NYC Marathon In Review

Thursday 2nd November 2017

Up at 3:30am to get on a 6am Qantas flight from Adelaide to Sydney.  Thank-you Mum for dropping me at the airport!  Flew Adelaide - Sydney - LA - JFK.  Sat next to a guy from Sydney who was also running the NYC marathon.  It seemed like half the plane was traveling over for the marathon (technically there were 1006 Aussies running). 

On the plane, had the chance re-read the George Sheehan classic, 'Running and Being'.  Written by a cardiologist, runner and writer his approach to writing and running always inspires. 

Landed into JFK and collected my bags.  Waiting along side Hawthorn great (now Brisbane Lion) Luke Hodge who was also there to run the marathon.  (He did a very decent time of 3:21 by the way).

Friday 3rd November

Had dinner with friends Luke and Marie last night. It was a nice feeling being back in NYC and seeing some familiar faces.

Headed to the expo at the Javits Centre.  Was super impressed by the organisation and speed of number pick-up considering how many people were going through. 

Adelaide to New York...only a 20 hour plane ride away!

Met a lady who was running the marathon for the fifth time.  Her secret was to consume a beer at the 32km mark.  She thought that was the absolute key to finishing strong - with a good combo of carbohydrates, electrolytes and alcohol to numb the pain.  I will have to try that next time.

After the expo, I headed over to my old gym, the New York Health & Racquet club on 56th street.  Ran three kilometers on the treadmill. Ran a couple of kilometers on the treadmill and then went for a swim, stretch and massage on the foam roller.  Unwinding the residual tightness from the flight. 

A quick lunch at Starbucks and then headed over to Central Park to hear Dean Karinazes speak about his ultra-marathons.  His main advice for the marathon - take it easy in the first half and come home strong.

Saturday 4th November

Went to the NYRR in the morning to hear the world champion runners speak and about their careers and NYC marathon strategy. 

Running Royalty...from left Haile Gebrselassie, Paula Radcliffe, Bill Rodgers, German Silva and Ryan Hall

There were many pearls of wisdom, but Paula Radcliffe's advice particularly stood out:

“Run the first third of the marathon with your head, second third with your legs and the final with your heart”

After listening to the runners, I  dropped my bag off at Orthology, located a stone's throw from the finish line at Columbus Circle.   Had a quick run in Central Park to stretch the legs out one last time. 

Then spent the afternoon with the feet up and watching the running documentary, Breaking 2.

Inspirational watching these guys run and put everything on the line.  I won't wreck the ending if you haven't already seen it, but just to say, if you haven't yet seen it, please do. 

Cooked up some pasta for dinner and tried to have an early night.

Race Day - Sunday 5th November

Didn't sleep too well, as you'd expect.  Woke at 2am and didn't really get back to sleep.  Got up at 4:45am and had a quick breakfast of toast and cereal and then walked over to the 72nd St subway station to get the 1 train down to South Ferry. 

Got on board the 6:30am ferry to Staten Island and then a bus over to the start line. 

Passed the first test - getting over to Staten Island in one piece. Even had time for half a bagel and cup of tea

I was in wave 2 that started at 10:15am, so I had a few minutes to do some final preparation - ensuring my laces were down up properly, taping my knees, doing a few hip openers, applying some sunscreen and preparing my gels and snacks in my flip belt for easy access.

A few deep breaths and then we were called up to the start line.  

This is the moment of truth and before every race I always feel a lot of gratitude, just to make it to the starting line.  It's a nice chance to reflect on your journey, the many small battles won and the abundant learning experiences training for a marathon provides.  And most importantly, very grateful to all of the people that helped me along the way. 

The weather was close to perfect - about 14 degrees with heavy cloud cover and a few light showers in the forecast, although I would have liked it a little colder.

I decided to run with the 3:40 pacer and that allowed me to run on top of the Verrazano-Narrows bridge.  After the gun went off to signal the start, we hear Frank Sinatra's song New York, New York playing out across the bridge. 

My goal during the race was to stick with the 3:40 group as long as possible.  Runners, like cyclists, can benefit from a drafting effect.  The person running in front of you buffers you from the wind and you save precious energy.  There were probably about 20 people in the group.

As I did most of my long training runs on my own, running in a big group is so much easier psychologically.  It is almost like being carried through the streets in a big comfy lounge chair.  You just have to be careful of potholes and obstacles on the course that come up quickly due to your lack of peripheral vision.  

The best thing about running with a pacer is that they know the course inside out and know when to push and when to take it easy. 

Mentally that frees you up big time so you can then pay attention to what's going on in your body.  The main metric that I tracked on my GPS watch was cadence.  I was trying to maintain 175-180 as much as possible. 

When I started feeling a bit tired or sluggish, I noticed my cadence had dropped to 165-170 and by increasing by 5-10% it would immediately ease the pressure on my legs.

It's one of the ironic things about running that I'm still trying to get my head around. 

