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The Boston Marathon is less than a week away! The weather forecast, so far, is setting us up for a great day -partly sunny with a high in the upper 50’s. I always hope for nice weather because that will encourage more spectators to come out. I can clearly remember not just the sound of the crowd but the feel as I passed through the center of Wellsley in 2011.  The cheering was beyond loud, it was deafening, like it was literally traveling through me. It was awesome! I’m expecting that times 10 this year!  The crowd was a little more subdued in 2012 because it was so hot.Boston_strong_edited-1

When I crossed the finish line in 2012 in the 90 degree heat, I decided right then that I would take a break from Boston in 2013. Watching the events of the 2013 marathon unfold on TV brought a sense of anger and sadness to me. Marathon Monday is supposed to be a day filled with joy, pride and happiness.  Everyone is there because they want to be, whether they’re running, volunteering or lining the course cheering for the runners. People who have qualified for the race have a sense of personal achievement and pride.  The people running for the charities have their hearts filled with pride because of the difference they are helping make. Everyone has worked hard to get to the starting line of the Boston Marathon and each person should have the happiness of crossing the finish line and celebrating with their friends & family. That was thoughtlessly taken away from so many people last year, leaving physical and emotional scars. I have heard many stories of people who are coming back with more determination than ever this year; to cross the finish line, to have their closure. I’m really looking forward to hearing their stories after.

There is a Tibetan saying – ‘Tragedy should be utilized as a source of strength.’ The support that the world will have for the city of Boston, the runners and everyone associated with the marathon will be overwhelming. That will reinforce the strength the running community has this year, which is already immeasurable. It’s going to be a great year to run Boston!  As I have been reflecting back on past experiences and thinking about this year’s race, I came up with the following list that I hope will enhance the Boston marathon experience…

Things for runners to do on Marathon Monday:

Talk to someone you don’t know on the bus to the start. My first year I sat next to an older fellow with a long grey beard. After asking him his name and where he was from, I asked him how many times he has run Boston. Without saying a word, he unzipped his warm-up jacket to reveal a home-made race bib he had pinned to his shirt. It said: “BILL, 25th Boston, 100th lifetime marathon”  This was the year he would make the Quarter Century Club!

Breathe. The long early downhill miles are not as metabolically demanding so you won’t feel the need to breathe as deeply. You can probably carry on a conversation without too much work. This can set you up for cramping and early fatigue later in the race as the course levels out and heads into the hills.  Try to take a few really deep breaths every mile to keep the lower regions of your lungs trading oxygen for CO2.

A little motivation at the 40k mark

A little motivation at the 40k mark

High-five 50-100 cheering spectators in a row along the course. Nothing picks you up like being right next to the crowd and drawing from their energy. That strategy has helped me through some tough sections in the past.  Technique is important here to keep moving: don’t make full hand to hand contact because each hand you hit slows you down just a little and you’ll be reduce to a walk after just 4-5 people.

Thank a volunteer. Whether it’s the bus driver that you pass at 7am, the person handing you water at the half or the person putting your finisher’s medal around your neck, the marathon would not be the experience it is without volunteers. Be appreciative and let them know it!

Smile. Researchers have been looking more closely at the ways our brain effects our performance. Keeping a positive attitude is paramount, whether you’re trying to set a new PR or just finish the race. I try to keep positive words in my head (“up”, “light”, “fast”) and congratulate my self for staying strong up a hill or keeping good running form when I’m tired. The minute negative thoughts enter our head, we start a downward spiral that makes us feel worse and slows us down.

Remember you’re running The Boston Marathon. People come from all around the globe to run this race because of its history.  It’s one of the few remaining races that’s not shrouded in cheating, doping or other unnecessary drama. This is also a race where you can actually compete against the best runners in the world! True, you’re probably not going to run next to them on the course, but you’re still running the exact same course on the same day as the best.  I consider myself fortunate that I grew up about 40 min from the start line and now only have to drive a few hours to get to the race. I never take a single step of it for granted.

 

Are you running Boston?  What would you add to the above list?

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I’m a huge supporter of Daniel Leiberman’s theory that humans look and move the way we do because of endurance running.  As we evolved, there was a point when we began benefitting from running and therefore adapted traits that helped us run more efficiently, which led to us to become very efficient endurance runners.  Many new studies have been coming out that give more detail as to why humans need to be moving to be healthy.  Believe it or not, simply standing is healthier than sitting.  Standing work stations are becoming more popular for people who are stuck at computers all day.  Even though standing doesn’t raise your heart rate there are significant health benefits.  The most profound benefit of standing during the work day is how the production of the enzyme Lipoprotein Lipase, which is minimal when we sit and much higher when we stand, affects us metabolically.  Standing and increasing production of this enzyme has a very positive effect on our physical health.  Standing also prevents muscles and tendons from tightening up, specifically hamstrings and hip flexors, which directly affects runners.

