Download to - American Running Association

RUNNING & FITNEWS®
April/March 2006 • Volume 24, Number 2
E-Running & FitNews® - April Release (March - April)
The e-Running & FitNews® is accessible by clicking on the link at the bottom of
this letter. It will take you to the ARA website and the latest edition of the “eFitNews”. In addition, there is a WORD version posted to allow any user to print
out the text conversion of the e-newsletter. Follow the links from the Members
Only page. Past issues are also posted in both the web-based HTML version and a
text WORD version. Please pass it along to friends and family.
The lead story in this issue is especially pertinent to any group, community
organization, family or school that is interested in starting a physical activity
program such as a Walk-Run Club. Our editor has researched a story on some of
the true community stars in communities and towns across America.
Our partnership with the YOUTH RUNNER –
www.youthrunner.com is expanding with this
issue. The
publisher of Youth Runner’s website is unveiling a section or community set aside
for ARA’s WALK-RUN efforts. Any teacher, parent, or club can join and create
their own web presence at no charge. “We are excited to build a national
community of parents, youth and educators who are committed to WALK-RUN”,
said Dan Kesterson, publisher of Youth Runner Magazine and website. The
partnership between ARA and Youth Runner will permit a teacher or coach to
share training successes, post photos, tell stories and grow their Walk-Run
programs’ success. Here is what we need ARA members and friends to do:
*Go to Youth Runner’s website at www.youthrunner.com and click on
REGISTER. Once you get to the detailed registration page add WALK-Run
Program or click on “Search for Team Name” and find Walk-Run Program. Once
you are logged in, you can create your own web space and invited other friends to
join. Teachers can invite the parents of kids in their classes. Team names can be
added; logos uploaded and photos posted.
-American Running Association Board of Directors and Staff
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Taking Action, Getting Active in Our Communities
There is little question the American media now has a conceptual hold on the “obesity epidemic”
afflicting the nation’s youth, and politicians and policy makers are bandying about the
watchwords with gravitas. Yet while schools continue to offer physical education classes as
infrequently as one 30-minute period a week—often without actual physical activity—there are
those too often unsung among us who do more than pay lip service to the childhood overweight
and obesity problem.
Ann Arbor YMCA
Enter Diane Carr, senior program director of the newly renovated YMCA in Ann Arbor,
Michigan, whose brand new facilities, improved location, and dedication to reaching the fitness
periphery has earned it a worthy highlight here, as well as role model status. In Michigan, as
elsewhere, kids receive one paltry 30-minute PE class per week, and it simply isn’t enough to
even get them excited about moving their bodies, let alone promote lifestyle change. But as a
member of the Gulick Project (a group of YMCAs committed to fighting obesity in the nation’s
communities), the Ann Arbor YMCA has employed sophisticated data collection techniques to
both recruit new members and to discover and overcome common barriers to exercise.
A major part of the new strategy involves a shift in focus from regular exercisers to those who
would like to start an exercise program, or who have done so in the past with little long-term
adherence to it. Redefining exercise to encompass a broader scope of physical activity is
paramount to this shift. In the past, the 15 or 20% of adults who regularly exercise have
traditionally made up the target membership of the Y, but now cities like Ann Arbor are realizing
these people will exercise regardless of what’s made available to them.
Fifty-five percent of adults are what Carr categorizes as “healthseekers”—people who may have
had some success in the past with an exercise regimen, but have fallen off despite knowing the
benefits. These healthseekers are people who want to get fit but have been frustrated by diets or
fitness programs that do not meet their needs. Carr has stepped up to provide a variety of services
for them. For example, the Ann Arbor YMCA helps build small support communities by creating
“member appreciation” events and informal clubs for groups sharing various activities or classes.
These communities increase member engagement and support long-term, healthy lifestyles. Carr
sees that it’s vital to establish connections between people with similar goals and obstacles to
fitness, rather than connections between them and YMCA employees alone.
“The Gulick Project focuses on making a person feel healthier and successful rather than on
weight loss,” says Larry Thomas, an Ann Arbor YMCA personal coach. “Weight loss is a byproduct of this individualized program that is based on a long-term relationship between the
member and the YMCA community.”
Membership in the Ann Arbor YMCA has increased dramatically since 2005. Carr attributes this
to the new facility, and its highly accessible location. “When people can pass by and see some of
the things going on in the building, that helps a lot,” she says.
