Friday, September 25, 2015

Developing a good stride and Managing Failure... whatever the distance

This season has been a running year, or well kind of a running year.  With a new born, lots of work, a major live in remodel (done mostly by myself), the training isn't great.  Thanks to a good friend with a goal to do a 50 miler however, he was able to break me free from the chain and crank.

For a mountain person such as myself the midwest is a bit mysterious in its trees, lakes, swaps, dragon bugs, humidity, and general flatness.  Uncognitively (I"m not sure thats a real word) I've been traveling back to the Midwest ever couple of years and doing some type of run.  50k on the North Shore of Lake Superior, A run in the poison Ivy infested Red River Gorge, and finally the pictured rocks 50 miler in the UP (upper peninsula for those of us from the mountains).

 I often go into these runs with attitude of "I'm from the mountains, this will be super easy."  I mean, I've ran things like the little big horn 50 and the Speed Goat 50k, how hard could a flat, low altitude run be?  Like with every run, the experience is never what you expect.

In the world of mountain running we tend to have two speed groups, the up and the down.

Up in my case has two basic strides, the run and the walk.  The run is a small, quick stride that helps maintain a good cadence, yet manages the heart rate on most moderate climbs.  I often hear people use tips like: 'swing those arms a lot', 'run on your toes', 'keep your feet under you.'  My personal balanced cadence is somewhere around the 70 spm.  As the grade increases the stride length decreases.  Imagine your wearing a backpack with a rope connected to a tractor tire your dragging along behind you.

When things get really steep I transition to a sort of power walk.  Often times this can be faster than the above short fast running side, and possibly more important it uses a different muscle group.  The gluts, ham sting and the top of the quad (think groin to femoral apex) tend to take the brunt of this stride and the core relaxes a bit.  In this stride you step forward with a big step forward.  Often times you will see people with a hand on each leg pushing down to assist in the stepping.

If your a cyclist, think climbing in a small gear with a high cadence is the same as the former method and the ladder is like standing up in the big ring and powering though a climb.

On the down, the Ultra runner often uses gravity vs. using work.  So think big slow, strides.  Almost like falling down hill.  Your probably thinking that doesn't sound good for the knees, ankles, and hips.  Well your right, its not.  Some thing that helps reduce the suffering is by having a good forward stride.  This means intentionally leaning forward where the ball of the foot strikes first, and the foot plants below the knee, not in front of the knee.  This lets you use the calf muscle properly as the initial shock  as apposed to a heal strike which directly transmits everything to the knee and the hip.

The final zone is the flats.  For the record, I'm spend little to no time developing this one.  But basically its a combination of the up and the down.  A longer stride, with a quick cadence (again about 70 spm for me) where you are running forward on the toes, planting the foot under the knee and the torso, not in front.  Most people have a well developed stride in this zone regardless of if its correct or not.

This season I attempted to develop my flat stride with a number of fun runs, but I have an inherent problem of always looking up towards the mountains.  I think this was a problem for me not in the lack of stride, but more importantly in the little muscles in the core that come along with it.

At about mile 33 of 50 on my flat run I started to have the desire to Urinate every time I took a shot of water.  The kind where you start looking for a gas station or abandon lot if your driving.  For more on what really was happening, see my previous post .  After a good long slow pace zone while downing 140 oz of water, I started to feel a bit better.  With  7 miles to the finish I figured I was good to go and my partner put down a semi-aerobic pace for a quick finish.  I was a bit nervous about hitting it so hard, but went ahead and tried for it.  about 4 miles in however, the problem returned, and now with pain.  Disheartened I slowed to a walk again and returned to the water.  This time it did not go away.

How should we respond to this type of failure?  I think its important to remember a couple of things:

1.) Ultra running always has unexpected problems and highs and lows.  The theme of the Wasatch 100 is '100 miles of heaven and hell.'  There are lots of ups and downs and you don't know when they are coming, just know they aren't staying!

2.)  Even with the best preparation, sometimes things do go wrong.

3.)  Listen to your body... sometimes.  If your body is telling you that it wants to stop, you need to think hard WHY its telling you that.  If its because you've been running for 8 hours and your tired, thats not a good excuse, if its because your feet are sore, not a good excuse.  But if your can see the blood coming through your shoe because a blister has formed, broke, and is now bleeding, the answer is stop.  To the best of your ability in your exhausted state you need to ask yourself the following questions:

1.)  What are the likely consequences of continuing?  If the answer is an extra day of soreness, you know the answer.  But if the answer is a trip to the ER, you know the answer too.  The trick is deciding where your problem fits.  Ibuprofen is a common tool for helping us run faster and farther, but be careful with it as it can also mask serious problems for a long time or even cause them.    Blood is mostly a bad sign.  blood on your feet, in your urine or excriment.  On your nurps well, that's a bummer but get a band-aid.  Pain in your legs, feet, and joints can be normal, but again be careful.  Any sharp pain should be taken seriously.  Is it sharp pain in your lower leg on every stride?  This could be serious.