Intuitively, you'd think to run faster you need to step out with a bigger stride.  But the opposite is true - higher cadence, turning your legs over more quickly with a forwards lean actually makes you go faster, (with better efficiency). 

Running with the pacing group was also beneficial because you didn't have to constantly check times and pace so you could enjoy the spectacle that is the NYC marathon!

For me, the NYC race is all about the people. 

The way New Yorkers get behind the marathon is second to none.  They 100% have your back on race day.  If you are showing even the slightest bit of struggle they will go out of their way to yell your name and put a fire in your belly.  The day after the marathon, again many people go out of their way to congratulate you on finishing.

Anyway, back to the race.  

The first mile is up and down the Verrazano-Narrows bridge and after that, it's a pretty flat run through Brooklyn and up through Queens. 

Things went well early on and I was enjoying the feeling of running and seeing the miles tick by quite quickly and reasonably enjoyably. 

At the first 5km checkpoint, I ate a banana and then from there, every 5km a Winners gel (30g of carbohydrate) along with one Allens lolly snake and either a gulp full of water or Gatorade. 

At around 12km, I felt the early inklings of some leg cramps, so I downed the salty pickle juice that my nutritionist had recommended.  That seemed to help calm the legs over the next 10km. 

By the 25km mark I was holding pretty strong as we ran up the Queensborough bridge - the second steepest part of the race.  There were lots of people slowing down and feeling the burn...and I was one of them.  Managed to lose contact with Paul, the 3:40 pacer. 

At the top of the bridge, I was pushing close to my limit and was around 300m behind the pacer. 

On the downhill I picked up the pace and latched back onto him as we were greeted with a  massively cheering crowd on 1st avenue in Manhattan.  

From there, it was a long, straight stretch up to the Bronx.  This was a hard part of the race where the reality of running a marathon really kicks in.  The race really goes up a notch as the intensity from the crowd ramps up.  Trying to keep up with Paul the pacer was tough as I think he picked up the pace a bit too.  Thankfully he did the difficult job of weaving around people and making a path and I was close on his heels.

Over the Willis Ave bridge (that connects Manhattan to the Bronx), at about 31km, my legs had enough and I could feel a full blown cramp not too far off.  It was mainly in the back of legs in the hamstrings, but the quads weren't too far off either.   My legs were pretty cooked after chasing the pacer down the bridge and the glycogen stores were running low.  I slowed right down to a walk for about a minute and then once over the bridge and started shuffling again.  Thank-fully the walk freshened up the legs and I started feeling better.

In 2015 I also suffered from cramps and so this time, I carried some salt packets, with me.  The sodium helps replace the loss from your sweat.  I went through the packets pretty quickly and thankfully, the first aid stations were also handing them out and I found these really gave me a few more kilometres of cramp-free running. 

Made it through the Bronx and then back over into Harlem and finally made it up 5th Avenue which is long slow uphill.  Getting over that and then a few nice downhills in Central Park, although I was slowing right down by then and doing a walk / run combo. 

Finally, over to Colombus Circle and up to 67th street Central Park, crossing the finish line in a time of 3:46:50. 

Really happy, relieved and actually quite shocked by the time...easily beating my goal of under four hours!

Just after crossing the finish line...

Slow walk up Central Park West

After party at Orthology with Sophia and Jun

Monday 6th November

Walked over to the morning at the Marathon Pavillion, getting my medal engraved and some more foam rolling and stretching out.  Then over back over to the NYRR to watch a replay of the marathon.  Didn't feel too bad, all things considered.  As the day progressed, the delayed onset muscles soreness crept in, in particular the quads...damn subway stairs!

Stretching out in a sea of foam rollers and therabands the day after the marathon. Thanks to the Physios at the Hospital For Special Surgery

My Biggest Struggle

I don't think anyone is every 100% fit before a marathon. 

There are always niggles and you try and manage the best way you can. 

For me, my left knee was the major concern. 

An old football injury nearly 20 years ago resulted in a torn medial meniscus and degeneration.  I had an MRI done a few months before the marathon and it didn't look great. 

I must admit that deflated me a bit. 

Obviously I was wary of any aggravating the pain and potentially causing more damage to the knee.  But I also found that the more running I did, the better the knee felt. 

What really helped was making a list with two categories - modifiable and non-modifiable contributing factors to knee pain:

Non-modifiable Risk Factors

• Structural pathology - damage already down to the mensicus

• Genetics

• Age

Modifiable Risk Factors

• Load management

• Running technique

• Recovery strategies

• Food / diet

• Strength / Flexibility

• Weight

• Movement habits

Accepting that my knee was not 100% and never will be allowed me to focus on ensuring the rest of the foundation was as optimal as possible.

Reflecting back over the past few months, I came up with a few other things that I think helped me achieve my marathon goal:

Philosophy

Capacity vs Demand

Build capacity in a developmental sequence, allowing plenty of time at each stage for adaptation to occur.  Running is a high load activity e.g. running 10km is 10,000 steps at 3 x body weight.  All that force has to go somewhere. 

