Marathon Times – A Perspective – Part II

As I introduced in my previous post, there have been quantum improvements in race management, course accuracy, split timing, registration, place and final time accuracy as well as ability to correct errors quickly. The entertainment value of some races (i.e. Rock’nRoll series) have lead to huge entry lists and reasonably lucrative businesses as well as boons to charity fund raising.

With the bulge in race sizes it has also increased the numbers of slower runners by comparison to 20 or 30 years ago. We have become a victim of our own success. At one time, faster runners could easily find there way to “seed” themselves at the front. This is no longer the case. Without coming off too elitist there is a very real problem with races growing size in respect to fast racing.

What once was “understood” for racing etiquette is no longer the case. Faster runners have always known who they are, second tier knew themselves and so on once upon a time. In recent years, so many runners enter races who have never been – for lack of a better term – indoctrinated into race etiquette. Everyone wants a front row seat – walkers, joggers, run-walkers, race walkers, baby stroller pushers, pets-on-leash-runners, 8 year olds; and the faster racers. Everyone wants to get their picture in the local paper by being in the front in the first 100 meters.

The issue is not one of 15 seconds of fame. The issue is threefold:
* Faster runners are impaired from achieving their goal of running fast times, winning age group categories, or even qualifying for Boston.
* Safety is jeopardized for all runners as a result of race sizes and lack of seeding.
* Race courses are held open – closing roadways and occupying facilities – for many hours beyond reason.

I have heard hundreds of stories and I have experienced it myself. Pushed hundreds or even thousands of runners to the arrears (heaven forbid a walker give up that front row to a five-minute miler) once the gun goes off, faster runners struggle as they dangerously weave their way past strollers, walkers and children to get on pace.

Efforts have been made to ameliorate this. Some races like Boston do better because at least you are seeded by a qualifying time. Your number dictates your corral. Much more difficult to cheat this. In many races there are corrals created by minutes per mile pacing. Other races post huge signs at the sides of the starting area “x” yards apart that state an estimated minutes per mile pace. But, in most races this is an honor-system deal. It fails.

Chip timing helps in some ways. However, remember that only gun timing determines places in the top places (i.e. state, national, and age group USATF championship races for instance). Also, it is possible that someone who finishes behind you actually beats you. Yet, you never knew where they were or who they are because they were always behind you. You find out only when results are posted that you lost to a competitor you never saw and actually physically finished behind you! [Yup, that happened once to me.] You should be able to start with your “peers” and know who you’re racing. You should be allowed to hunt someone down in your race and allow competitive spirit to prevail.

Finally, to close down roadways for 6, 8 , 12 or more hours for a marathon is an imposition on the community. As athletes we share but do not have a right to monopolize a community and disrupt transportation indefinitely. I am glad that people are out getting in shape. But, I would call for separate events… like a volksmarch in Europe. But, let’s keep it on the sidewalks and allow communities to keep moving too.

I do not mean to portray the running and racing explosion in bad light. I absolutely do not infer that any novice runner or charity team runner does not have a place at the starting line. They absolutely do! The good aspects far outweigh the bad. But, the ones who have suffered from the explosion has been the faster runners.

Systems need to be developed to identify and seed faster runners. OK, OK, I know what you’re thinking. No, I don’t think we need a sudden proliferation of qualifying times submitted (though nowadays with every race electronically scored and followed that is not an absurd proposal). And yes, I realize that self-reporting has it’s flaws. But, even a self-reporting with registration would be better than what exists now. My experience is that the group of runners I am talking about tend to be quite accurate in their time reports. I guess my faith in human honesty outweighs my skepticism of a novice runner entering a misleadingly fast time. Putting it in writing (on a registration form) has more power in being honest than a sign on the side of the road saying “eight-minute mile pace starts here”.

So, there is my two cents worth. I welcome your civil replies.

Marathon Times – A Perspective – Part I

Here is information published in recent articles on the state of marathon running. In 1980, the median finishing time for male runners in United States marathons was 3 hours 32 minutes 17 seconds, a pace of about eight minutes per mile. In 2008, the median finishing time was 4:16, a pace of 9:46. For women, that time in 1980 was 4:03:39. Last year, it was 4:43:32.