2.)  Ask your partner!  Chances are your partner has a bit more objective view of what your experiencing.  The more experience they have the more effective their advice.

3.)  If in doubt, drop out.  Whatever it is, even if its the Hardrock at mile 90, you can always come back another year.  That being said, this is not an excuse to DNF on every race.  You put a lot of time in, don't waste it.

Sunday, July 26, 2015

Rhabdomyolosis, renal failure, and bladder flap.... blood in the urine of the ultra runner.

It was my second time running the SpeedGoat 50k and shortly after starting the last and final decent from the tram at Snowbird, it happened again -- a repeated and almost painful desire to urinate with little more than a few drops of success.  I could barely run, if not barely walk fast.  Every time I would jostle the bladder, the urge would return.  Not just return as in I need to find a bathroom, but return as in the kidney stone pushing its razor edges into the lining of the Urethra.  I was less than ten miles from the finish, and my pace slowed almost to a crawl...  I guess it was better than the guy who ran past me the wrong direction from confusion and dilution thinking the course went the other direction.

The Speed Goat 50k is touted by many to be the hardest 50k in the US if not the world.  30.8 miles and 12000ft of vertical with painfully difficult climb after climb, after climb, followed by equally painful decent after decent.  A race that I am always determined to DNF, yet have somehow finished every time.  Even Killian Jornet have shown up for this sufferfest before.  Based on my observation, as many people DNF in this race as in the Wasatch 100.  For me, it wasn't new, and it wasn't going any better.  The previous year the exact same thing happened, and I had no idea the cause.  This year I was sure it was dehydration, but I just couldn't bring myself to down that last 10 oz of water.  By the time I reached the finish line I was not just going crazy from the bladder pain, but also borderline suffering from heat exhaustion.  After dousing myself with water, downing a coke or two, and a lot of water things started to come back to normal.  I figured it was the crazyness of the race and lack of training for ridiculous downhill sections that jostle the insides.  That was back in 2009.

Fast forward to 2015 and a friend and I are running just under 50 miles of the North Country Trail in flat Michigan.  34 miles in I got the same problem.  Unfortunately the trail was totally flat, the temperature was moderate, and the running was easy.  At least I knew what was coming and I quickly degenerated to walking and pounding water.

SO this time I had to ask myself what causes this problem since I can't seem to fix it on my own?  Is it dehydration, over hydration, electrolyte deficiency, or excessive electrolytes.  I figured it MUST be one of these things.  As always, the internet has lots to say, and so do runners... most of which had no real medical advice on dealing with the issue.  Here are the facts, as much as I can tell as a NOT doctor.

Symptoms:  Desire to Urinate often with little to no success, discoloration in the Urine caused by either blood or  myoglobin often describes as 'coca-cola' urine, possible pain in the lower back.

Diagnosis:  From best to worst, 1.) empty bladder (bladder flap) 2.) Rhabdomyolysis 3.)Renal Failure.

1.) Trauma to the bladder (I like bladder flap) caused by not having enough liquid in the bladder is one possible cause.  It appears to be mostly harmless, with some corrective action and verification from a physician it is actually the cause.  Dr. Bill Roberts recommendations are as follows: to relieve this form of hematuria is to void [the bladder] 20-30 minutes before your run so there is some urine in the bladder to soften the slap."  Unfortunately, when my run is longer than an hour or so, I'll be voiding a lot more times during a run.2

2.) Rhabdomyolysis is the rapid destruction of skeletal muscle resulting in leakage into the urine of the muscle protein myoglobin. 1 Myoglobin is a protein that is contained in muscle cells, and if enough is spilled into the blood stream, it can clog the kidney's filtering system and lead to kidney failure and a variety of other serious medical consequences and complications. While muscles routinely get sore after physical activity, rhabdomyolysis takes that muscle injury to a higher level.

3.) Renal failure in our case is cased by Rhabdomyolysis progressing to the point of completely blocking the kidney.3  This is a life threatening.  Some sources show as high as 33-50 percent of cases of Rhabdomyolysis lead to renal failure.  Unlike non-exercise-induced rhabdomyolysis (crush injuries, infections, drugs and toxins, for example) where the progression from rhabdomyolysis to acute renal failure is between 17 – 40 percent of cases, exercise-induced rhabdomyolysis only very rarely progresses to acute renal failure.4

So if your like me, it can be pretty upsetting when I get into the 'coca cola' Urine state.  Remember the color of the Urine in actually caused by Myoglobin, not blood in the Urine, so if you can clearly identify blood, you are not suffering from Rhabdomyolysis.

