me?  Having a high LT as a % of VO2 max means that I can run almost to my max before my body shifts to anaerobic metabolism.  It could be better though, and my coach, Sarah Seads, suggests that I work on bringing my LT up to 95% of my VO2 max before I try to up my VO2 max.  How is all this done?  By using these numbers to determine your five training zones, which can done with online calculators, or by an experienced coach or exercise physiologist (Dean gave me my zones during my session).  Knowing your specific heart rate zones can help you train more intelligently and keep your easy runs truly easy, and your tempo or speed workouts truly effective.

Now, we'll see if all this knowledge pays off for me. Ultimately, it's up to me now to apply this information to my training.  Thanks Dean and Richard for a great testing experience!

A Strong Body is Rarely a Painful Body

When you're not running, do you spend more time stretching or strengthening?  In my work as a physiotherapist at the Running & Gait Centre at the Pan Am Clinic, I have had the opportunity to perform many running gait assessments since we launched in November.  We have been performing assessments on injured athletes and on those who simply want to identify any “red flags” within their running biomechanics that could lead to injury in order to prevent any down time.  Already, I am starting to see some patterns and themes develop that confirm what many coaches and successful runners already know.  A strong body is rarely a painful body.

I have been known to say that if runners would spend as much time strengthening as they do stretching, I would see a lot less running injuries in my practice.  Coincidentally, lately I have found myself prescribing far more focused strengthening than stretching exercises to the keen runners who have come to our centre seeking solutions to their running injuries. Don't get me wrong.  Spending time stretching is good, but we can't forget strengthening as well.

Strength needs to be balanced and it needs to be functional.  A joint needs to be supported on both sides, side to side and front to back.  Multiple joints need to be able to work together as part of the whole lower kinetic chain in order to produce the desired motion for any sport.  Strengthening exercises for running need to replicate the desired muscle, joint or lower kinetic chain function as closely as possible to result in optimal biomechanical function and performance.

As your running season progresses and you find yourself spending more and more time logging miles, it’s easy to neglect your strengthening regime.  However, even a few short strengthening sessions per week can create better balance in your body and protect you from injury.  Here are some suggestions when choosing your strengthening exercises:

1. Make it functional.  Always ask yourself, ‘why am I doing this exercise?’  Keeping in mind this article is intended for runners, try to do most of your exercises standing up.  Better yet, consider standing on one foot as much as possible, as 100% of running is spent with either one foot or no feet on the ground.  You will improve not only in strength, but neuromuscular control, balance, proprioception and your ankle and foot cannot help but get stronger.
2. Go minimal while strength training.  As long as it is safe and allowable to do so, wearing minimal shoes or going barefoot while doing your functional strength training encourages your foot and ankle muscles to work more.  You will be able to sense fine adjustments needed to stand stronger on one foot while barefoot than you will with your running shoes on.  Try to keep your arch engaged (pretend there is a pebble or tack under your arch) and your toes relaxed, while avoiding rolling onto the outer edge of your foot. This encourages the deep muscles in the sole of your foot to work optimally. 
3. Work multiple muscle groups at once.  Not only is this more functional, but it is more efficient and every runner knows that time is precious.
4. Don’t neglect eccentrics.  The eccentric or negative function of a muscle is a controlled lengthening contraction.  Running is essentially a controlled fall with every foot strike and your muscles need to slow the impact force of your body weight as each foot hits the ground. This happens eccentrically for most muscle groups and is where breakdown of the body and injury most often occurs.  For each exercise you do, try a 2:1:4 tempo, where you shorten the muscle on a 2 count, hold for a 1 count, and lengthen or return to the starting position on a 4 count.
5. Optimize your core for running.  We all know that having a strong core is important and there are dozens of great exercises out there.  Generally, while running the core functions to control rotation and derotation as we transfer energy from one limb to the other with our arms swinging in the opposite direction.  While you will be generally working your core if your workouts are functional, you should incorporate specific core exercises that involve reciprocal motions similar to running, such as mountain climbers, reverse mountain climbers, and the bicycle.