Recovery

• Nutrition advice from Steph Gaskell at Nutrition Strategies in particular ensuring intake of 20g protein x 3-4 spread throughout the day, rather than all at dinner time.

• Daily foam roller + tennis ball release (great techniques learnt thanks to Yoga with Jem)

• Restorative Yoga with Evelyn at Yogita

• Pilates x 1 week

• Regular ice baths

Got A Running Coach

Thanks to Sam Hicks who really helped me with strength training and building a road map towards my goal.  He had me do some quality runs in the last few weeks before the marathon that really helped prime my body for race day. 

More Running, Less Hills

Previously I did too much Mt Lofty.   Running up there x 2 week was good for the cardio-vascular fitness at the expense of my hip flexors getting really tight.  This time I trained hills x 1 per week but they were short sharp repeats that allowed more time for the longer runs.

Flip belt

This was a life saver - carrying my gels, lollies etc in a comfortable position around my waist.  I would recommend you try this in all of your long runs as it took a little bit of getting used to.

Music During The Marathon

In 2015 I wanted to experience the full vibe of NYC and didn't wear head phones. 

This time I took my phone and at around the half way point (as soon as I was starting to struggle) put on the NYC playlist. 

I found this was a REALLY good way to re-focus. 

Even though the crowd is amazing, it's sometimes nice to get back in your own space for a few minutes. 

You can check and out my cheesy motivational Playlist here

In Summary

NYC marathon was an incredibly fun and inspiring experience - it's definitely a 'bucket list' thing to do.  I can say the process and learning journey building up to the marathon  was just as satisfying as the race itself.  

If you ever get the opportunity to run the NYC marathon, I'd highly recommend you take it!

Tendinopathy Update

The past weekend I attended Peter Malliaras's course, 'Mastering Lower Limb Tendinopathies'.

Peter is an Associate Professor at Monash University and has spent many years researching and working with people with tendon problems. 

In recent years there has been a lot of significant new research in the world of tendon rehab.

If you've ever had an issue with an ongoing tendon problem, you can understand how frustrating the long term pain and dysfunction can be. 

There is much conflicting advice and out dated treatment approaches that can contribute to the poor outcomes many people face with tendon injuries. 

Thankfully, Peter has put all of the latest based evidence into a comprehensible format and in this blog post I'd like to share just a little summary.

This blog would be particularly helpful if you suffer from ongoing pain in the:

• Achilles tendon

• Hamstring

• Patella tendon

• Hip pain/bursitis

• Plantar fascia

What is a tendon?

Tendons connect the muscle to bone.  They are made up primarily of collagen fibres.

In the lower limb, role of tendon is to absorb and release energy

Tendons are like springs that absorb stretching forces and then release energy when we move.

What causes tendon problems?

Tendons are very sensitive to changes in load. 

Essentially, tendons become injured when we over-load them too soon, or when demand exceeds capacity.

This can be from:

• too much volume

• too much intensity

• change in footwear or surface

For example a runner may start to include sprinting or hill work too soon or increase mileage suddenly leading up to a big race.

High training load is not a risk for injuries, it's how you get there that is the important factor (i.e. avoiding acute spikes in training loads).

                   Tendons become damaged when demand exceeds their capacity

What is the difference between Tendinitis and Tendinopathy?

Tendinitis refers to the inflammation in the early stages of an injury. 

This is opposed to tendinopathy that refers to the process of degeneration that tendon goes through in response to chronic overload.

Recent research suggests a lot of what we previously thought of as tendon inflammation was actually related to tendinopathy.

Who is likely to suffer from a tendon problem?

Patella tendon (front of knee)

Usually occurs in younger people involved in jumping sports such as volleyball, basketball and football.  There is some evidence to suggest pathological tendon changes can begin in early adolescence if there excess load on the maturing collagen in the tendon.

Achilles tendon (back of heel)

Affects people across the lifespan, in particular long distance runners, sprinters, football and soccer players.  Often there is pain and stiffness that is worse on waking and when running. 

Gluteal tendon (side of hip)

Common in young females that are doing a lot of running or playing sport.  Also older women, especially around menopause or after post a hip injury / surgery.  Pain is often worse at night time, standing and walking.  There is some research showing a reduction in oestrogen can pre-dispose to tendinopathy. 

Hamstring tendon (back of hip)

Fast walkers, footballers, runners and people who do a lot of yoga are susceptible to hamstring tendinopathy.  They often experience pain on sitting, walking and bending forwards. 

What are the key risk factors for developing tendinopathy?

One of the biggest risk factors for a tendon injury is a past injury (2-19x greater risk of injury).

According to the research, people with tendon problems are not getting the rehabilitation and re-building of capacity they need.

Often patients self-discharge when their pain has gone away. 