Now, looking beyond the physical benefits, new research is indicating that physical activity may help maintain brain health- more than simply helping us clear our mind after a long, stressful day.  The New York Times article- Exercise and the Ever Smarter Human Brain is based on research that goes a little more in depth about the theory of why and how exercise helps our brains.  Researchers theorize that physical activity helped to mold the structure of our brains over millions of years.  If that’s the case, then it’s likely that physical activity remains essential to brain health today.  Similarly, we evolved as social creatures and we still need social interaction to be well balanced.  I use this example because the social aspect is something that we can easily perceive and are more attuned to.  We have the desire to spend time with others, to talk to people, to solve problems or to feel loved and accepted.  Many people enjoy running with another person or group of people.  I think this is a deeply rooted instinct that comes from when we ran and worked together for a successful hunt.  See my post on persistence hunting to see how people ran and work together to chase down their prey.

Researchers have found evidence that “regular exercise, even walking, leads to more robust mental abilities.”  This does not mean that every couch potato who starts running will become a genius.  In stark contrast, Stephen Hawking has been wheelchair bound and unable to feed himself since the mid 70’s, yet is one of the most intelligent people in the world.  We all fall somewhere under the bell curve and everyone has their potential.  The bottom line is that physical activity can help with decision making and keep our memory sharp, helping each individual achieve their full cognitive potential.

Unfortunately, the brain experiences a similar use-it-or-lose-it phenomenon that skeletal muscle does.  Other research has shown that animals who were showing cognitive improvement from exercise demonstrated signs of decrease after just one week of inactivity. Within three weeks of inactivity, the exercise group had results very similar to the group that had never exercised.

So if someone you know has been excessively inactive, try to get them out walking either during lunch or after work.  Suggest an up/down work station for their desk.  Any light activity will help them both physically and mentally and may be the catalyst for an overall healthier lifestyle.

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On Sunday, I ran in the first annual Sleepy Hollow Mountain Race.  This race is the first of six in the USATF New England Mountain Running Series, with other races in Vermont, Massachusetts and New Hampshire.

S.H. Mtn Race

The race was co-organized by 2011 U.S. and World Mountain Running Champion Kasie Enman and held in her back yard (literally) on the trails of the Sleepy Hollow Inn and X-C Ski Center.

With the preceding two weeks of wet weather here in VT, it was expected that the 10K course would be on the muddy side… and muddy it was!!  There were sections of ankle deep mud and saturated meadows that looked dry until you ran through them.  There were also sections of runner friendly single track and wide grassy trails.  Oh, and hills.  There were a few hills to run up, and down.  After all, it is part of a mountain series.

Uphill Start

Uphill Start

The race started with a climb for the first 9/10 of a mile to the highest point.  To make things interesting, there was a special prize (VT Maple Syrup of course) for the first man and woman to reach the top of the first climb.  The entire second mile was downhill.  This is where we encountered some of the first serious mud of the day.  Mile three sent us back up hill rather abruptly for the longest climb of the course.  Just over a mile long, the second climb continued with the muddy-trail motif.  Mile four sent us back down hill, this time on some drier terrain.  Mile five offered a little more single track, less mud and less climbing.  Mile 6 was all down hill again along a wide soft grassy road that let you enjoy the run instead of deciding where and where not to step.

Choosing an aggressive soled shoe for this course was very important.  I decided to wear my Inov-8 Oroc 340’s because of the giant lugs on the bottom and because I converted my Talon 212’s into road shoes by shaving the lugs off them.  I noticed that the Inov-8 Talon 212 was a popular choice for this race, as was the Roclite 295. As a Physical Therapist, I really like the Inov-8 brand.  I think they have a great philosophy and design.  I was curious to see what other styles of Inov-8 were at this race.  Here’s what I found.

X-Talon 190

X-Talon 190

Roclite 295

Roclite 295

Terafly 303

Terafly 303

F-Lite 230

F-Lite 230

Oroc 340

Oroc 340

I noticed that even Scott Mason, the race photographer had Roclites on.

