running injuries

Running Preggers: Pelvic floor

Nicole Lowe McBrideLeave a comment

There are three muscles that take the brunt of the stress from pregnancy: the uterus (which is a group of muscles), the rectus abdominis (six pack), and the pelvic floor. It takes the uterus approximately 6-8 weeks to return to it’s normal pre-pregnancy size after the baby is born. We addressed the rectus abdominis in my last post regarding Diastasis Recti.

The pelvic floor muscles are like a sling or hammock that attaches to your pelvic bone and your tail bone. Having a week pelvic floor is not an uncommon thing even in those who have never been pregnant. In fact, men can have problems with their pelvic floor.

Your pelvic floor holds in your uterus, bladder and bowl. Only bladder and bowl in men obviously. Having a strong pelvic floor is important for both pregnant and non-pregnant people. The main symptom of a weak pelvic floor is incontinence or urine leaking, especially, when you cough, sneeze, laugh or during running. You can also have feces leak, but that’s less common. Because this is so common among women, many think it’s normal, but it’s not.

An even more serious issue than leakage is prolapse, which is when one of your organs falls down into your vagina. prolapse has to be corrected with surgery.

Having a strong pelvic floor during pregnancy is obviously important because it holds your uterus inside your pelvis. You should begin doing pelvic floor exercises as soon as you know you are pregnant. In fact, everyone should do them, especially, runners because we can stress our pelvic floor every time we run.

So what are some pelvic floor exercises? First you have to be able to isolate those muscles. The best way to figure out if you are flexing the pelvic floor is to stop the flow of urine. Kegel exercises are the most recommended pelvic floor exercise. A kegel is done by flexing the pelvic floor. Men identify the pelvic floor and do kegels in the same way as women. If you can’t feel your pelvic floor (not unusual after childbirth), use visualization.

You should be doing kegels three times a day, at least. You want to do ten repetitions of two types. First, pull your pelvic floor up and hold for ten seconds, then release for ten seconds. You can shorten the time between each as you get stronger. The second is to flex and release 2 seconds up and 2 seconds relaxed.

Other exercises that work your pelvic floor are:

  1. bridge
  2. clams
  3. hover: sit on your heels with your knees apart rise up and pull your pelvic floor up.
  4. split squats
  5. wall sits
  6. squats.
  7. elevator: pull your pelvic floor up halfway and hold it for 3-5 seconds and then pull it in as much as you can. Release in the same way.

Begin with ten repetitions and two sets. Do these three to four times a week.

When doing pelvic floor exercises it’s important to coordinate with your diaphragm and your rectus abdominus. You should be using your diaphragm to breathe. To make sure you are, lay on your back and place one hand right at the bottom of your ribs and the other hand on your chest. As you inhale it should begin in the bottom of your ribs not in your chest.

You should be relaxing your pelvic floor with each inhalation and contracting your pelvic floor with each exhalation.

You can begin doing kegels a few days after your child being born. If you have stitches you may have to wait a little longer if they cause any pain.

Pelvic floor exercises should be done in a variety of positions including laying down, sitting and standing.

Training not Where You Wanted it to Be?

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Life can get in the way of the best laid plans. Even when running is LIFE, the other pieces can interfere and put us a week out from race day with inadequate training and a mindset lacking in enthusiasm for the event ahead of us.

What do you do when your training just hasn’t been what you wanted it to be? Maybe it has been a lot less than you wanted it to be, to the point where you’re questioning your ability to finish the race? You have three options to choose from.

First, you can DNS (did not start) and cut your losses with that (most races won’t let you transfer your registration to another runner or carry it over to the next year). Second, you can go out hard pretending that your training was amazing and nothing can stop you. Third, you can show up to the start and see what the day brings with only an expectation to enjoy yourself.

The second option is likely to get you injured, which will only compound any frustration you feel about the situation. The first, I can understand if you’re coming back from an injury, which has killed your training and you really don’t want to risk causing more injury or compromising the healing process.