It is imperative for the treating clinician to educate the patient that rehabilitation is a two step process:

1.  Reducing pain and then

2.  Re-building capacity in the tissues to match the demands placed on them

Other systemic conditions that can increase the risk of developing tendon pain include:

• Type 2 Diabetes ( 3 x risk)

• High cholesterol

• High blood pressure

• Menopause

• Obesity

• Inflammatory arthropathies

Some other factors that put you at a higher risk of ongoing tendon pain:

• unrealistic beliefs about likely healing time and optimal load management strategies

• inaccurate beliefs pain e.g. avoiding movement due to fear or rupturing a tendon

• too much passive treatment

• reduced variability of movement / exercise

How is a diagnosis made? 

Tendon issues are diagnosed with a combination of history and physical testing. 

If you have a localised pain that gets worse with movement and you can recall a sudden change in loading, there is a good chance you have a tendon problem.

Do I need a scan? 

Ultrasound scans can be useful to confirm the diagnosis and rule out certain other conditions. 

(See below for more info on scans)

Recovery and Management :

1.  Education ... (And Addressing Beliefs About Pain)

The long term goal is to create greater capacity in the tissues and this is your job, under the guidance of the physiotherapist looking after you.  

Manual therapy and dry needling does have a role to play in the short term to decrease pain and normalise muscle tone.

Credit: Jill Cook

Pain and Pathology

You may have a scary sounding ultrasound report, with words such as 'severely degenerative'.

The bad news first.  Your scans will most probably always look terrible. 

Structurally over time, there will be no change, despite what you do in terms of treatment.

The good news:

Many high quality research studies have shown that there is no correlation between pain and structural changes on scans. 

Your tendon will always be degenerated.

However, the thing we do have control over is the mechanical adaptation in the tissues around the tendon, as well as optimising biomechanics and sharing the load around the body.

The goal of treatment is to build the capacity in the tissues surrounding the tendon so that it meets the demand and creates a buffer zone of relaxation.

Some very important things to remember:

"Pathology is common in people without pain, so it cannot be the cause of pain.

Worse pathology does not mean it will be harder for you to get better.

Tendon pathology often does not change, even when the pain resolves" - Peter Malliaras
 

Recovery Time Line

It's important to understand the nature of recovery is often a case of 2 steps forward and 1 step back pattern. 

It's normal for your pain levels to fluctuate.

If you can accept this, while continuing with your rehab, you will have a much greater chance of success.

Credit: Adam Meakins

2.  Reduce the load temporarily while reducing pain and inflammation

Pain can be brought under control by managing load and using ice and NSAID's. 

You may need to take a short break from any aggravating activities.

If you can't take anti-inflammatories you may need to look at your diet for areas to address inflammation.

How can isometrics help decrease pain?

Isometric refers to a static contraction of a muscle without any movement. 

For example the diagram below shows an isometric contraction of the calf/achilles:

Benefits of isometric contractions in tendon healing (Malliaras et al 2013):

• Isometrics can decrease pain without adding excess load to the tendon.  

• time under tension can be maximized to allow greater tendon strain, which is a likely stimulus for tendon adaptation

• there is minimal soreness after doing isometrics, making them an ideal exercise 'during season'

• loading can be performed in a range that is not painful and tendon compression can be minimized

The positive research around isometrics is in it's early stages and mainly focuses around the patella tendon.

3. Assess current load capacity and tolerance then begin re-loading the tendon.

Your Physiotherapist will take you through a comprehensive load capacity assessment and then develop a re-loading strategy.

This most important factor is that we progress the load over time to bring out positive adaptation and improved load tolerance. 

You will most likely meet with your Physio once per week in the short term to closely monitor and progress the load at a suitable rate.

4.  Clean up biomechanical issues and kinetic chain deficits

Biomechanical issues that may need addressing:

• poor running technique

• over-pronation

• landing mechanics

• postural issues

Kinetic chain deficits that may need addressing:

• weak glutes

• weak calves

• weak quads

• weak hamstrings, adductors

• weak core

• excessively tight muscles and joint restrictions

We will address these factors in the clinic.  By optimising your movement efficiency, you will increase the likelihood of successfully returning to doing what you love and staying pain-free.

5.  Progress the load and build capacity to greater than demand and gradually ease back into sport / exercise

This is where you get to really to push the boundaries of building capacity and gradually resume training and getting back to what you love. 

It's important at this stage to think not only about training but also proper recovery to allow the tissues to optimally adapt. 

You will want to optimise things like sleep, food / protein intake and foam rolling to keep your muscles tuned up.

This stage may weeks / months to fine tune and this is where we will monitor you loads to ensure a successful return.

In Summary - 5 Take Home Messages:

1.  There Is Hope

Despite your ugly looking scan and long-term pain, there is good evidence to suggest you can make a good recovery and get back to doing what you enjoy.

2.  It Takes Time

Tendons are resilient and adapt.  But you need to give them time. 