And that, in turn, helps attract youth. “We’ve always been family oriented, but now that we’re in
more of a neighborhood area, our family membership has increased. It’s walkable—we were
centered downtown before.”
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The Ann Arbor Y offers a variety of programs that kids can’t readily enjoy at school:
gymnastics, swimming (starting at 6 months), dance, martial ways, and league sports like
basketball and baseball. Most classes are free to members, others involve a nominal fee. Carr
believes in teaching healthy habits at a very young age, but also at any age. Parents receive
nutritional education, and get involved with their children’s fitness by having the opportunity to
volunteer coach. Personalized training is also available at the YMCA.
The new facility celebrated its one-year anniversary in April, and is one of 30 national
YMCAs participating in The Gulick Project, which is named after Luther Gulick, an early
YMCA health and wellness pioneer. By re-engineering the way national YMCAs work with
prospective and current members to promote healthy living, people like Diane Carr hope to one
day reverse trends toward overweight and sedentary life among not only the country’s youth but
anyone with the desire to change. There is little doubt that the fight against obesity starts in the
local community. This takes us to another part of Michigan, for a local success story involving
the American Running Association’s One-on-One Walk & Run program.
Howe Elementary School, Dearborn, MI
ARA youth fitness honoree Rhonda Snyder, BSN, RN, a school nurse in Dearborn, is a perfect
model for how a run/walk program can infect an entire school. Snyder reports, “I had been a
labor and delivery nurse most of my career. Six years ago when I came to [Howe Elementary] I
noticed the students with cognitive impairments didn't move. I knew they were all future cardiac
and diabetic candidates. I wanted to start a program which both moved the students and educated
the staff, students, and community on the personal responsibility we have to live a healthy
lifestyle.” Snyder needed an easy exercise program that would fit into the teachers’ day. She
notes, “Teachers are so busy and once they get their daily regimen in place it's tough to ask for
more of their precious time.”
The program she created, which has teachers and their classes logging miles on the school track,
began with the special education students and has expanded schoolwide. It works because many
students can exercise under the supervision of one faculty member. The program has expanded
dramatically from its first year, in which only one teacher participated. The following year, a
handful of other teachers decided to participate. “I needed them to keep track knowing that their
consistency and length of time walking and running would increase if they wrote it down,”
Snyder says. No stranger to the benefits of giving out prizes for meeting fitness goals, she says,
“I bought some LiveStrong yellow bracelets for incentive. There were only a handful of older
students that could run a mile without stopping. They received yellow bracelets as a
reward.” Since then, ARA executive director Dave Watt has given Howe Elementary t-shirts and
red bracelets as more "carrots." As Rhonda has no budget, she greatly appreciates the freebies.
Snyder says she allows any 10 minutes of exercise to count as a mile—unless the exercise is
walking or running—because she just wants the kids away from the TV, computer, and
telephone as much as possible.
You can quantify the results. This year the 130-odd participating students have logged over
14,000 miles in laps and outside sports. The special ed side logs their miles solely on the track.
There are 49 of these students, and they have logged approximately 3,500 miles this way. “I
think that is a miracle,” Rhonda says. Now the students also regularly write about healthy
lifestyle choices, journal their exercise achievements, and graph their miles.
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Snyder now witnesses staff walking on their lunch hours. Students approach her and tell her of
their newfound exercise experiences at home. They are aware of heart health. She insists this
model can work for any school, anywhere. “I just found the program, adjusted it to fit our school,
and pestered, encouraged, and pleaded with the staff to keep records and get with the program."
They clearly have.
For more information on starting a program in your community, visit
www.americanrunning.org/displaycommon.cfm?an=1&subarticlenbr=63.
New Treatment for Painful Heel Bumps
These days, as ever, the sport of running comes with aches, pains, and conditions for which we
seek immediate and long-term remedy. However, the bright future is always around the bend,
with almost constant advancements in medicine that keep us going longer, stronger, and with less
rehab time than ever before. Witness the new treatment for a common condition in runners
known as Haglund’s syndrome, an enlargement of the outside of the heel bone near the Achilles
tendon. The condition results in a painful bump on the heel, but is frequently misdiagnosed as
tendinitis.
As chief of Ultrasound and Body CT at the Hospital for Special Surgery in Manhattan, professor
of Radiology at Cornell University Ronald Adler, MD, PhD, uses ultrasound guided injections of
medication into the affected area, giving patients immediate and often lasting relief from
Haglund’s syndrome. Adler talks about the treatment in a peer reviewed article published in the
February issue of the HSS Journal, in which he also differentiates among the surgical, blind
injection, and (his preferred) ultrasound guided injection treatments available to Haglund’s
sufferers.