The third is the option I encourage most runners to take. You paid for the race after all and I think you will surprise yourself if you hold to a few suggestions and trust in your running foundation.

It’s important that you stay positive about the event and situation as much as possible-Hey at least you’re able to be out there. Make sure you are encouraging other runners as you come in contact with them along the course. Not only will your encouraging words impact them, they will impact you because, you hear them as well.

Summon your inner confidence. You’re a strong runner who has done hard things before. You finished races before. You know where to slow down and where to pick up the pace. You know how to fuel and hydrate. You know how to utilize your crew and pacers to help you reach the finish line. You’ve dealt with the “pain and suffering” of running before and can do it again.

Don’t discount consistency. If you’ve been able to maintain consistency in your training schedule but not the miles remember that consistency goes a long long way when it comes to running. Yeah, sure you wish you could have gotten in more long runs and more time on the trails, but at least you ran every day you had scheduled to be a run day even if it was only for an hour. Consistency keeps your muscles and tendons strong. It also keeps your mental game strong.

Trust your foundation. If you’ve been running for years and this is just one of many races you’ve done trust your body. You have the running foundation to push through a race even on less than the best training.

Get out to the starting line and assess your body’s condition as you go. You don’t want to get injured, but don’t miss a chance to play on the trails and show yourself you can do things even when they don’t turn out just the way you had planned.

Running Preggers: Diastasis Recti

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This is something I had never heard of before this pregnancy (my third). Diastasis Recti is a condition when the muscles of the abdomen separate, the rectus abdominis (six pack), separate. This usually occurs during pregnancy, however, it can occur because of other conditions. It’s what causes the classic “mamma pouch.” approximately 44% of women have it even at 6 months post partum and 33% at 12 months post partum.

This separation occurs to make more room for your growing uterus, which is exerting pressure on your abdominal wall causing the muscles to bulge forward. It’s not a tear, but a stretching of the linea alba, aka the connective tissue that runs vertically along the midline of your abdominal wall.

Diastasis Recti can cause serious health problems if the separation is large. Most women do not suffer from a large separation. It can cause back pain, pelvic pain, and basically you don’t have anything protecting your organs. It’s fairly easy to check yourself for a larger than normal separation between the abdominal muscles. Here is a video .

How to check for it: lay on your back with your knees bent like your going to do a bridge. Then pull your pelvic floor up and lift your head and shoulders like your doing a crunch. In this position place your fingers on your belly button and move straight up in a line feeling for the separation go three inches above and three inches below the belly button. If the separation is more than one finger widths you have Diastasis Recti. If it’s three fingers you should see a physical therapist.

If it’s two or less, there are some exercises you can do to heal at home. The central component of all of these exercises is the core compression. To do a core compression squeeze your core to draw your belly button in and up toward your spine while doing a forceful exhalation at the same time. Perform your core compression while doing these six exercises:

  1. Cat-cow without the cow
  2. wall sit
  3. single leg lift while lying on your back
  4. Standing inner thigh lift: lift one leg with a slight 45 degree bend in your leg and then move your foot in and up.
  5. side plank
  6. Tricep kickbacks: bend over at the waist and move your arms from 90 degrees to straight. You can use light weights if you have them.

Perform 2-3 sets with 10-12 reps 3-4 times a week. You should see improvement in 8-12 weeks. If you don’t, consider seeing a physical therapist. As always check with your doctor before beginning this program.

Exercises you should avoid are the ones which cause your abdominal muscles to push out (a sure sign that you’re increasing the abdominal pressure). Also any exercises which you cannot perform without arching your lower back off the floor.  These include push-ups, front planks, sit-ups, crunches (anything that has you raise your shoulders and head off the floor), and leg lowers (either seated or laying on your back).

As you recover from pregnancy and child birth, keep in mind that it took nine months to get your body into the shape it’s in and it’s going to take some time to get back to your pre-pregnancy shape. Be patient and be kind.

 

 

Cut It Short?

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There is a time and place when we have to cut our runs short. This can be a very difficult choice for many runners, especially, those who have a busy scheduled with little flexibility. So what do you do when, you reach a point in your run and begin to think it might be best to cut it short?