Race Photographer Scott Mason

The race photographer – Scott Mason

There were 136 runners at this years race and ZERO injuries that required medical attention!!  Overall it was a great day!!

Kasie

Kasie

A much deserved rest

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IT band syndrome and IT band friction syndrome are two common diagnoses that mean the same thing for lateral knee pain.  I know first hand how painful and annoying this type of knee pain can be.  Years ago, I was on a run two days before a big race when I started feeling a slight pain along the outside of my left knee.  I figured it would go away.  But within five minutes it had progressed to a very sharp pain, like a knife was being jabbed into the outside of my knee every time my foot hit the ground.  I had to stop and walk home.  Over the next two days, my knee felt tight & sore and stairs remained painful to walk down.  After a few days of rest I tried running again but the pain returned, this time more quickly.  A trip to the knee doc and an MRI only intensified my frustration.  He said there was nothing showing up in the MRI.  And his advice – my blood pressure still goes up even thinking about this –  ”I don’t see anything wrong with your knee.  Maybe you just shouldn’t run so much.  Do you like biking?”  WHAT!!!!!?????  Are you kidding me!?  I couldn’t believe THAT was his answer.  Fortunately, I was half way through the Physical Therapy program and eventually figured out that I had IT band syndrome.  So I’m always very excited when I can prevent other people from having that same frustrating experience.

Like I said in part 1, there are always exceptions to types of knee pain.  Not everyone will have the exact same intensity of pain that I had.  Also, there are other causes of lateral knee pain (see disclaimer below).  But for runners who haven’t fallen or had some other traumatic knee injury, IT band syndrome is usually the problem.  Below is an explanation, beginning with a self-assessment to help you better understand what’s going on.

Start by standing in front of a mirror with shorts on so you can see our knees.  Stand relaxed and look at your kneecaps.  Do you see one or both oriented somewhat inward instead of straight ahead?  In an extreme case, a person might even notice their knees are closer together than their feet. Next, you’re going to tighten your glutes, AKA: squeeze your butt muscles (not with your hands, I actually had a guy do that once) – watch what your knees do – they’ll slightly rotate laterally to the point where your knee caps are now facing more forward.  Tighten and relax your glutes a few times and you’ll see your knees rotating in and out.  As you’re tightening your glutes you’re externally rotating your hip, which directly affects your knee orientation.  If your knees face inward when you stand relaxed, then the hip external rotator muscles that should be maintaining the alignment of your hips have become weakened.  This leads to knee pain.  So when you need your muscles to support your hips in the proper position while running (which is much more demanding than standing), they eventually fatigue to the point where they can no longer do their job.  This is why your knee pain doesn’t set in until you’ve run a few miles.  Over time, the distance you could run would lessen, stairs would become more painful and eventually you’d have knee pain all the time.

Side view of the knee

Side view of the knee

What’s causing my knee pain if the problem is in my hip?  The IT band starts at the hip as a wide tendon where it attaches to the hip bone (Ilium), the glutes and a small muscle called the tensor facia lata (TFL).  It runs down the outside of your thigh to just below the knee, attaching to the tibia.  This is why it’s called the “IT band.”  It connects the ilium to the tibia.  As the IT band approaches the knee, it rubs against the lateral condyle of the femur (see small image).  I like to use the car front-end alignment analogy to explain this:  If the alignment is off in a car, the tires wear more quickly.  The problem is not the tires, it’s the parts that align the tires.  In our knees, the IT band pain is the same as the worn tires, just a symptom of the root problem.

IT Band

IT Band

How is this related to running?  Think of your knees as simple hinge joints, similar to a door hinge.  They can only go forward and back.  Our kneecaps point in the direction that the hinge is facing.  So if you’re running forward you want your knees to flex straight forward and back, not at an angle.  If your knee is rotated inward, the friction of the IT band on the lateral condyle is greater and things become irritated, especially during repetitive movements like running.  When you see runner’s with their feet kicking out to the sides when they push off, you’re seeing the poor biomechanics of hip internal rotation in action.  They probably have painful knees.

How did this muscle weakness happen?  The short answer is sitting.  When we sit for hours at a time, the muscles are not active.  The use-it-or-lose-it philosophy rings very true here.  Over time, the muscles become more accustomed to being at rest and lose their strength.  I’ve noticed a trend when I talk to people about this subject.  The knee pain usually starts after about 5-6 years of working at a desk job.  Unfortunately, you can count graduate school as a sit-down job.  Incidentally, sit-stand work stations are becoming more popular and I strongly encourage people to consider those if they’re stuck behind a desk work.