I’ve had a number of discussions with runners (old and young) as well as coaches (older and younger) on this topic. I want to share my thoughts and welcome everyone else to comment.

I have run and raced since the “running boom” of the seventies; I have been a race director; and I coach all levels of runners and feel that I have a pretty balanced view of this whole phenomenon. I remember the days of walking up to a race paying $2-3; using a sign-in sheet (no waiver or registration forms); having no numbers to pin on; no age groups; knowing the course was an estimated distance that went from point A and returned; the distance was within half a mile of the stated race distance; no water stations; running in cotton shorts and t-shirts; and never knowing who was going to show up (local high school, college or even Boston Marathon winners/Olympians like Bill Rodgers and Frank Shorter amongst others). There was no issue with use of headphones because my 8-track player couldn’t be removed from my car nor did it come with any headphone jack (Younger readers please research this to understand). Other than comparing your time to the previous year on that same course – most comparisons were pretty meaningless. The primary goal was to race others to the finish. Few ran just to finish.

I’ve witnessed the mushrooming growth of running, races, and running as a means of fund raising. As well I have seen from the start what was once the novelty of triathons, duathlons and the myriad of endurance events into something far beyond fads. These are very good things. It is good for our western lifestyles. It is good for charities. It is great for the sporting goods industry.

Expectations of race management nowadays would NEVER have been acceptable even 25 years ago. Results not only have to be accurate but they must be posted within moments of the finish – hard copy as well as online. Every mile marker is under scrutiny as the throngs of runners with GPSs critique their splits. Every water/aid station is expected have everything for everyone regardless of how long it takes for someone to pass. These expectations have lead to far superior race management, result accuracy, problem resolution as well as safer races.

Despite the improvement of these race environment elements all is not well in the racing world. More on that tomorrow.

Electromuscular Stimulation Update

OK, I have to admit, my first posts certainly reflected that there appears to be some efficacy in the use of EMS units in both rehabilitation as well as actual training – improving conditioning.

As I mentioned in the last post, it does require dedication to be consistent and reap benefits from using the EMS device. I have been very diligent in using the EMS and I have logged all my treatments – or should I call them workouts?

I continue to progress with the EMS on my quads. When I started I could barely tolerate the very modest milli-amperage of 16-25. (Jonathan informed me that the usual starting point is 30 or so!)

After 4 weeks I moved to 30 milli-amps. But as of last week I am at 42 milli-amps. It feels good! I feel much stronger and there is no doubt my quads have progressed. I no longer have ANY peri-knee tendonitis issues that I had for months. And those very knee tendon (quad insertion points) were the ones that the physical therapist told me that EMS would NOT help – “so stick with traditional exercises.” In retrospect, I realize in her answer that she was not very familiar with EMS as a treatment and did not want to use it. When I had asked some “whys” the answers were vague and dismissive.

Lesson Learned: Just because you go to a physical therapist it doesn’t mean they are well versed in all modalities and it does not mean they know how to deal with athletes. Choose a PT who has extensive experience with athletes and not just rehabing 85 year olds with hip replacements (like my Dad).

As I related previously, within only a few treatments I noticed a demonstrable difference in decreased discomfort. To my surprise and pleasure that trend has continued.

It is now week seven. I hit a snag a couple weeks ago (just about the time I made the last posts). My Achilles tendonitis acted up in my right leg. So I took time off. I’ll get back at running this week I hope. But I have maintained my EMS treatments throughout.

One thought occurred to me was that perhaps it acted up due to an imbalance of muscles. Though I’ve been doing EMS to my quads there is no such thing as all our muscle groups being completely unconnected. It’s the old, foot-bone connected to the shin-bone; shin-bone connected to the thigh-bone… Imbalances can create a change in running form and yield compensation injuries. My long history of Achilles tendonitis is of course a good predictor of future injuries anyway. Next up, I may also use the EMS on my lower legs. Pretty soon I’ll be hooked up to this thing constantly!

I’ll update everyone on my use of EMS as I continue to rise back through the ranks! I’m coming back… I’m always coming back!