I’ve had this thought a bunch of times out on the trail. The struggle is deciding whether or not this is a real reason to cut a run or if this is a day where you need to push through a tough spot in a run. We all have tough spots in runs and as ultrarunners, it’s very important to learn how to push through those.

There are a few things to take into consideration when making the choice to either push through a training run or to cut is short. Start by asking yourself just how weak and tired you actually feel? If you are exhausted and have nothing to give-cut it short. If it feels more like a time when your energy has just bottomed out but will come back with a snack-get a snack and push on through.

What about the middle? If you’re some where in the middle you have to ask more questions: First, what do you have planned the rest of the day? If you have a jam packed schedule requiring concentration and focus, cut the run short. If you have a day of other physical activities, cut the run short. If you have a day free from mental and physical strain and think you can spend that time recovering on the couch with a good book or movie, go ahead and finish the run.

Second, what has your sleep and rest looked like over the last week? what does your future schedule hold for sleep and rest? If you’ve had little rest and no high quality sleep for the past few days and you’re looking at more of the same, cut the run short. If you’ve had horrible sleep, but this will improve beginning with the next day, go ahead and finish the run.

Third, are you nursing any injuries? if you have that telltale twinge from your ankle, hamstring or hip flexor that says you’re pushing the limit, cut the run short. Running when you feel weak and tired coupled with a problematic area feeling twingy is not a good combination. You could end up taking a week or more off if you make a poor choice in your foot plant or just push the muscle/tendon beyond what it can do that day.

Fourth,  what does your running schedule look like the rest of the week? if you have another hard run in 48 hours, cut your run short. If you have a few easy days or are willing to adjust them to easy days, go ahead and finish the run. BUT you have to be able to stick to the easy days.

Cutting a run short is a difficult decision. You have to learn to listen to your body and know when it’s a head game and when it’s time to rest.

 

The Importance of Interval Training

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Love it or hate it, interval training is here to stay and you should be doing it. I’ve never been a big proponent of doing speed work as an ultrarunner. Ultrarunners don’t run “fast” so why should we train fast? it increases your risk of injury and I’d rather focus on things that reduce my risk of injury. So the big questions why would we do interval training as ultrarunners and how do we reduce our risk of injury.

First, let’s address the injury issue. There are things you can do to reduce the possibility of sustaining an injury during interval training. Do a warm up! Run at a slow pace for 10 minutes. Don’t use static stretching before you run. Do use dynamic stretches such as high knees, butt kicks and toy soldiers before you start, but not a ton 20 meters of each is enough. Do three box jumps. Take advantage of your recovery time. If you have a history of hamstring pulls, knee pain, or other lower body injuries do your intervals on hills rather than on flat ground. If your injury prone or coming back from an injury do your intervals on a bike or other stationary exercise equipment. You can even do them in the swimming pool as pool running.

The Why. You should do interval training because at some point you’re going to hit a plateau in your training if you are always running near the same pace. Most of the gains you’ll make will happen early. Later gains will come but much more slowly and then it will feel like you’re not making any progress.

The reason is you’re not challenging your body and it has adapted as far as it’s going to without another stressor. As runners we want to be able to improve the cardiovascular and respiratory systems along with muscle strength. That’s how we get better.  Interval training trains a different part of those same systems. When you make an improvement in one aspect, it increases your ability to make gains in the one that has plateaued.

Interval training is the best way to increase your Vo2 Max and your Lactate threshold, which are two aspects of that same system we use as ultrarunners. Here are a couple workouts you can use to increase both. It’s best to use these your early training blocks and then as you get closer to race day drop these in favor of more race specific training such as climbing/descending, heat training and the like.

Vo2 max: All out for three minutes, recover for three minutes. Repeat 5-8 times. Do this two days a week for four to six weeks.

Lactate threshold: Run as fast as you can sustain for 40 to 60 minutes (like a tempo run). Do this two days a week for four to six weeks. You can break these up into ten minute blocks (ten on ten off) but keep the total hard time as 40-60 minutes.