Essentially, surgery is often required but is not a desirable first step, while blind injections can
cause tendon damage. Guided injections have been shown to alleviate the pain within hours of
treatment, stave off pain for several days, and generally postpone and in many cases eliminate
the need for surgery altogether.
The condition is common in runners because it is caused by the back of the shoe constantly
rubbing against the heel. In addition to Achilles tendinitis, the condition is also sometimes
mistaken for superficial irritation or inflammatory arthritis. Haglund’s syndrome must be
properly diagnosed to ensure that patients receive the appropriate treatment.
Once the diagnosis is confirmed, doctors use ultrasound to guide an injection of steroids directly
into the affected area. “An ultrasound guided injection allows us to directly target the painful
area or bursa, thereby avoiding an injection into the tendon,” Adler reports. “This is the real
advantage of ultrasound, since blind injections into the tendon can further weaken it,
predisposing the tendon to rupture.”
A surgical option requires longer rehabilitation, with several months of restricted activity. These
are the words runners least like to hear. By contrast, Adler says, “Ultrasound is a nonsurgical
outpatient procedure that does not require sedation and, when used in conjunction with
modifications in footwear and activity, is an appropriate initial treatment for relief of the pain
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associated with this condition.”
(HSS Journal, 2006, Vol. 2, No. 1, pp. 27-29)
A Disposable Camera That’s Easy to Swallow
Doctors can now examine the human colon and small intestine with a camera that patients
swallow. Called a wireless capsule endoscope, this stunning new pill contains a tiny video
camera, four tiny light sources, a TV transmitter, and an eight-hour battery. It can send images of
the insides of both intestines for several hours. On a recent edition of National Public Radio’s
Day to Day, Sydney Spiesel, MD, spoke in detail about the promising new technology. Spiesel
teaches at Yale Medical School and writes a medical column for the online magazine Slate.
Wireless capsule endoscopes are not only much less invasive, but seem to work better at
detecting certain diseases of the intestines than traditional periscope-like cameras. Roughly the
same shape and size as a large vitamin capsule, the camera is activated as soon as the patient
swallows it. It then transmits images at a rate of about two per second. The patient wears a belt
pack that records everything. As the camera drifts south, it continues to record images until the
battery runs out, which in most people allows it to cover the full length of the small intestine.
Occasionally, patients with strictures in the intestines due to certain illnesses have experienced
the capsule getting stuck; Spiesel says it is easily retrieved or washed out in these instances.
In increasingly common procedures like colonoscopy, doctors look for signs of disease that
affect the inside of the intestine. One such sign is GI bleeding, which could indicate a cancerous
polyp or tumor, or inflammation of the lining of the bowel. Polyps in and of themselves are not
necessarily dangerous, but colon cancer is among the most treatable of cancers if caught early,
hence the popularity of regular colonoscopy for the general population. The procedure is
recommended to people beginning as early as age 30, depending on family history and other
factors.
The ease, comfort, reacquisition of dignity, and improved safety of the new wireless endoscope
aside, “these swallowed capsules are one of the best ways of identifying bleeding sites,” says
Spiesel. He also points out that the pill was superior in detecting Crohn’s disease in patients in a
recent study in Berlin.
Crohn’s disease is a long-term swelling bowel disease of unknown cause that most often affects
the lower part of the small intestine, colon, or both. The disease is marked by many attacks of
diarrhea, sever stomach pain, nausea, fever, chills, and loss of appetite and body weight.
Endoscopy involving a camera on a long tether inserted into the rectum and snaked through the
bowel has for many years been the traditional test, but there is evidence now that the capsule
method is superior to both traditional endoscopy and x-ray for detecting the disease. In the Berlin
study, not only did the pill method of detection spot the disease 35 percent more often than these
other methods, but it detected it higher up in the small intestine than it has ever been seen. This
latter achievement could change medical opinion about how to best treat the disease.
While the last 20 years have seen major advancements in the preparation before, discomfort
during, and recovery after traditional colonoscopy, there is little doubt that patients will delight
in the availability of the new wireless capsule endoscope.
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(Tiny Video Camera Offers Inside View of Human Body, National Public Radio, Day to Day,
May 1, 2006, int. Sydney Spiesel, MD,
www.npr.org/templates/story/story.php?storyId=5373685; Mosby Medical Encyclopedia,
revised ed., 1992, Plume, New York, NY, 926 pp.)