Post Race Depression

How many of you have felt a let-down after a big race? How many of you after months of preparation for a marathon feel in the dumps soon after you’ve completed your race? How many of you had feelings of depression, the blues, or simply been seemingly sapped of all motivation after that big effort?

The good news is that you aren’t alone. The bad news is that this phenomena is very real and it happens at all levels of competition (yup – even Olympic Gold Medalists). Other good news is that you can do something about it.

There could be several underlying causes to the whole post-big event let down. Some of you may be thinking that it occurs more with people who do not reach their goals in that race (i.e. make a Boston Qualifying time). But, I will pose to you that in fact it is more common in those who do in fact reach their goals.

Failing to meet a goal most certainly is disappointing. And it is absolutely normal to have an emotional reaction to that. However, my experience with athletes actually indicates that when an athlete fails at a goal – they tend to pick themselves up and continue the fight after a very short time. Even in the case of epic failures I’ve seen renewed focus and energy to either persist and attack once again that race goal or to fervently pursue OTHER distances and goals.

Contrast that to the successful endeavor. You labor for four or five or six months (or even more) to get that Boston Qualifier or that All-American status in your track event. Suddenly it’s race day. All your preparation pays off. You did it! Now what?

The very thing that gave us purpose day-to-day isn’t there. We ate to succeed. We slept to succeed. We worked out to succeed. We cross-trained to succeed. We told everyone we know what we were working towards. Everyone knew our goal. For many athletes this driving force and all encompassing focus for months is gone.

And truth be told most athletes lived all these months to experience something that actually was accomplished in a split second. [Remember, a goal isn't reached until you cross the finish line. Only when the stop watch stops did you officially reach your goal.] In that split second there is relief, celebration, satisfaction and pride. But the reactions to the accomplishment for many runners ends up anticlimactic; all those months of work and discipline for a split second.

Those positive initial emotional reactions may last for awhile. The story of how you made it may last a lifetime (just ask any runner about the “special” run and most will tell you a story… as if it were yesterday).

For some the fleeting post-race high is replaced with a lingering sense of loss; lack of motivation; and let down. A short break from the disciplined build up to the race is not only normal but healthy to take. Mind and body need some down time. But, if it lingers very long you are actually most likely suffering from a type of post-competition depression.

What should you do if this happens to you?

Get back to basics. Run just to run for awhile. It’ll take pressure off and still get some good chemical action going in your body (which of course helps us think better).

Run with others – especially if you are accustomed to running on your own. This is a sound change as socializing assists us in moving on.

A major reason we experience this loss and lack of motivation is that we forget our purpose in running as well as to set our next goal. Purpose and goals focus our behavior and thoughts.

Re-establish your purpose for running.

Set short-term goals.

Change your goals to new distances, new races, new destinations or race venues. This might add some “umph” to your running.

Variety in trying some unique racing can be stimulating. For instance, enter novel races like Mt. Washington race in Hew Hampshire (only one hill); the Empire State Building Stair run; The Bisbee (AZ) 5K (up hillsides on stairs); the Jerome (AZ) Hill Climb; the Mud Run; and join group ventures like Hood to Coast and RAGNAR Relay teams.

If your symptoms persist you should seek professional help. You could be suffering from something other than merely post-race blues or a “down” period.

So, to break out of those post-race doldrums take action; lighten up; run with others and bring fun back into your running life.

EMS and Performance III

OK, so in the past couple posts I’ve introduced electromuscular stimulation (EMS) as an option for rehab, training as well as recovery for runners. The unit I used was manufactured by Globus Internationalhttp://www.globussht.com/home28
and Giovanni Ciriani. Globus Sport & Health Technologies is the exclusive distributor of Globus Italia and of Domino, its manufacturing affiliate. Globus Sport and Health Technologies offices and warehouse are in Connecticut.

The version I use is the Premium Fitness model. It has 4 leads from the device (therefore 4 muscle groups can be stimulated at a time i.e. two groups on each quadriceps).

There are numerous settings and specific programs by muscle emphasis: warm-up, maximum force, resistance force, reactivity, aerobic resistance (endurance – the one I used), active recovery, jogging and fitness. You can set milliamp settings, time durations and tailor anything you like into this.