 

Hip Engagement: Part Two

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This is the second part of a two-part post on engaging and strengthening your hips to improve your running and to reduce your injury risk. Here is a link to the first part.

When we analyze our injuries, as we recover from them, we look for ways to prevent the same injury and reduce the risk of other injuries we fear will follow. At times we forget to look upstream and downstream in the kinetic chain. Lower body injuries often times begin in the hips and thus, hip strength and engagement should become an essential part of our training.

  1. Knee-out running.

This one is going to feel awkward, but it helps with knee alignment and getting the max benefit from engaging your glutes. This is a drill not the way that you will run. Part of what the glute does is rotate your hip outward. This outward turn allows you to get maximal hip extension. It’s easiest to practice this on a line such as on a track or the white line at the edge of the road. Try to keep your knee turned out a bit while your feet remain directly beneath you. Start with short distances or 30 seconds a few times during a run and work up to longer durations of 60-90 seconds.

  1. High knees.

High knee drills are the staple of many track teams and there is a reason for it. It works the hip muscles for both legs. You use your abdominals to lift one leg while you get a lengthening in the other hip.

While you’re running be aware of your knee height because this extra length in your hip flexor is going to give you more power. You don’t want to exaggerate the movement like you do in drills, but just checking in with your lift during your run will bring your attention to it enough to make sure your engaging those muscles.

  1. Arm swing.

This one goes back to those tendons that connect your shoulder blades to the opposite hip. Maintaining a good arm swing where your wrist/hand comes to your hip on the back swing and your elbow comes in front of your hip on the forward swing, will help maintain a good strong rotation in your legs. Especially, in the later miles of an ultra. When your legs are thrashed from all the climbs and descents, have your crew remind you to run with your arms. You can also put a note in your drop bags.

  1. Strong feet.

Having a strong foot is important for efficient powerful running. Feet, although necessary to running, are remarkably the lower body muscle group most neglected by runners.  Your feet are what pushes you off the ground. Poor push off can misalign your leg as it comes forward. You also loose power if you don’t roll forward onto your toes. You can improve feet strength through single leg calf raises where you lower your heel below your toes on a step. You can also strengthen your feet using an exercise band by wrapping the band around your forefoot and holding it back with your hand to get the right amount of tension. Extend your toes out (tension pulling your forefoot to your chest), turn your foot in (tension should be pulling your forefoot to the outside0, and turn it out(tension should be pulling your forefoot to the inside).

No one wants to be injured. Research has shown over and over again many running injuries originate in the hips and spending some time each week focused on strengthening hips is well worth the time even if it cuts into running time.

Hip Engagement

Nicole Lowe McBride1 Comment

This post has two parts. This is the first part. As runners, we aren’t too surprised when we end up with an injury in our quadriceps, hamstrings, calves, or pretty much anywhere in our legs. We may spend hours, days, or even weeks wondering what caused the injury- too much training, shoes, not enough sleep, too much junk food or whatever. After spending some time wondering how and why we became injured we start looking for ways to heal and then prevent future injuries.

Having strong engaged hips is essential for preventing injuries in every muscle and tendon below the hips. Increasing your hip strength and engagement leads to running faster and reducing injury risks.  Here are some drills and strategies to ensure you’re engaging and strengthening your hips to get the most bang for your buck.

  1. Lean forward, so you have your chest, over your knee, over your foot.

The forward lean while running allows you to engage your hip as the primary source of your forward momentum. It you’re upright you’re forcing your knee and ankle to do the work. You knee and ankle are supported by smaller muscles and thus they get tired and worn out faster than the bigger muscles of the hips.

  1. Mildly arch your back or at a minimum keep it neutral.

The mild arch in your back should come from just below your shoulder blades, rather than just above your pelvis at the lower back. There are tendons which connect your shoulder blade on the right to the hip on the left and the left shoulder blade to the right hip. This brings the power of your arm swing and shoulder into your running. This is something you want to maintain while running.