A Look at Patellofemoral Pain Syndrome
The Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT) is the first hospitalbased facility dedicated to the study of sports medicine in the country. It was established by
James Nicholas, MD, at Lenox Hill Hospital in New York City in 1973. The goal of the
NISMAT physical therapy clinic is to return the injured professional and recreational athlete to
his or her chosen sport or exercise. On the excellent NISMAT website, detailed information on
various common sports injuries can be accessed (www.nismat.org). Here we take a close look at
an extremely common condition in runners: patellofemoral pain syndrome.
Common manifestations of this pain include pain while squatting, sitting in a car or movie
theater for long periods, or going up and down stairs. NISMAT reports that some 2.5 million
Americans experience this pain, which refers to the joint between the kneecap (patella) and thigh
bone (femur). Though it can appear due to malalignment of the patella and femur or from tight
structures on the outside of the knee, it often results from weak quadriceps muscles in
combination with the stress running creates on the joint.
When people bemoan the loss of the ability to run as they did in, say, college due to knee pain,
they often simply need to strengthen their quadriceps muscles (see the strengthening exercises
discussed below). The quads are important muscles that support the joint that otherwise takes the
brunt of the impact stress due to running.
Patellofemoral pain may be felt behind or around the kneecap, or the knee may feel like it gives
way at random. Mild swelling can occur around the knee. Sometimes the knee will make
grinding noises upon bending or straightening. The primary goals of rehabilitation from
patellofemoral pain syndrome are to re-establish motion, power, and stability to the joint. Often
stretching and strengthening are sufficient to alleviate this condition. Be careful not to increase
your mileage too quickly, as this is often the cause of and/or reason for exacerbation of the
problem. As is often noted, generally, to run safe and injury free, you should not increase weekly
mileage by more than 10 percent.
Nonsteroidal anti-inflammatory medication, whether over-the-counter or prescribed, can help
decrease the discomfort due to patellofemoral pain syndrome. Consult your doctor before
beginning regular use of these drugs. To decrease pain immediately, ice packs can help; a
heating pad is beneficial when your symptoms are less acute. Do not apply these treatments for
longer than ten-minute sessions.
The following exercises will help you strengthen the muscles in the affected area, taking pressure
off the kneecap:
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Straight leg raises:
Lying on your back, bend the unaffected knee to stabilize the
back. Contract the quadriceps in the affected leg and raise to the
level of the bent knee. Hold for a count of one and bring the leg
back down. Perform 3 sets of 15 repetitions. You can use an
ankle weight to increase your muscle strength as you progress
with this and other exercises in this series. A rule of thumb is to
begin conservatively with weights equivalent to 20 percent of
your body weight.
Hip abduction:
Lay on your side with the affected leg kept straight and facing the
ceiling. The bottom leg is bent. Keeping the top leg straight,
bring your foot toward the ceiling, hold for a count of one, then
return the foot. Do not bend your body at the hip. Do not allow
your body to roll toward the stomach or back. Perform 3 sets of
15 repetitions.
Hip adduction:
Laying on your side, place your affected leg on the bottom. Bend
the top leg and keep it behind or in front of the straight leg. Raise
the bottom leg and hold for a count of one before returning it to
the starting position. Perform 3 sets of 15 repetitions.
Hip flexion:
Sit at the edge of a table or chair, back straight and knees flexed.
Bring the affected knee toward the ceiling. Hold the leg in this
position for a count of one and then return to the starting
position. You can use your hands for support on the surface, but
do not lean forward or backward. Perform 3 sets of 15
repetitions.
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In addition to these strengthening exercises, perform the usual hamstring, quadriceps, iliotibial
band, and calf muscle stretches after warming up, during cooldown, and throughout the day.
Remember to never bounce when you stretch.
(NISMAT Physical Therapy Corner: Patellofemoral Pain Syndrome, 2005, The Nicholas
Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital, www.nismat.org)
Plyometrics for Speed and Power
Plyometrics, though enjoying renewed popularity these days, has been used by track and field
athletes in Europe as far back as 1920. The benefits of this type of training, whether you are a
sprinter or a marathoner, are numerous in part because of the running-specific nature of many of
the exercises. The body is vertical, as in running, and the forces developed are similar. Here is an
overview of plyometric principles, as well as exercises you can incorporate into your weekly
training.