A recent article in Ultrarunning magazine has this recommendation from Tamara Hew-Butler DPM, PhD and Marty Hoffman MD:4

Because the incidence of rhabdomyolysis and renal failure seems to be increasing disproportionately in ultramarathon circles, the four basic questions and answers below are ones you should understand and share with your crew:

1) How dangerous is rhabdomyolysis? Exercise-associated rhabdomyolysis in and of itself is not dangerous nor is it an uncommon biochemical finding in runners competing in an ultramarathon race. In fact, it’s more normal than abnormal! In the rare instances where rhabdomyolysis progresses to renal failure in athletes, the “perfect storm” of additional factors must be present.

2) What are the warning signs that rhabdomyolysis is harming my kidneys? When urine output becomes sparse and very dark, it is a good idea to start monitoring fluid intake and output carefully. In many cases, runners will urinate a reddish brown urine which resolves itself over the course of a race. However, if “coca cola” urine continues or gets worse, urinating becomes more difficult, you begin to feel “bloated”, or you develop lower back pain in addition to severe muscular pain, then you need to seek the advice of a medical professional immediately – on or off the course.

3) What are some factors that put me more at risk for developing renal failure associated with rhabdomyolysis? Excessive heat, severe dehydration, NSAID and/ or analgesic usage, and prior viral or bacterial infection are well-documented risk factors for developing exercise-associated rhabdomyolysis leading to renal failure. We have found in a recent analysis that development of hyponatremia during the run, under-training (especially if an injury limited training time), and being a relatively younger and faster male runner pushing through pain to finish the race, may be additional risk factors for developing renal failure associated with rhabdomyolysis.

4) How can I prevent developing rhabdomyolysis-induced renal failure during an ultramarathon?
■ Avoid taking NSAIDs (Advil, Motrin, Aleve, Celebrex, et al.) and/or analgesics during an ultramarathon race
■ Do NOT race if you had a recent viral or bacterial infection
■ Do NOT over- or under-hydrate
■ Train properly for the event; if you get injured, race only when you have regained proper fitness
■ Listen to your body; if you have any of the above-mentioned warning signs, seek medical attention immediately!

Be safe, Run far, and hydrate properly.


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Tuesday, July 14, 2015

10 tips for developing speed, endurance, and top CR's on Strava

This summer I transitioned from cycling to running after a number of years focused on cycling.  As I get older and life gets busier I've developed a strict training method for getting fast and going far... fast.  If your not a runner, most of these things can translate really well to cycling too, just insert 'cycling' where 'running' is mentioned.  Here are my top 10 tips:

1.) Tapering is for sissies.  Tapering requires meeting training goals, especially your pre-peak week.

2.)  Speed work is clearly for people with a max heart rate over 200.

3.)  Lube for the short runs, not the long ones.  Lube is an excellent way to stop discomfort in a number of places when you spend a lot of time running, especially the feet for runners and the you know where for cyclist.

4.)  Similar to number 3, if you have a super motivational running partner, make sure and leave him out of the long days, and bring him along for the shorts.

5.)  One of my personal favorites, plan for 10 miles and the run 30 miles.  This way you can experience things like hallucinations, dehydration, low glucose, and of course peeing rocks- with out all the hype of an ultra.

6.)  The best time for a beer is never the end of the run, why wait?  I prefer mine at the beginning.

7.)  Gu's and electrolyte mix is expensive, try an alternative like McDonald's fries and a coke.  All the same ingredients (plus a few bonus's) at a fraction of the cost.

8.)  If you're having a hard time getting out of the bottom two thirds on your favorite segments(on Strava), stuck somewhere between the geriatrics and the biggest looser (before, not the after) Try starting your own segment in a uncommon location, something like a freeway close to downtown.
Isn't the whole reason segments exist is so someone slow like us can have the CR for a day?

9.) If number 8 fails you, the  last resort is riding your bike while in running mode on Strava.

10.)  Finally, make sure to show up to every big event with the newest tech gadgets and gear.  When you make new friends be sure to throw in key words like hill repeats, interval training, V02 max, lactate threshold, PR, CR and stride development, as well as your latest power estimate (times 3 or 4).  Always make sure to note some of your training buddies who happen to be sponsored by such and such(insert newest hip company like Lulu Lemon).

Hopefully these tips have been very helpful.  If you'd like more information on the details of my training program for the moderately unsuccessful feel free to contact me at anytime.  Chances are I'll be out running on a freeway somewhere...