The time-frame on average to achieve this is a minimum of 12 weeks (but continual small improvements can still occur up to 5 years later).

3.  Get Assessed By A Physiotherapist

There is a significant degree of complexity involved in a tendon problem and a Physiotherapist, after a comprehensive assessment will be able to guide you towards a positive outcome. 

4.  Only Exercise Can Increase Load Tolerance

"Your tissue capacity will only be as good as the load you put on it" - Professor Jill Cook

The end game is to build your resilience and capacity to create a 'buffer' zone of relaxation. 

5.  Think Quality Of Movement Before Quantity

Movement capacity develops step by step. 

Small mindful movement of the muscle-tendon complex can improve efficiency and help ensure that your tendon issue becomes a thing of the past.

This is where Pilates can be very useful. 

Pilates provides the perfect environment for sharpening the mind-muscle connection and also introduces elements of movement variability that help improve resilience.

Bonus Tips:

• PRP injections are a waste of time

• Steroid injections can have short term benefit but 12 months later can end up worse due to weakening of the tendon.

• Fast walking can cause hamstring issues

• For a tendon problem, generally it's best to avoid stretching

• Hip bursitis is treated with same strategies as gluteal tendinopathy

• Extracorporal Shockwave therapy is worth trying (more info about this click visit our friends at Adelaide Podiatry)

Thanks for reading this summary and if you have any questions or comments, please feel free to email dan@kinfolkwellness.com.au

If you have a tendon issue you would like to have assessed, I'd be honoured to help guide you.  

You can make a booking using our easy online system here.

Why I Decided To Run The New York Marathon Again

In 2015 I experienced my first marathon in New York City. 

I managed to achieve my goal...that was to survive to the finish line at 42.2km.

It was a surreal experience running through the 5 boroughs of NYC. 

The energy from the crowd, the comradery running along side runners from 90 different countries and the finish line in Central Park was incredible.

But after the race I was really sore. 

Those post-race subways stairs were an absolute killer...for days afterwards.

I vowed that marathons weren't made for me. 

Although I did want to do another one...someday.

If I was to do it again, I wanted to run it properly in a somewhat respectable time.

Getting in

So when an opportunity presented itself to head back to New York to run the marathon in 2017, I wasn't quite sure what to do. 

Running a marathon could be seen as overly taxing on your body. 

That is definitely true if you are under prepared. 

In 2015, I was coming off a really low base and that limited my enjoyment of the marathon, having to walk a lot of the second half due to cramps and muscle/joint overload. 

So this year I've had the chance to build a more substantial base and take the slow and steady route to the the peak.

Getting Mentally Prepared

I was reading an article that listed several psychological strategies to help overcome then mental barriers during the marathon. 

One of the them was 'find your why' and repeat it to yourself when the going gets tough. 

So I sat down and compiled a list of the top 7 reasons why I wanted to run the NYC marathon again.

7 Reasons I'm Running New York Again

1.  For My Daughter

To show her that you can do anything if you put your mind to it and don't let any limitations get in your way. 

2.  For My Patients

To demonstrate that you can do anything, including running a marathon despite being diagnosed with things like torn meniscus, FAI hips, labral tears, lumbar disc bulge/tear, plantar fasciitis e.t.c.

I am the proof that this is true!

With a good physical foundation and plenty of quality recovery, you can do anything you set your mind to. 

Of course, you will get knocked down - spiritually, physically and emotionally at times throughout your life.  Whatever issues you face, there are people out there ready to help guide you towards your goal.

Keep going and most importantly, use the pain as fuel on the fire of self-transformation. 

““Fall down seven times and get up eight”- Japanese saying”

3.  To Learn More About The Human Body

Running helps keep me in touch with what's going on in my body. 

Long runs become a form of mindfulness meditation and a great chance for reflection.

Being aware of what comes up.  Then either accept it or learn to problem solve it. 

Running has a way of placing a spotlight on your weaknesses. 

If you want to test your physical foundation, go for a 20km run and see what sort of pain you feel.  That is a good indication of what might be happening in your body and where you can improve on. 

Using a 'Growth Mindset', you take your weaknesses, failures and frustrations and turn them into strengths.   As long as you're patient and not in a hurry, you can use this to your advantage.

For me personally, running a marathon is a really difficult mountain to climb.  I'm by no means a 'natural' runner.  It is a skill that has taken many years to optimise (with plenty of room for improvement).

I think from an evolutionary perspective, running is the end product of many small movement foundation steps.  It's almost like a computer game, you have to 'complete' each level before moving onto the next. 

Running the marathon successfully provides a positive confirmation that you've achieved an adequate base of function e.g. core stability, leg strength, flexibility, endurance,  breathing and recovery.

Proactively creating a stronger and more resilient body as it adapts to appropriately applied stress is deeply satisfying. 

4.  To Make Me Accountable

I have a form inflammatory arthritis that primarily affects my hips and lower back.  As my body reacts adversely to any non-steroidal anti-inflammatory drugs, the main form of treatment is exercise and movement. 