Plyometric exercises consist of hopping, skipping, bounding, and jumping to assist in developing
lower-body strength, speed, and power. These exercises also improve neural response, the
essential component of quickness. Plyometrics helps you maximize force while minimizing the
time it takes to achieve that force, that is, it aids in explosiveness. By contrast, in weight training
the focus is on the magnitude of the force; in plyometrics, the focus is on the speed of muscle
contraction. The better trained you are, the less time it takes for your muscles to contract.
To help clarify the role plyometrics can play in your training, consider the three types of muscle
contractions. Eccentric contraction, in which your muscles lengthen under loading, usually
precedes a maximal effort, as when you cock a baseball bat the second before hitting the ball.
Concentric contraction involves a shortening of the muscles under loading and is used to
accelerate the body or move an object, as when you suddenly move in the opposite direction to
hit the baseball. Isometric contraction occurs when muscles are loaded while stationary (e.g.,
two hands pushing against each other).
In effective plyometric training, an eccentric contraction is followed immediately by a concentric
contraction to produce a powerful force. The rapid stretch during eccentric contraction (cocking
the bat) loads the muscles with energy, and the quick switch to concentric contraction (swinging
at the ball in the opposite direction) results in a powerful reflex reaction force. The two essential
controlling factors for increasing power in plyometrics are: a more rapid initial stretch, which
generates more power in the muscle group moving in the opposite direction in the second phase
of the action; and a shorter time between eccentric and concentric contractions. There should be
no hesitation. In skipping, for example, the rapid prestretch on landing and immediate change of
direction generates a powerful force.
The following beginner exercises, then, will help runners of all distances achieve greater
strength, ankle mobility, running economy, speed, coordination, and stride push-off, as well as
better injury prevention. Sprinters, of course, will improve their explosiveness at the start. It’s a
good idea to have a solid weight training base before beginning a rigorous plyometric training
component. But any runner with a solid mileage base and good lower-body strength can begin
plyometrics. For advanced exercises like jumping from boxes and over hurdles, it’s best to first
be able to squat 1.5 times your body weight. We’ll look at more advanced techniques in a future
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issue. For now, to work up to jumping from a box and springing up, you can try a stretch-andhold routine: drop from a box and freeze, rather than continuing immediately into a jump up.
Beginning plyometrics, attempt 40 to 60 foot contacts per session (a two-legged landing counts
as two contacts), with one to two minutes between sets.
Two-legged ankle hops. Standing with your feet shoulder-width apart and using only your
ankles, hop up and down in one spot rapidly, trying for minimal foot contact time with the
ground.
Two-legged small hops. Stand tall and move forward with small, quick hops. Move your
arms together and as they move forward, hop forward. As your arms move backward, move
forward again. Repeat for about 10 meters.
Two-legged big hops. With knees slightly flexed, jump forward as far as possible with a
strong arm swing from behind.
Fast feet. Run in one spot on your toes with your feet barely leaving the ground. For a
variation, try moving over a distance of 20 to 30 meters with very short steps and then suddenly
accelerate into a fast running stride.
Sprinting itself is plyometric, which helps explain why the exercises are perfect for
runners—there is a built-in sport specificity to this type of training.
Trampoline. This is a great plyometric activity that achieves high-impact benefits with
low-impact forces. It is also an excellent aerobic workout, and very good for balance. Just
remember to warm up and start gradually.
Rope skipping. As you become used to the feel of hopping and bounding, introduce a
jump rope into your beginner plyometric regimen. This is another great aerobic workout that
improves coordination and tones the upper body a bit as well.
(The Complete Guide to Running: How to be a Champion from 9 to 90 by Earl Fee, 2005,
Oxford: Meyer & Meyer Sport, UK, pp. 353-359)
What’s in a Warm-Up?
Racing is part of what we love as runners. It is an opportunity to test our mettle against others, or
to set goals and meet them in an internal test of will. Races motivate and shape our training. We
use them to stay on target, and to see if we are hitting the bull’s eye in our day-to-day running.
Of course, racing differs from training, usually requiring more intensity, focus, and mental
psyching. Yet much of the preparation on race day is not so different from our daily training;
indeed, it’s important to find common ground between the two. So what are the essential
components of effective race-day preparation? The following are some general characteristics of
a good race warm-up.