Once you have it set up (I had Jonathan to help me on this) you can memorize past workouts. This makes it much easier. When you start up the next time it leads you through choosing memorized programs. Four little clicks and you are up and running.

Applying the reusable 2″X2″ electrical stimulation pads is easy. You put them back on the plastic media after using them and seal them in a ziploc baggy. WARNING: If you are hairy, trim it down or you will regret it when you remove these suckers! Also, I tried to get more electrodes through a medical supplies company and they required a prescription. They said it is a federal law and cannot be dispensed without it. So, stick with ordering them online.

The manual that comes with the unit is typical of manuals that come from technical companies. It does not provide all the answers. The wording appears to have been translated from another language (most likely Italian in this case since that is where the parent company is located). Not well articulated – almost like they wanted it so succinct but in the process it loses meaning.

It does make scary reading! The number of contraindications are long numbering 11 – including that you should not hook this up to your genitals. The warnings and precautions are longer A through Q. This all along with two adverse effects and four risk/benefits. There are obviously too many lawyers who have time on their hands. And if you want to apply this to your genitals you should be locked up… not the maker of the device.

Most obviously missing is a parts replacement order form & price list. The guide tells you what you should have when you receive it. One paragraph in the book states to contact Globus for replacement parts and only gives the website which also has no order form or price list. (Or at least not easily found if it is there.)

I do not believe that most athletes could use this unit without the help of a professionally trained individual on the application and use of it. Even with a medical, coaching and athletic background, I was at a loss. As Giovanni mentioned to me (and I quoted in the first post) that if this is not used properly in a structured program the results will be effected. It is this in fact that most practitioners here in the US don’t quite get (my paraphrasing).

These units do not come cheap. There are different levels of models that Globus manufactures: The Premium Fitness model goes for $599, the Premium Sport is $899 and the Premium Sport+ is $1100. Compex is a competitor and has units for $699-999.

Even with that here is a cost analysis for you. I spent over $360 in co-pays for physical therapy and made no improvement. If you don’t have insurance that will easily be four-fold. After six weeks of PT I was not better and could not run. After 3 treatments with EMS I could run. After a couple weeks I was running 20-25 miles per week virtually pain free. Only you can decide what your running is worth to you.

The Globus support and customer service appears to be extensive and of very good quality. They (by “they” I mean Giovanni) are not only passionate about what they do; they also want you to be successful!

If you are not truly motivated to improve your performance or you are not dedicated and disciplined – pass this gadget up. Everyone else – take note; it might be just the thing to get over recurring injuries; gain strength beyond what you imagined; and maybe… just maybe… breakthrough to new performance highs!

Electromuscular Stimulation and Performance II

For and overview on EMS please refer to my previous post.

To get going I had a phone consultation with Jonathan Siegel,CSCS Jonathan was very knowledgeable and obviously was well versed in the units themselves but more importantly the application of training programs with them.

Here is a sample of how the EMS can be integrated into a comprehensive training program.

Week 1
	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Workout	Power-VO2	Active Recovery	Medium Endurance	Lactate Threshold	Active Recovery	Extensive endurance	Active Recovery
EMS	Globus			Globus
EMS	Active rec.	Active rec.	Active rec.	Active rec.	Active rec.	Active rec.	Active rec.

I’ve now had 6 weeks and a total of 21 treatments. I’ve been good at tracking each treatment and the milliamps per treatment. I did the EMS treatment every 2-3 days. I built up to a setting of 35 milliamps.

Finding #1:
Jonathan stated that the range is up to 130 milliamps though treatments and workouts typically start around 30. I started with the warm-up and massage programs and could only manage 12 milliamps. Yikes! This was an eyeopener. This was going to take some getting used to! The electrodes provide you with a vibrating near burning sensation where they are placed.

Finding #2:
Within only 3 treatments I already felt a reduction in the previous symptoms of peri-knee discomforts due to weak quad muscle group.

I comfortably ran 20-25 miles per week. And contrary to almost all data out there (regarding time off – I should be completely de-trained by now), I am able to run 6 miles @ well sub-7 minute pace on only 3 weeks of training. I do feel stronger by the week. I continue to try to wrap my mind around this of course being the skeptic. I work on tuning in astutely to my body and specifically those muscle groups. I don’t have a definitive answer yet; but there is no doubt a difference. Almost no pain at all around my knees.