If I'm not moving at least one hour per day, I tend to get very stiff, sore and fatigued.

Signing up for the marathon has made me really accountable on a daily basis.  Not just for the movement side of things but also what I eat. 

As the training runs got longer, my body seemed to respond better to the long runs. 

Overall, I'd say I'm much healthier now, than before I started the training for the marathon earlier in the year.

5.  To Learn To Become Friends With Pain

Pushing your body to the limit on three hour training runs gets you face to face with pain and it's interesting to know how you react to it. 

Practicing breathing, relaxation and staying calm in times of stress helps build the neural pathways that support your healing and recovery in many other aspects of your life.

6.  NYC Marathon Is Full Of Positive Energy

There is a lot negativity in the world and it's easy to get caught up in it. 

There's a saying, if you ever doubt the goodness of humanity, go and stand at the finish line of a marathon.  There you will see some of the best in human spirit, encouragement and celebration.

The connections you make with people through the marathon are inspiring, to say the least. 

Everyone has a comeback story and it's great to connect with and hear people's journey. 

It really brings people together in such an empowering way.

7.  To Test My Theories On Running

In my work as a Physio I give out a lot of advice to runners and also teach workshops on how to improve and optimise the running experience.

So it's always a good opportunity to put into practice what I teach and make sure it works and in the process, hopefully making me a better Physio and do a better job of helping you with your running.  

It's been fun to use myself as a guinea pig, studying a lot of research and finding out what works and what doesn't at the coal face. 

I have learned lots, in theory and practice, and happy report that everything holds up and I can't wait to pass this knowledge on to you.

If you're interested in running a half-marathon or marathon I'd love to help guide you along the way, just shoot me an email dan@kinfolkwellness.com.au

Over to you...

What is your reasons for running a marathon?  I'd love to hear in the comments below. 

How To Make Friends With Your Hamstrings

The hamstrings have a long history of being the 'enemy' of good movement.

Tight, painful, cramping and all around bad guy, the poor old hammy cops a lot of negative press.

In this blog post, I wanted to share my thoughts with you about how to make friends with the hamstrings so you can all get on well together. 

What are the hamstrings?

The hamstrings are made up of three muscles - the inside two are called the semimembranous and semitendinosus and the large outside hamstring is known as the biceps femoris. 

The back of a right leg from hip to knee

In a bigger contex:

The Superficial Back Line, from Thomas Myers Anatomy Trains

The hamstrings are part of the Superficial Back Line - which is a myofascial line of tissue that incorporates the muscles and fascia from the bottom of the foot up to the back of the head. 

When one area isn't functionally overly well, there will be compensations up or down the chain.  Ever heard of hamstring issues affecting your lower back? 

Tight hamstrings means that the instead of stretch and movement occurring through the back of the leg, the lower back gets compressed, especially when sitting or bending forwards. 

That is one of the reasons we take a holistic view of your body and movement when you come in for an assessment.  We leave no stone unturned in our quest to get to the source of your problem. 

It doesn't matter where you feel your symptoms, we don't chase pain.  We focus on finding the weak link/primary source and then allow your (powerful healing) body to do the rest.

"Where you think it is, it ain't" - Ida Rolf

What is the role of the hamstrings?

The primary role of the hamstrings in walking and running is to eccentrically control the landing of the foot.  The hamstring complex undergoes a substantial eccentric contraction during the late swing phase (Yu et al, 2008) of gait.

Eccentric refers to a type of contraction where a muscle lengthens while contracting vs a concentric contraction where the muscle in contracting and shortening (e.g. doing a bicep curl). 

As you can see, just before your foot lands, your knee is going from a bent position to an extended straight position and the hamstrings job is to allow for a controlled, smooth landing.

Whilst it is important to have adequate flexibility, the actual more important job of the hamstring to have enough strength and capacity to walk and run properly.

If a muscle doesn't have much capacity to contract when needed, it will most likely get overloaded.  When it gets overloaded, it's muscle fibers contract and knot up, limiting flexibility.

For a runner, strength and stability trumps flexibility everyday of the week.

Trigger points in the hamstrings can refer pain to the upper thigh, buttock and around the knee

3 Steps To Making Friends With Your Hamstrings:

1.  Stop stretching them. 

Never again do a standing hamstring stretch.  I don't mean avoid it for a few weeks or months.

I mean NEVER* do this stretch whilst you are alive on this planet! 

Like an addict, you gotta give it up cold turkey. 

Yes, you can still do yoga and downward dog and continue to move through functional range of movements but no mindless, static stretching. 

Stretching in this position, you are actually making the hamstring weaker

Hang on a sec...I thought stretching was a good thing!?

Stretching the hamstring in this position, you are actually making the hamstring weaker and sending confusing mixed messages to the brain about what the function of the muscle is. 

Anytime your brain is confused, it's going straight into fight-flight mode and will want to tighten everything up to protect it.