Bicycle

Mountain Climbers

Reverse Mountain Climber

Reverse Mountain Climber - TRX

If you have very little experience with strength training, consider asking for help from a professional such as a coach, personal trainer, or physiotherapist.  If you know your body is a little bit complicated or cranky, and you want a tailored plan to address your specific weaknesses, consider visiting us at the Running & Gait Centre for a comprehensive biomechanical and physical assessment. We’d love to help!

Kim Sénéchal is the lead physiotherapist at the Running & Gait Centre: Foundation Rehabilitation Services at the Pan Am Clinic.  She is also an ultra marathon runner and run coach.

**This article was originally published in the Manitoba Runners Association February newsletter, On The Run.

Running Strong and Injury-Free: Using the Off Season to Your Advantage

The race season is over.  There are no more race goals, no more training plans on the fridge.  The holiday season has arrived and it’s easy to lose focus and start running inconsistently, setting yourself up for a potential injury. Conversely, maybe you’ve been battling an injury all season and are hoping it will start to heal over the holidays.

The off-season is the prime time to check in with your body.  It’s an opportunity to be proactive rather than reactive.  

Some primary causes of running injuries are:

• Training errors: This includes too much too soon, poor planning and periodization, and overtraining.
• Sub-optimal biomechanics: This leads to less ability to absorb training errors.
• Poor body alignment: Sometimes you can change this, sometime you can’t.
• Muscle Imbalances: Imbalances in strength and muscle length can lead to an asymmetrical gait pattern which is a big predicator of injury in runners.
• Lack of variety:  Running involves highly repetitive movement patterns that can lead to overuse of key muscles if each footstep lands on the ground in the same way.
• Incorrect or worn out shoes: This is less of a factor if you have addressed biomechanical, alignment and muscular factors, but should be considered.

Here are my top five suggestions for setting yourself up to be injury free in the new year.

• Slow down and do a self assessment.  Pay attention to those niggles and pains that you’ve been ignoring all season.
• Identify and correct the risk factors you can on your own.  If your gut is telling you something needs to be changed, follow your instinct.  Make changes slowly and gradually.
• Cross train.  When the weather precludes you from getting outside as much as you’d like, the off-season can present the perfect opportunity to add variety to your training through cross-training.  Consider activities like spinning, cross-country skiing, skating, weight training and yoga.
• Make a plan.  Take the time to develop a training plan for the next season or race.  Hiring a coach can provide invaluable guidance, but there are many good training plans available online.  This will help you train smart by increasing your mileage gradually and intelligently, and balancing hard training days with recovery and rest days. Recovery is as much a part of training as running hard, and it’s important to build rest into your plan.
• Get professional help in areas you can’t correct yourself.  Attempting to make changes to your biomechanics, alignment and strength are best done in the off-season, not at the peak of your training cycle when your body cannot absorb those changes well.  Having professional guidance can help you focus your efforts in the areas you need to address most.

If you are a runner who has been dealing with an injury for a long time with no resolution, or a runner who wants to prevent future injuries from occurring as you reach for your next big goal, you might want to consider visiting the Running and Gait Centre at the Pan Am Clinic for a 3D Biomechanical Gait Analysis.  The centre is the only clinic in Manitoba to offer this highly advanced assessment in a clinical setting.

3D Gait Analysis

During the assessment you will have 16 sensors attached to your joints, and five sensor clusters attached to your legs and pelvis. As you run, six cameras measure your gait pattern.  A report is generated with 16 gait variables, comparing you to a database of thousands of runners.  This data is combined with a very thorough physical assessment that seeks to correlate your gait report with your measures of alignment and muscle strength and length.

You will then return to the centre for a second visit where you will be presented with a comprehensive report and plan for addressing your individual risk factors and weaknesses.  Specific strengthening, stretching, shoe and orthotic recommendations, and targeted physiotherapy treatment will all result in improved running form and efficiency. Research has shown this method to be very effective in helping runners perform pain-free, and to their peak potential.