How do I fix it?  The permanent fix is to re-strengthen the hip external rotators.  I’ll describe a few exercises below.  In the mean time, there are a couple of things to try that might give some temporary relief.

You can never go wrong with putting ice on the painful area.  This will help decrease any swelling and pain.

Many people try using a foam roller on their IT bands.  That works, but it can be quite uncomfortable and not everyone has positive results.  In the clinic, I do a manual technique called the IT band release.  The closest thing I can describe that a person can do on their own legs is to work up and down the outside of your leg (4-5 times) pressing down and twisting, similar to how you’d open a medication bottle.  You do this WITHOUT any massage cream or lotion.  The idea is to get the layers of fascia, muscle and connective tissue to move independently of each other under the skin. It will feel like a dull ache as you apply pressure.  You can have another person do this for you as you lay on your side, just be careful because your leg will be very sensitive the first few times.  If done correctly, when you stand up and walk around after, your knees should feel lighter and easier to move.  This usually carries over to running.

Exercises: A person will benefit from any exercise that involves hip extension.  I encourage people to avoid machines and do functional exercises.  Functional exercises are more dynamic, require balance and often include the core.  That being said, some functional exercises will be too advanced for someone with significant hip imbalances.  Below are some good basic exercises to start off with.

Standing hip Extension:  Start with a thera-band or cable machine passed under your foot and the handle or loop around your heel.  Stand tall with knees slightly bent.  Without tipping forward or bending your knee, extend your leg backward 1-2 feet (don’t strain to achieve more movement).  Hold for 1 second and SLOWLY return to start.  Try to stay balanced on one foot the entire time as you do 12-15 repetitions.  You should feel your low back, glutes and hamstrings working.  Repeat other side.  Alternate sides, doing 2-3 sets each side.

Standing Hip Extension

Standing Hip Extension

Hamstring curl on a ball:  Lay on your back with heels on an exercise ball and arms out to the side for balance.  Lift your hips up so your body is in a straight line through your knees, hips and shoulders.  Bend your knees and roll the ball toward you with your feet until your knees are bent to about 90 degrees.  Keep your knees, hips and shoulders aligned the entire time.  At this point, you may feel like most of your weight is on your shoulders and upper back.  SLOWLY straighten your knees returning to the start position.  Repeat 12 times, 2-3 sets.  If you have trouble lifting your hips all the way, raise them as high as you can and avoid touching the floor when you straighten your knees.

Hamstring Curl On A Ball

Hamstring Curl On A Ball

Ball squat:  Place an exercise ball against a wall and lean against it with your low back.  Feet should be ~12-16 inches out in front of your hips.  Keeping your back straight and your weight on your heels, SLOWLY squat down as far as you’re comfortable, not letting your knees bend past 90 degrees.  If your knees go out beyond your toes, move your feet forward so knees are above the middle of your foot.  Push through your heels and straighten your knees.  Do not bend forward as you press up and do not let your knees quickly snap straight.  Repeat 12-15 times 2-3 sets.

Ball Squat

Ball Squat

Step Up:  A small weight (3-5#) is helpful in this exercise.  Start with the weight in your right hand and your right foot on a 5-8 inch step.  Step up on the right foot and simultaneously raise the weight straight up and lift your LEFT knee to hip height (as if a string was attached from your right elbow to your left knee).  Hold for 1 second.  Lower back down.  Repeat 12 times.  Switch the weight to left hand, place your left foot on the step and repeat.  Alternate sides for 2-3 sets.

Step Up

Step Up

In the next knee pain post I’ll be talking about anterior knee pain.  The type of pain that feels like it’s under your knee cap or just above or below the knee.

Have you experienced this type of knee pain? Has this post been helpful? Feel free to ask specific questions in the comment area!

Please let me know if any of the exercise descriptions are unclear and I’ll try to fix it.

***This blog is intended for information purposes only.  It is not intended to diagnose or treat any injury.  Please consult with your doctor or physical therapist if you have any knee pain.  Please consult your doctor or physical therapist prior to starting any exercises or treatment plan on yourself or others.

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This was my third year running the Boston Marathon, and the second year of very unique weather conditions.  Last year we had a tail wind that would help Geoffrey Mutai run the fastest marathon ever.  This year, the intense heat would slow even the elite runners, to a winning time of 2:12:40.  With the exception of 2007, when rain and a relentless 30 mph head wind slowed the winner to 2:14:13, a winning Boston time hasn’t been over 2:12 since 1985.