Intuitively stretching feels good and it often does give some short term relief. 

But in the long run, with continued stretching, the hamstring becomes weaker and more likely to become overloaded and tight.  Then you've got yourself into a real pickle. 

The hamstring, once locked down, becomes an inefficient blob that hampers everything you try and do.

Our first step in making friends with the hamstring is to stop pissing it off, so no more stretching. 

By the way, as an added bonus, your lower back pain and sciatica will thank you as the standing hamstring stretch has a good way of irritating it.

*If you desperately feel the need to stretch, then you can apply heat packs or use the foam roller/spiky ball directly on the muscle. 

2.  Reset.

To reset the hamstrings, I recommend first releasing the muscle with 3-4 sessions of deep tissue dry needling and myo-fascial release massage.  This is like pushing re-set on your muscle tone and creating a fresh slate to work with.  After a few sessions, the muscle will release and then we can move onto the final step.

It's important to get a twitch response that stimulates the blood flow and releases the chemicals in the muscle that have been holding it tight. 

Be prepared for some significant post-treatment soreness for a 1-2 days.  Months/years/decades of tightness ain't going down without a fight!

Check out more about dry needling here and see how it can get your healing on the fast track. 

3.  Build 'Em Back Up.

The biggest issue around the hamstring is it's near universal lack of strength. 

When was the last time you did a specific hamstring strengthening exercise? 

Most of us tend towards an excessive quads/hip flexors vs hamstrings ratio due to excess sitting, walking and running. 

Quads are strong, hammies weak.

This imbalance is perceived by the hamstrings as threatening. 

Powerfully contracting the quads during the running and kicking motion could potentially damage the hamstring. 

How does the brain / muscle respond to threat? 

You guessed - it tightens up.

Graduated Strengthening Program For Hamstrings:

The best long term strategy to make friends with your hamstrings is to build capacity so they can perform their job of eccentrically controlling the foot in landing.

If the hamstrings can happily do their job, they'll most likely start to feel safe, protected and will naturally start to release all on their very own. 

Trust me, I'm a Physiotherapist!

It will take time (3-6 months) to build strength, so listen to your body and take it easy at the start.  If you can only manage 2-3 reps in the beginning, that is fine.  No rushing!

The goal is to push the hamstring to fatigue (feeling some hamstring soreness the following day is a good sign) and then allow it to adapt, recover and get stronger. 

Make sure you create the right environment for healing via eating well (protein + vegies), drink plenty of water and get enough sleep.

Aim to do these strengthening exercises twice per week.

How many reps? 

If you figure every 10k your run is approximately 5,000 steps on each side, then the hamstring needs a fair amount of endurance capacity.  I would keep gradually increasing the reps until you are not feeling any pain on your walks and runs.

Quick note: avoid the hamstring curl machine at the gym.  This exercise strengthens and shortens the hamstring, which is what you don't want.

Step 1: Bridge

Try 3 x 30 sec holds.  Relax your lower back and squeeze your glutes. 

Tuck your pelvis so you feel the opening of the front of the hips. 

Keep the bridge high as you extend one leg in front. 

Hold for one breath and then switch sides.  When you can repeat x 10 each side, move to step 2.

Step 2: Bridge on Foam Roller

Make sure the roller isn't too far away from you, otherwise the hamstrings will cramp.  

The goal is to gradually build up the strength in the hamstrings.  It may take 3-6 months so no rushing. 

If you push too hard, then you most likely will lock the muscle down and you'll have to start over.

When you can complete 3 x 10 reps on each side, move onto step 3.

Step 3: Hamstring Curls on Swiss Ball

The perfect Eccentric Hamstring Exercise: Strengthening AND lengthening.

Quickly pull the ball in towards you and then SLOWLY (slow as you can) lower the ball away from you. 

Count to as least 5 seconds as you do this. 

Repeat until fatigue. and then do another x 2 rounds. 

If you can do x 30 reps pretty easily, try one legged.

Practicing this movement will have a direct improvement on your hamstring problems, especially for runners.

Step Four: Single Leg Deadlift

Hold a dumbbell in each hand and stand on your right leg, lifting your left leg a few inches behind you (a). Keeping your back straight, lean forward from your hips until your body is almost parallel to the floor, the weights in line with your shoulders (b). Return to start.  Do 12, then switch legs.

Bonus Tip:

Don't forget to strengthen the glutes, lower back and calf muscles above and below the hamstring.  Often if these muscles have reduced capacity, the hamstring can become overloaded and then lock down. 

So there you have it.

Have a go and please write in the comments how you get on.

I'd really appreciate your feedback :-)

References:

Hamstring muscle kinematics and activation during overground sprinting.

Yu B, Queen RM, Abbey AN, Liu Y, Moorman CT, Garrett WE. J Biomech. 2008 Nov 14;41(15):3121-6

10 Alternatives to Running When You're Injured

Sometimes injuries are a blessing in disguise.  They force you to re-examine your training style and open you up to other possibilities in the way you go about doing things. 