Muscular activity. It may seem obvious, but you should concentrate on the muscles that are
going to be doing the running. You will enhance your performance with a slight elevation in
muscle temperature. Keep in mind, though, that more than a degree or two of increased muscle
temperature can lead to a worse performance. If the race is longer than one mile, and the weather
is very humid, be careful not to overdo it on the warm-up; if, for example, the weather is warm
enough to sit around without a warm-up suit on, it is too warm to wear one during your warm-up.
One known enemy of all distance runners is heat. Far better to put on your warm-up suit between
the warm-up and the race if you feel you will cool down.
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Stretching. Following the bulk of warm-up activity, stretching prepares your body for efficient
movement and allows time for a bit of mental prep. Avoid stretching more than is usual for your
regular training, otherwise you might find yourself with increased muscle soreness on
subsequent days.
Quality running. For shorter distances, quick strides or even more prolonged threshold-intensity
running prepares the body for the task ahead. The idea here is to make fuel sources readily
available while obtaining a feel for race pace. High-intensity running stimulates carbohydrate
metabolism, which is useful for most distances, rather than fat oxidation. The exception is a
marathon warm-up since this distance uses a combination of fat and carbohydrate fuel sources,
the latter being a precious commodity to be used sparingly ahead of time. Stick to easy running
and stretching for full and even half-marathon distances.
Mental prep. Vast individual differences can occur in this area of pre-race routine. Some athletes
want quiet time, others talk incessantly with their coaches, friends, or other supporters right up
until the gun. Some runners need to avoid thinking about their race, others seem to thrive on
constant visualization of how things will proceed from start to finish. Do make a point of
thinking only positive thoughts. Visualize yourself adjusting to mid-race surprises, your legs
effortlessly carrying you as you float over the ground, and then your mind and body achieving a
strong finish. Have a plan for the race but stay flexible.
Finally, remember that each race is a chance to learn, no matter the outcome. The best that can
happen is your pre-race expectations are exceeded, the worst is that they are not met. Look for a
lesson and log the experience in a positive way. If you felt great and performed well, remember
as many specifics about how you ran the race and how you felt along the way. If you fell short of
your goals, think about how the race could have been run differently. Remember to relax before,
during, and after every race.
(Daniels’ Running Formula by Jack Daniels, PhD, 1998, Human Kinetics, Champaign, IL, pp.
221-227)
THE CLINIC
Hypertension Concerns
I am a 53-year-old female with 25 years of running under my belt. I currently run about 35 miles
a week, as I’m training for a marathon. I am 5’ 5” and 120 lbs. I run a 5K in 24:30 and a
marathon in about 4:15. I do tempo runs, long runs, and speedwork.
I consume an enormous amount of salt, and it concerns me. I do not particularly like salt, but
find, most often in the summer, that I crave it. I do sweat profusely. I have a history of
hypertension in the family. At 120 over 75, my blood pressure is still good, if slightly higher than
the 110 over 60 from 10 years ago. Recently two of my running buddies, who happen to be very
strong athletes, have developed hypertension; this surprises and worries me. Without a lot of salt,
my training schedule makes me very lethargic. Can my sodium intake be harmful? How often
should I check my blood pressure? I am a bit of a type-A personality and have had trouble
sleeping, plus hot flashes associated with menopause. I really wish to avoid developing
hypertension.
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Sue Fenimore
Baltimore, MD
With a blood pressure of 120 over 75 and clearly a salty sweater, you are doing the right thing
and should not worry unless you actually develop hypertension.
Athletes sweating in the summer sun should not abide by the dietary guidelines established for
sedentary adults: 2,300 milligrams of sodium daily. This equates to a teaspoon of table salt a day.
As internist for the Oklahoma Sooners, I have found some OU football players, during two-a-day
workouts, to lose five teaspoons of salt a day. Heat cramping and exhaustion result from lack of
sodium. Never drink more than you sweat. Overdrinking, even fluids with sodium, can dilute
blood sodium. If you gain weight during a long run, drink less next time.
If you see salt on your skin or clothing or sweat burns your eyes, you may need more salt than
most people during a workout in the sun. Foods with lots of sodium include tomato juice, canned
soup, pickles, pretzels, and pizza.
Randy Eichner, MD
[CITY, STATE]
As noted above, your desire for salt seems like your body’s appropriate response to your exercise
regimen. You might obtain a home blood pressure monitor at your local pharmacy and monitor it
twice a week. Keep a diary of these readings to be sure you’re on the right dietary track. While
excess sodium does carry the risk of hypertension, the dangers of hyponatremia—dangerously
low blood sodium—are worth reading up on as well.