The Running and Gait Centre is currently accepting bookings for January 2016.  For more information, visit our website or call 204-805-1912.Kim Sénéchal is the lead physiotherapist at the Running & Gait Centre: Foundation Rehabilitation Services at the Pan Am Clinic.  She is also an ultra marathon runner and run coach.

NB: This article was written for the Manitoba Runner's Association newsletter, Dec 2015.

Let's Play!

Have you ever noticed how incredibly serious runners can be?  We analyze everything.  A GPS tells us our distance, speed, pace, cadence, heart rate, and compares us to everyone else who has ever run that route via Strava.  We painstakingly choose our shoes, analyzing the last, amount of motion control, heel to toe drop, weight, lacing mechanism, and color.  We hire coaches who develop training programs that are pinned to the fridge and we worry when we aren't able to complete them perfectly.  It gets even worse when a niggle starts to develop. Where is it coming from?  What am I doing wrong? Should I stop running?  Then we often seek professional help from those who are experts.  Ironically, I find myself one of those "experts" who is paid to perform a very detailed 3D analysis of a person's running gait and then a very thorough physical assessment as part of my job as the Lead Physiotherapist at the Running and Gait Centre at the Pan Am Clinic in Winnipeg.  Don't get me wrong - I love my job and can't believe I get paid to do what I do.  But all this analyzing can easily weigh me down.  It's easy to miss the forest for the trees.

A friend this week thanked me for "letting him play" with his running.  It took me back a bit.  We had been creatively brainstorming training options (see post: Creative Downhill Training: Flatlander Style), which was kind of fun. I told him that running SHOULD be playful and creative.  That's how innovation happens.  And then Sarah Seads posted something about playing in the woods (as she always does).  And it got me to thinking...again.

The next time you are at the park, watch little kids play and run.  They run for pure joy - chasing each other around, playing tag, twirling and dancing, holding hands and skipping.  As adults, we forget how to play.  And we forget that simple human movement is easiest way to play.

Playfulness starts with a mindset.  It starts with gratitude for the ability to run, and acknowledgement of the gift of the moment.  It starts with putting a smile on your face as you head out the door, and keeping it on as you run.  It continues with leaving the data-trackers at home.

Here are several ways to bring play back into your run:

• Get off the road.  Find a trail that winds up and down, around and around.  Don't worry about getting dirty or wet.  Jump in the puddles, get muddy.  Break your own trail in the snow.  Leave footprints that will make the next person wonder what in the world you were doing!
• Fartlek.  Fartlek means "speed play."  Add variety to your runs by changing speed continually like you would if you were a kid playing tag.  Better yet, play tag with your running partner!
• Use music. Put your entire music collection on shuffle and see what comes up.  Change your style of running and your pace based on the song.  You will run completely differently to Thunderstruck than you will to Barney's Christmas.  Just saying....
• Dance. Seriously.  This works especially well when running downhill on a trail.  But even on the flats, don't be afraid to add a little wiggle or a twirl when you're running...even if you have to wait until there is no one watching. I love dancing.
• Wear something crazy to a race or just for a training run: a funny hat, a tutu, a shirt with a funny saying.  Elicit a few laughs and you will feel playful.
• Smile and say hello to EVERYONE you pass.  Even if you pass them 3 times.  Hold out your hand for high fives.  The surprised smiles you get in return will brighten your day.
• Stop to make snow angels, appreciate your neighbourhood Christmas lights, or the roaring waterfalls.  Wherever you happen to run, look around you.

Longevity in running requires recognizing there is a time and a season for everything.  There is a time to be serious and train hard; and there is a time to lighten up and play.  Variety is a key element needed to run healthy, mentally and physically.  I need to remind myself of this regularly, especially now that it seems my whole life revolves around running.

So make this your December Challenge: to bring the play back into your life.  Get outside and let the rain fall off your eyelashes and the snow fall onto your cheeks.  And don't forget to smile :)