  1. Pawback pull.

This is one is the most complex and uses drills to perfect. The pawback ensures your foot lands beneath your center of gravity (reducing breaking) and it enhances hip extension (more power). Reducing the breaking forces when your foot hits the ground with each step and gaining more power with each push off should be enough for you to start doing this drill, but here are a few other reasons why it’s helpful: it preserves your quads because you don’t overstride, especially on downhills. It reduces shearing action inside of your shoe which reduces blisters.

How to do the pawback: from standing start by driving one leg up into a forward flexed position-knee up at a 90 degree angle. From there, flick the foot out in front of you. Then, pull it back so your foot returns to the floor. The important thing is when you pull it back flex that glute. Here is a video to make this more clear.

You’re obviously not going to do this while you’re running. How you pull these benefits into your everyday running is by being aware of your engagement of that glute and hamstring, which you’ve become very familiar with during these drills.

The next post will cover four more ways you can engage your hips and become a more powerful runner and reduce your risk of injury.

 

Taper Adaptations

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Tapering for a race is really difficult for many runners. I know that there are some elite athletes who don’t really taper at all, although, they may take the two days before a race off. An important, possibly critical, difference between elite runners (many not all) and us not so elite runners is we all work typically full-time jobs. This means we don’t have the same opportunity to recover between our runs during training and thus we reach race day more depleted making tapering more important for the average runner.

I’ve tried both three week tapers and two week tapers. I didn’t find any difference between the two. Again, that’s me. Other people may be different. Tapering is– as many aspects of running are– very runner dependent.

The professional research based recommendation is three to four weeks. This is because a taper  is giving your body the time and rest needed to take all the training you’ve been doing and lock it into place in your various bodily systems.

For ultrarunners, your aerobic system has pretty much reached maximum conditioning. Other system haven’t. There are actual changes down to the protein synthesis level. Some of the adaptations that your  body makes during your taper are:

  1. Training causes minor tears to muscles. The muscle need a chance to rebound and repair.
  2. Immune system needs time to get rid of any inflammation and repair cells.
  3. Hormone profile rebounds which takes some time especially cortisol and testosterone. Both of these become depleted during your training.
  4. Red blood cells become consistently damaged when you’re running high miles, so your having to manage that while training. The taper allows those to be repaired and to increase. This is important for oxygen transportation to muscles.
  5. Metabolic wise, rest allows you to store more  glycogen in your muscles and liver.
  6. Running 100 miles is a mental as well as physical challenge. We also tend to be a bit sleep deprived which has both physical an mental components impacting our performance. It improves your vigor and mood.
  7. Many ultrarunners have some level of dehydration pretty much all the time. The taper gives you time to balance your hydration.

In addition to sleep and reducing your running, nutrition is a major part of recovery. Eat healthy whole foods, which will give you what you  need and reduce the chance of gaining weight close to the race once your body is using less calories to rebuild.

Regardless of whether you run by time or miles, you should reduce your running by 20% each week beginning three weeks from race. You on’t need to reduce the intensity, but you shouldn’t increase it. You can maintain the number of runs per week. It’s very important that you keep in mind you are going to feel better as your body rests and recovers (the point of the taper), but you shouldn’t increase your efforts. You’ll need to use pace rather than perceived effort during your runs. You’re not going to lose any fitness by giving yourself the three weeks to rest and repair.

Here is an easy way to remember the “rules” of tapering:

Trust in your training

Adjust your Calorie Intake

Perfect your race day strategy

Embrace the “free” time

Rest and recover

Coming to Terms with a DNF

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At some point in an ultrarunner’s career there will be a DNF, Did Not Finish. They happen for many reasons. Regardless of the reason, in the moment, it feels like an absolutely legitimate reason. Then there is the next morning, where you’ve slept and eaten a real meal, at that time, your reason for pulling out of the race may feel like the wrong decision.

It’s hard not to beat yourself up over, what you see as, a less than adequate reason for the DNF. And maybe some self criticism is warranted, doubtful but maybe. The problem is it gets you no where. It doesn’t help you improve. It doesn’t make the DNF go away. It doesn’t make you feel like getting back out there.