Finding #3:
By week 3 I had moved up to 30+ milliamps. This is quite a challenge. Each treatment is 30 minutes. As I mentioned the electrodes give you a funky sensation somewhere between vibrating-numbing-burning. There is no doubt that not everyone will find this pleasurable. It is indeed a workout. The muscle groups tense up quite dramatically. (Think of it like doing a leg extension at the gym and holding your leg out locking your knee. Your quads ripple!) This is NOT like an easy massage. It is NOT anything like a TENS unit.

Finding #4:
I found that on days I ran doing these treatments posed an issue. Doing them before a workout very clearly fatigued my quads to the point that it was very difficult to finish the run. So, I changed to doing the treatments only on an off day or after the workout. If you do the light treatment options (warm-up, massage) it is fine. These levels are designed to get you ready to go workout.

Finding #5:
You need to be motivated to do this. It requires time. Set up is simple (more on that in my next post) but the treatments last about 30 minutes.
So, you really need to schedule this time commitment just like a workout.

I found that the electrodes made it through 21 uses. They state they should last 20-25 uses.

This is an intriguing experiment on returning to high level competition. I am getting stronger by the week. I really look forward to continued progress. Stay tuned, my next post will be a review of the product itself.

Electromuscular Stimulation and Performance Improvement I

Can EMS stimulation devices actually help condition you as well as help you recover from hard workouts or is this just one more expensive fad? This was the question I had after a series of communications on the topic.

Awhile back I posted articles on recovery and conditioning and related the research on several modalities (aqua running, massage, ice baths, etc.). Subsequent to that I was contacted by a gentleman – Giovanni Ciriani – from Globus Corporation. They make an electromuscular stimulation or EMS device. The gist of the contact was that they have conducted studies which show even better recovery from workouts with EMS than all other modalities. Furthermore, their device has been shown as beneficial in playing a role in actual conditioning of the athlete – not just recovery.

EMS Basics Kick Start
I will not go into the detailed science behind how EMS works. Go here for that. EMS is different than a TENS unit. TENS (Transcutaneous Electrical Nerve Stimulator) is primarily used for pain relief or control. EMS units innervate muscles to contract in order to elicit variable strength muscle contractions. The devices are FDA approved. You do not need a doctor’s prescription to obtain or use one. However, I will tell you that training on its use is essential. It is stated that “EMS is used for rehabilitation purposes, for instance in the prevention of disuse muscle atrophy” as well as conditioning, addressing muscle spasms and improve range of motion.

I responded to Giovanni about my skepticism. The main level of skepticism is that of course he represents the company and most of the research is sponsored or conducted by them. Not that it isn’t relevant or valid – but – anyone who has something to sell of course will show you only what promotes their product and can hardly be held up as objective. The studies however are compelling in general. Giovanni says, “The main reason that many (or most) practitioners are skeptical, and a good portion of peer-reviewed studies dispute results, is that EMS is not simple and has to be done correctly. Utilizing the correct stimulation programs is part of the answer (there are half a dozen parameters to be set correctly), and that’s why our machine and other serious competitor like Compex enjoy some success: the programs for different athletic goals are already there, putting results within reach. However, you still need to know what to do, and have enough background in sport science and experience to use those programs in a way consistent with what the body needs.”

I was impressed both by his candor and his offer to let me try out the unit and see for myself if it works. OK, that sounded like a deal. I’m coming back from chronic little injuries (quads, hams, Achilles) over the past year now and have not been able to run consistently. Therefore, muscularly I have lost a lot of tone and strength – most specifically in my quads. This has resulted in very slow progress in my conditioning. This is my Experiment of One I have so often referred to in my articles.

Past injuries are the best predictor of future injuries. Something to keep in mind on the injury front is that most runners get re-injured because they do not completely rehabilitate and strengthen muscle groups after an injury. That is why when they return to running they are more likely to be re-injured (even if it is not the same injury – because of compensation). Rest alone does not correct the underlying problem.