Lloyd Lense, MD [check]
Old Field, NY
ACL Repair and Return to Running
I am a 120-lb female in my 50s and I have been running for 13 years. I average three to five
miles once or twice during the week, then a longer run on the weekend, totaling about 15 or 20
miles. I have run 15 marathons in the last 5 years, using the run/walk method, with finishing
times of 5:00 to 6:00. A month ago on a ski vacation, I fell and tore my right ACL. My
orthopedic surgeon recommended physical therapy three times a week instead of surgery; he
stressed that if I participated in sports such as basketball or tennis, surgery on my knee would be
necessary, but that running would be possible without an intact ACL. At times my knee feels
unstable and as though it will never heal. Is it simply too soon to know? Should I give up
marathoning and stick to shorter distances? Is it even possible to run without an intact ACL? At
my age, how dangerous is ACL surgery versus the more conservative physical therapy approach?
Josephine Moore
Palmdale, CA
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I feel your orthopedic surgeon is correct, since you must rehab your knee prior to any surgery.
This takes at least 90 days, so you are worrying a bit ahead of schedule. An ACL repair can be
performed successfully at any time up to one year, so there is no rush.
Robert Erickson, MD
[CITY, STATE]
If after a year you have instability in the knee you should have reconstruction of your ACL. I
believe that while recovery from ACL reconstruction is a challenge, you should be able to
recover and run without difficulty. If you tear your meniscus, you won’t be able to run;
instability in the knee will likely lead to a torn meniscus. An allograft reconstruction can be done
arthroscopically in about 20 to 30 minutes. It’s possible to be off crutches in three to five days
and out of all braces within a week.
Warren King, MD
[CITY, STATE]
You can run without an ACL; tennis, racquetball, and activities that require a start/stop or
cut/turn will give you problems. Your orthopedist is right—give yourself at least three to six
months of evaluating your limitations, then go back to your doctor and review the options. An
arthroscopic allograft reconstruction works for a lot of people in your situation. While your knee
recovers, time on the bike, stair stepper, rowing machine, and the like can keep you in great
shape and extend your patience.
Larry Hull, MD
Centralia, WA
Diagnosing a Hamstring Problem
Every time I run a long distance I feel discomfort in my right hamstring. I want to increase my
speed after six miles but cannot due to the pain. After a recent half-marathon during which I had
hamstring pain from the midpoint of the race to the finish, I experienced pain in the gluteus
maximus and right knee. What’s wrong? This has happened to me in the last five half-marathons
I’ve run.
Sue Caldwell
Pipe Creek, TX
This is a very common problem with several possible causes. It is an overuse problem with its
root in a mechanical error. Are you a veteran runner or is this a relatively new sport for you?
Training can be a factor. What is the time frame in which you’ve run all these half-marathons?
Make sure you are allowing enough recovery time between races and hard workouts.
There is likely a weakness in the stabilizing muscles of your pelvis. This can lead to overuse of
the hamstrings and adductors and cause strain or tendinitis in these groups. Another cause may
be a dysfunctional sacroiliac joint (between your tailbone and hip). You will likely need to see a
physical therapist to overcome the problem, whatever its cause. In the meantime, take time off
from running, and crosstrain as long as it doesn’t hurt.
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John Cianca, MD
Houston, TX
Track-Induced Nausea
My son is a 16-year-old track runner. He has a lot of speed and promise, with one nagging
problem. Upon completion of the 400 meters and relays, he vomits. It does not occur when he
plays varsity soccer. He has competed at various sports since age six, many of which require
extensive running, and we have never before seen this problem. His recent UGI indicated severe
gastric reflux, and his GI specialist advised that he begin taking Prilosec and stop running. Are
there other possible causes of this problem, and/or solutions?
Jean Harkens
Tucson, AZ
Upper GI symptoms like belching, nausea, and vomiting are not uncommon in athletes. Maximal
exertion, which occurs during sprinting, is often implicated. One reason gastric reflux occurs in
runners is the transient relaxation of the lower esophageal sphincter secondary to the swallowing
of air. This is not due to an increase in acid production, but a decrease in gastric mucosal
secretions as blood is shunted away from the stomach and intestines to power the leg muscles.
Delayed gastric emptying with strenuous exercise can contribute to the problem. Use of NSAIDs
such as ibuprofen can make things worse.