Being a glass-half-full type of person, I’ve been reflecting back on the high points of the day.

  • My pre-race routine went exactly as I planned.  (With the exception of the bus I was on taking a wrong turn.  I hear stories every year of lost busses and this year I was on one.  Fortunately, we got back on the right path within 15 minutes.)
  • I felt like I ate and drank exactly what I should have before the race.
  • I walked to the starting line feeling surprisingly calm and confident.
  • At 9:50 I still didn’t think the heat was too bad.

I entered my corral and immediately made my way over to the left edge where things appeared to be less chaotic (I always start on the edges in big races).  I realized that I was directly in front of the route where the elite runners make their way to the start!  Just as I realized this, they came out from the church with Mutai leading the crowd.  I was impressed with the reverence the other elites showed him.  No one would walk in front of or next to Mutai.  With a smile, Mutai humbly encouraged the others to go ahead, but they insisted he lead the way to the start.  That was nice to see.

Shortly after, the gun fired and we were heading down hill.  It took me a few minutes to really get my head focused.  Something finally clicked and the realization of “you’re running the Boston marathon” sunk in.  I assessed my pace and thought about how I wanted to run these first downhill miles.

  • About 2 miles into the race I saw that I was about to pass Joan Benoit-Samuelson!  I said “Hi Joanie!” as I went by, and she wished me good luck.
  • I passed Dick and Rick Hoyt around 8 miles and said hello to them.
  • My plan to go out a little more reserved was going very well.  I hit the half at 1:21:45.
  • I made it up the first couple Newton hills without any trouble.

Considering the heat, I was very comfortable and happy with my pace.  Even if I backed off this pace a little, I’d still be well under 2:50.  Eighty degrees?  Whatever! …  To continue with the positive points of the day I‘ll have to skip over miles 19-25.  The heat finally hit me during those miles.  My legs wanted to go but my brain was saying “you’re walking now”.

high five at 40k

high five at 40k

  • I discovered that high-fiving the crowd really took my mind off how heavy and slow I was feeling.
  • From mile 25 to the finish I was able to pull it together enough to run the whole way.
  • The faster you run down Bolyston St., the louder the crowds cheer!

I crossed the finish line at 3:02:43.  Considering the fact that the heat even slowed the Kenyan runners, being 17 minutes off my goal time wasn’t that bad.  But the best was yet to come.

  • I could still walk!!
  • This year my preparation for the race was much more thorough and I got through the race without blisters, cramping, chaffing or heat exhaustion.
  • The post-race muscle soreness that followed has been very minimal!!  I consider that a huge success.

The first goal I had set for myself was to not let the course beat me.  Last year, I could barely walk or go down stairs for a full week.  My original time goal of sub 2:45, would have been about 40-45 minutes behind the winner of the race.  When all was said and done on Monday April 16 2012, my finishing time was 50 minutes behind the winner.  I’ll take it.   That’s one of the unique things about endurance sports.  Everyday people get the chance to compare their times directly with the best in the world, on the same day, on the same course, in the same conditions.  When will you get a chance to play in a tournament with Tiger Woods, or sprint against Usain Bolt, or swim in the lane next to Michael Phelps?  Probably never.  But if you sign up for the Boston Marathon, you’ll get a chance to race Geoffrey Mutai, Ryan Hall, Desiree Davilla, Joan Benoit-Samuelson, and probably the next big name in marathon racing.

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The folks at the BAA have been monitoring the weather for Monday and sending updates regularly.  The latest report was not very uplifting…

“We are now making the recommendation that if you are not highly fit or if you have any underlying medical conditions (for example-cardiac disease, pulmonary disease or any of a number of medical problems), you should NOT run this race.

Inexperienced marathoners should not run.

Those who have only trained in a cooler climate and who may not be acclimated (for at least the last 10 days) to warm weather running conditions should also consider not running.
 
For those very fit athletes who decide to run, you should take significant precautions:

Run at a slower pace and maintain hydration.

You should frequently take breaks by walking instead of running.

This will not be a day to run a personal best.”

The high of the day is predicted to be 87, but not until 3pm.  The race starts at 10am and I hope to be done around 12:45.  I’m feeling very ready for this race so I’m still going for it!!

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My number is 1095 this year.

I’m feeling ready for this race!  If all goes well I hope to be hitting the half around 1:19 and finishing under 2:45.

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