Unfortunately running injuries are common and being forced into a lay off for a few weeks/months can be quite daunting.  Being told you can't run can be a serious blow to a runner's sense of self.  You suddenly realise how addicted you are to the physical and emotional payoffs that running brings. 

Most runners tell me that there is nothing else quite like the endorphin buzz that running gives you.

Why runners are vulnerable to injury

One of the downfalls of running is that it's very repetitive and demanding on certain parts of the body that are vulnerable to overload.  Common areas include: knees, hips, ITB's, achilles, calf muscles and hamstring issues. 

Most runners generally have very good pain thresholds.  This comes as a blessing AND a curse.  Niggles that are ignored over a long period of time tend do have a tendency to develop into something more serious. 

If you are in pain, there is a good chance your Physio will recommend taking a short break from training to allow your tissues to recover and heal properly.

To help you get through your injury, try the following exercises, which are designed to:

1.  Maintain your cardio-vascular fitness

2.  Encourage blood flow and oxygen to assist the healing process

3.  Re-build your foundation so that you come back better and stronger that before

DISCLAIMER** Of course check with your physio to get the green light before trying any of these exercises**

Nutritious Movement

If you compare exercise to eating, running is like eating dessert and your foundation exercises (below) are like your main course. 

It's not healthy to only be eating dessert - running should be a part of wide base of 'nutritious movement'. 

This approach will sustain you and help you find longevity in your running career. 

1.  Swimming

We all know the benefits of getting in the water: the non-weight bearing movement of your body that helps decompresses the joints and allows you a full body workout without the stress of gravity wearing on your body. 

Try and build up to some intervals, for example 10 x 100m.  This will really help optimise your breathing and cardio-respiratory performance.

Even if you don't like swimming, just being in the water will be beneficial, assisting recovery.  Standing in the cold water at the beach in the middle of winter is refreshing and surprisingly therapeutic. 

2.  Kettlebell Strength Workout

A solid kettlebell workout is the closest thing I've come to experiencing the high that matches up with a good run.  Everyone should own a kettlebell or two.  If you have never tried, find a good personal trainer and get them to show you the basics over a few sessions.  Try swings, squats, lunges and other variations to get your body moving and re-build your capacity. 

3.  Pilates

Research tells us the biggest risk factor for an injury is a previous injury.  Pain and injury leads to compensatory movement patterning that helps us get through the short term but isn't an ideal long term solution.  Pilates help you to learn the principles of dynamic core alignment, so you will create a solid foundation that naturally leads to optimal performance in sport and life. 

Term 3 Pilates kicks of July 26th - Reserve your place here

4.  Stair workout

Stronger glutes = better running and lower risk of re-injury.  Stairs will also send your heart rate sky rocketing, boosting your VO2 max.

5.  Hiking

Hiking some trails in the great outdoors has a few benefits for runners:

• build better balance on uneven terrain

• breathe some fresh air

• learn how to 'slow down' and enjoy the scenery

• get to know your running friends better - talking is easier when you're not struggling to breathe!

6.  Boxing

Stressed?  Angry?  Let your fists do the talking.  Boxing will challenge your cardio-vascular system like nothing else.  Working with a trainer will quickly fine tune your power and precision and bring an intensity to your workout that may rival your running training.

7.  HIIT (High Intensity Interval Training)

Try something like the 7 minute workout or ask your local personal trainer to design you a program.  Add a challenge by using a foam roller or Swiss Ball to your workout.  Try a combination of burpees, squats, step-ups and mountain climbers for starters.

8.  Yoga

Reset your fundamental movement patterning, connect with your breathing and jump start your healing process by activating the para-sympathetic nervous system.  Most runners could benefit from finding a little bit more flexibility.  Restorative / yin yoga is particularly recommended for runners to keep their bodies balanced.

9.  Stand-Up Paddle-boarding

Stand-up paddle boarding is an ideal way to strengthen your core (obliques in particular that are important for runners) and also gives your quads a nice burn.  Also will improve your balance (especially if you find some fun waves to have a go at!).

10.  Elliptical / Cross Trainer

Minimal weight-bearing, using the elliptical machine is an nice way to get your blood and oxygen flowing.  It's also an easy way to keep an eye on your heart rate and push some challenging intervals sessions...crank up the resistance!

11.  Bonus Tip: Avoid Cycling

Despite it's popularity, I DON'T advise cycling as a good alternative to running as cycling strongly activates the hip flexors, and can mess up your muscle balance around your hip, knee and lower back. 

I would advise your to either choose cycling or running as your main form of exercise.  If you are triathlete, there are some specific exercises you can do to help reduce the negative effects of cycling.  You can email directly dan@kinfolkwellness.com.au and I will give you the details.

Over to you...

What form of exercise have you found most beneficial when you can't run? 

I'd love to hear your thoughts below.