My Case
One of my interests is to see if strengthening my quads can reduce or eliminate this chronic problem for me. Over the past year, my quads have chronic pain- just above the knee cap. It’s a tendonitis and attachment area pain. The initial injury (hill work in the summer of 08) has long been healed but the residual weaknesses are there. Because of this I have compensated and had other niggling injuries.

My next post will detail my 6-week update – what I have done and some results. And I will give a review of the EMS unit itself.

Help! I Can’t Finish Races without Walking

Here’s an intersting inquiry from a runner with 10 years running experience and 4 marathons (improved on each).

I have problems finishing races. I tend to give up and walk a lot in the last few miles, no matter what distance of a race that I am doing?! I am always trained, but I think that my mind won’t allow me to finish well.

Well since it happens in all your races there are several possibilities. Without a complete background it might be hard to pinpoint.

One – your training may not be tailored to the distances you want to race – you cannot train the same for a half marathon and run a 5k fast. So even a marathoner trying to blast a 5k unprepared for that pace – will succumb to great fatigue. It is possible to be completely out of gas and need to slow to a jog or give in and walk. Merely because you are “trained” doesn’t mean you have properly prepared for a given race. Of course, each race can have unique reasons for slowing to a walk – most certainly in the marathons it’s an endurance as well as pacing issue and could be nutrition/hydration.

Two – your pacing is off for all the races because you do not train at the correct paces. The key is to learn goal pacing. When in doubt, simply do time trials to be able to estimate what a goal pace should be for a given distance. Go here to calculate some paces for yourself.

Three – as you eluded to, it could be mental toughness is lacking. This is an entire area to work on. But I can tell you is that if you don’t consistently practice being mentally tough it will not magically show up on race day. You can work on your self-talk. (What do you tell yourself as you have the urge to stop and walk for instance?) You can do practice workouts that are very challenging to put yourself in a position to practice techniques to enhance your mental toughness. (Image certain things, use cue words, use affirmations, dissociate from the discomfort, associate or tune in to your body – are all examples.)

I know this is somewhat general but these are the themes that most likely contribute to your problem. Only by doing things in practice can you really begin to hone in on what is bothering you in races.

“But I can’t Run Fast”

Ah yes, a common refrain often heard along with the corollary – “But I can’t run long distances.”

Let’s be clear from the outset:
1. You are what you train.
2. Everyone can improve on endurance and/or speed.

Though everyone has genetic make-ups that allow us to be better at different aspects of sports – quickness, speed, strength, endurance, hand-eye coordination – all of these aspects of athletics are also trainable. Everyone can improve from where they are and move in the direction they desire to go.

Of course there are genetic limits in play but the wonderful thing about genetic limitations is that we never really know when we’ve reached the end point.

To improve speed one must begin to run faster. It sounds like the chicken or the egg issue. Which comes first? The answer is that you must start to run fast now with what abilities you currently have in order to build on them to run faster in the future.

How do you do that? By running parts of workouts far faster as well as integrating repeats (such as on a track) which are far faster than any current racing pace interspersed with bouts of rest between each rep.

There is plenty of science behind how fast how far and how much rest but let’s not focus on that right now. Let’s focus on the specific question at hand. Take your race pace for a given distance. It doesn’t matter whether you are a marathoner, 10K or 5K runner or 800 meter runner. Figure out how fast your average pace is.

If you run marathons in about 3:29 then your average pace is 8:00/mile or 2:00 per 400 meters.

If you run a 5K in 20:00 you then average 6:27/mile which broken down further is about 1:37/400 meters (one lap of the track).

If you run 800 meters in 3:00 then you average 45 seconds per 200 meters or about 67.5 seconds per 300 meters or 1:30/400 meters.

Notice that we break your current race paces down to much smaller increments.

Now, you want to run this shorter increment faster than race pacing. And as you get accustomed to the workouts – FAR faster than race pacing.

In the above examples that might mean:
Our marathoner runs 400 meter repeats in 1:45.
Our 5K runner runs 400 meter repeats in 1:30.
Our 800 meter runner runs 200 meter repeats in 42 seconds.

Of course your current conditioning will not allow you to continue this pace for long so we now intersperse rests between each repetition.