I have three DNFs. All three of them were in the same year! The first was at the Speedgoat 50k. My dropping from the race wasn’t voluntary. I missed the cut off by five minutes. The second was at my first 100 miler, Pony Express 100. I went into the race injured. I had rolled my ankle 5 weeks before and then proceeded to run on it for a relay run for 50 miles. I couldn’t let my team down and knew when I chose to do the relay, I was putting my 100 at risk. At mile 75 of the 100, my knee was so painful I could barely walk. I decided it wasn’t worth risking a long time injury. My last DNF was at Buffalo Run 50 miler. I pulled out 12 miles from the finish with mild hypothermia. I had stayed in an aid station waiting for warm broth. During the time I was there my body temperature dropped, since I wasn’t moving. The next morning I went out and finished the last 12 miles.

It sucks to get a DNF. I remember each of these very vividly. I did beat myself up after each and everyone, especially the Buffalo Run 100. After sulking for a week, I decided I was done and I was going to learn from each of these experiences. I went back and asked myself several questions about each.

What when wrong?

What could have prevented the DNF?

What can I do to include these prevention strategies in my training in the future?

Ultimately, I decided two of the three could have been prevented. I realized my training for Speedgoat was not what it should have been to make the cut off times. For Buffalo, I learned to never stay in an aid station for more than what is absolutely necessary. I talk to my crew about this every time. I also learned how to better educate my crew and how to pick crew who will throw me back out into the cold, even if it’s a blizzard.

You can look at a DNF in two different ways and you’ll likely see both in each DNF you have beginning with the Did Not Finish and concluding Did Nothing Fatal.

 

 

 

Where am I? Proprioception.

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Proprioceptors are the sensors in your muscles and tendons, which govern your balance. They tell your brain where your body is in relation to itself and other objects in your environment. Having good proprioception is essential to runners, especially trail runners, who are constantly being asked to shift their weight to adjust for the terrain. It’s also important for winter running.

Proprioception is something runners should be working to improve all the time, but it’s even more important after an injury. Injuries to muscles and tendons damage the proprioceptors. If proprioceptors are not functioning properly, you’re much more likely to get re-injured.

Take an ankle sprain for example. It’s your proprioceptors, which would send a message to your brain to prevent the initial roll of the ankle, but if you rolled it anyway the likelihood of rolling it again increases especially within the next four to six weeks after an injury. Injury prevention isn’t the only thing that improves with these exercises. Your speed will also improve.

Here is an easy test to give you an idea where you’re at proprioceptionwise. Stand up, balance on one leg and close your eyes. If you immediately put your foot to the ground because you lost your balance, you have some work to do.

It’s not difficult or time consuming to include a few proprioception exercises into your routine. You can do them after a run or do them when you’re hanging out watching TV. If you have kids, they’ll find the exercises fun and you can make it into a game (and teach them about their bodies). You don’t need any special equipment, but there are things that you can buy to make things more challenging as you improve. A stability cushion is $16.50 on Amazon. A  wobble balance board is $22.

Even if you choose to purchase either the cushion or the board, you should start on the flat ground. Stand on a flat hard surface. Take off your shoes (you can put them back on if it’s too difficult). Now, stand on one leg for 30 seconds. Then do the other leg. If you can do this easily, increase the time to 60 seconds. From there, you can close your eyes.

Other single leg balance exercises that can help improve your proprioception are:
Air Plane: standing on your right leg, hold your arms out like wings, bend over lifting your left leg up and back, and make a straight line from head to your left foot. Once you’ve mastered this. touch your right toes with your left finger tips and then your right, returning to arms straight out between each touch.

Single leg squats: stand on one leg, roll your hips forward and squat. You can bend the leg your not standing on and touch it down onto a step or stool or you can hold it straight in front of you for a piston squat.

Ball toss: stand on one leg and toss a tennis ball at a wall or to another person and catch it while remaining on the one leg.

Here are some exercises you can try on either the cushion or the balance board once you have achieved that level.