It does sound like your son has gastric reflux but has not found the right treatment regimen. I
have treated many runners with this problem and would not recommend that your son give up
running. Try the following in this order:
1. rule out any other potential cause, such as a cardiac problem
2. avoid large meals two to three hours prior to a race
3. try low-fat, low-protein liquid calorie/electrolyte solutions pre-race
4. avoid high concentration (hyperosmolar) feeds during training
5. use isotonic replacement fluids during training
6. reduce training and crosstrain with lower-impact activities like swimming and cycling
7. avoid lying down within three hours of a meal
8. avoid restrictive clothes
9. avoid citric and tomato juices, caffeine, chocolate, anti-inflammatory medications, fatty foods,
and alcohol
10. Try antacids like TUMS or Rolaids
11. Try nonprescription strength H2 receptor blockers (Zantac or Pepcid) taken before running
and up to twice a day
12. Try prescription strength H2 receptor blockers taken before running and up to twice a day
13. Try proton pump inhibitors (such as Prilosec) taken once or twice daily
14. Try a combination of an H2 receptor blocker and a proton pump inhibitor
It bears repeating that I do not think your son needs to stop running.
Troy Smurawa, MD
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Akron, OH
The Back Page
ARA is combining the One-On-One, Walk & Run program with the campaign to get more
families moving each day through walking and running, or WALK-RUN. WALK-RUN is our
simple message to kids, teachers, parents and community and corporate leaders. We are taking a
cue from Governor Huckabee (R-Arkansas) with our new tag line that ties into his push for a
ìHealthy Americaî. WALK-RUN includes the Walk-Run across America program.††
How are we getting this campaign started? Our new partner Youth Runner
www.youthrunner.com is completing a section on their website where individuals, parents,
school groups and running clubs can sign up for their own ìMy Youth Runnerî, all within the
framework of WALK-RUN. There is no charge for this online service.†The 12 week training
program is available to incorporate into youíre My YR page. Daily or weekly training calendars
can be implemented. Groups or classes can track their progress against other groups in other
parts of the country. Fairly soon we will have a network and community of WALK-RUN groups.
Many ask us how this can be sustained. It starts with each parent or child. If you walk and run,
the program will grow. Sponsors and advertisers will fund the websites and lead to WALK-RUN
events in your communities. ARAís long term plans include WALK-RUN events that bring
parents and kids together in towns and communities.
Check out the new YR programs for WALK-RUN at the YR website (hyperlink again:
www.youthrunner.com ). It all starts with a simple walk or run. It can lead to better fitness and
lower weight.† Who knows, one or more children could become the next national cross country
or track star. Letís keep it simpleñ grab your child and start a WALK-RUN program. Keep it
going during the summer break.†One day the WALK-RUN effort will lead to a healthier
America.
~Dave Watt
Executive Director, ARA
EDITORIAL BOARD
BOARD OF DIRECTORS
Kenneth Cooper, MD
Jack Daniels, PhD
Randy Eichner, MD
Mary Jo Feeney, MS, RD
Mitchell Goldflies, MD
Paul Kiell, MD
Sarah Harding Laidlaw, MS, RD
Paul Langer, DPM
Douglas Lentz, CSCS
Todd Miller, MD
Gabe Mirkin, MD
Bill Young, President
Sam Pettway,
Immediate Past-President
Geoff Hollister, Vice President
Robert Corliss, Secretary-Treasurer
Charles L. Schulman, MD,
AMAA President
Terry Adirim, MD, MPH
Gayle Barron
Senator Bill Frist, MD
Jeff Galloway
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Col Francis O’Connor, MD
Stephen Perle, DC, CCSP
Pete Pfitzinger, MS
Charles L. Schulman, MD
Bruce Wilk, PT, OCS
Mel Williams, PhD
Michael Yessis, PhD
Jeff Venables, Editor
Jeff Harbison
Ronald M. Lawrence, MD, PhD
Jeff Moore
Noel D. Nequin, MD
David Pattillo
A SSOCIATION S TAFF
Executive Director: Dave Watt
Programs/Membership Director: Barbara Baldwin,
MPH
Logistics Manager: Ed Farris
Running & FitNews is published by the American Running Association. Address inquiries to ARA, Attention: FitNews Editor, 4405 East-West
Highway., Suite 405, Bethesda, MD 20814 or send e-mail to [email protected] The American Running Association is a nonprofit
educational organization, designated 501(c)3 by the IRS. Running & FitNews provides sports medicine and nutrition information. For personal
medical advice, consult your physician.©
2006 The American Running Association.
All rights reserved.
SSN 0898-5162.
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