Start with one to two minute rests between.

Gradually your goal is to do the following:
Increase the number of repetitions.
Increase the distance of the repetitions.
Decrease the rest between the repetitions.

With this strategy anyone can get faster.

There is far more to the science of calculating correct paces and doing repeats and speed work but this general approach will work – immediately.

Addressing the corollary; if you gradually add distance to your training you will be able to run farther. It must be progressive and gradual to minimize chances of injury but it is as simple as just doing it. Body types do not matter – body builders and football players have run marathons. The bigger issue is that people can’t run “longer” because they really don’t want to.

If done correctly (gradually) there is little chance of injury. By the way, distances run (i.e. longer or more miles of training) have a stronger correlation to causing injuries than speed of training. There is no reason even beginners should not do faster running as part of their training.

Knee Pain and Running Marathons

This is an inquiry from one runner about a relative (and runner). She wants to run a marathon but each time, her knee acts up and she says it is so painful that she can’t run. She seems to be able to get to around 8-10 miles and her knees stops her in her tracks. The second attempt ended with the pain moving to the opposite knee and the one previously effected is no longer a problem. Now she can only run about 3-5 miles and it still hurts. She’s been told it is her ITB (from a running store) as well as that she doesn’t have the training background to do marathons (by other runners).

Are some people just not made or able to run marathons?
Is it an issue of mental strength to be able to push through the pain?
What does a person do when your knee or IT band acts up every time you hit the 5 mile mark but you want to run 26?
Could it be the shoes?
She will never ask a doctor or a foot doctor. Is this a good idea?

I’m sure every runner knows someone who has similar patterns. Knee/ITB pain or some other pain – it wouldn’t really matter; all can be dealt with similarly. So let’s look at the basics. Anything that has a pattern has to be analyzed.

Training: The fact that she breaks down once she is up around a 10 mile run may indicate that she is simply training incorrectly: that is too much, too soon; wrong workout combinations; poor rest and recovery integration. So, it could be that she is training wrong.

Injury Recurrence: The reason most runners get re-injured is because they don’t remediate the weakness that led them to the injury in the first place. Therefore, the pattern repeats.

Shoes: yes it could be shoes. Not all running stores do this assessment well. Why? Because of the human element. Not all workers at the shoe store are equally trained, astute or insightful to fit the right shoes.

Genetics: It could be that she is not made for long distances and will break down due to her own unique predisposition to injuries. Will power does not override this… without dire consequences.

Biomechanics: If she won’t go to a doctor this is a moot point however, there is no doubt something going on and it may not be as simple as getting a new or different pair of shoes. Leg length discrepancies and muscle imbalances are a couple examples of things that can cause her problems. She’ll take advice from other runners and a shoe store but not a sport medicine specialist? Not a good omen for turning this around. Just because someone runs or sells shoes does NOT mean they know what they are doing. Always consider the source. It is possible that a simple orthotic will solve the problem.

Pain Tolerance: Without a doubt everyone is different in their ability to handle discomfort. Not everyone is cut out for “enduring” long runs or races just like some do not “endure” the pain of an all out one mile time trial. However, it also is not “no pain no gain” approach in succeeding in a marathon. That is a formula for disaster.

The one thing that is definitive: if she continues to do what she has always done, she will continue to get what she always got. If she doesn’t get help and/or do things differently, she is doomed to repeat her failures (pain/injury). What is difficult for me in dealing with these athletes is the continued complaining about the issues yet the lack of action to change it.

So the action items that I would strongly suggest:
1. Back-off on any training to the point that there is no pain. Allow the body to heal. This may mean a few rest days or weeks or just backing off on mileage.
2. Go to a different store and get a footstrike analysis done to be sure she is in the right shoes.
3. Get a full biomechanical assessment from a trained sports medicine specialist (one who knows runners – not someone who specializes in a baseball pitcher’s rotator cuff repair).
4. Get prescribed (by a sports medicine professional) rehab exercises and orthotics (if necessary).
5. Religiously do the prescribed exercises.
6. Get a coach who knows what they are doing and design a training program specifically for her and who will work with her in support of her goals.

Only after all this can the question be answered whether her mind and body are capable of running a marathon.