Myrundoc

11 Common Sense Tips to Run Injury Free!

2012-01-31T15:41:00.000-08:00

My patients in my Grapevine, TX office are always asking me: “Why do some runners always seem to be hurt and others can run forever and never sidelined?” Great question!!

Amby Burfoot tried to answer that question in an article in Runner’s World in March 2010. He states that George Sheehan, MD, the medical editor of Runner’s World in the 1970’s, felt that one in 100 people were “motor geniuses” and never got hurt. The rest of us were destined to be injury plagued from time to time.

Ralph Waldo Emerson stated “that there is a crack in everything God has made,” meaning that nothing is perfect and that can be translated to runners as well!

An extensive review of the medical literature by Burfoot reveals a great number of papers on running injuries, but no conclusions. It turns out that running injuries can be caused by being female (funny), being male (more likely), being old, being young, pronating too much, pronating too little, training too much, training too little, having new shoes, having old shoes, and it goes on…..

So what can we conclude? Most of us will get hurt at some time during our running career! So what can we do to prevent major, career threatening injuries?

1. Know Your Limits. This is a hard one. Some people cannot tolerate long distance running year after year. I’ve seen this in my office all too often. Some people try again and again to get to the marathon distance, but just keep getting hurt. Everyone has a threshold. Learn yours. Follow the rules and avoid too much, too soon, too fast syndrome! If you get to 15 miles and get hurt every time, maybe your body is trying to tell you something. Work on your 5K time instead of trying to attempt a marathon yet again.
2. Listen to Your Body. I give this advice every time I talk to a group of runners. Many do not listen. If you get out of bed feeling like you got run over by a train, perhaps a little rest in is order; not a long run! Most injuries do not spontaneously occur; they start with little aches and pains. Ironman triathletes are the worse! Do not “train through the pain”. That’s just plain stupid (and yes, I’ve tried to do it too!)
3. Consider Shortening Your Stride. I have to admit, I hadn’t really thought of this advice until I read Amby Burfoot’s article. It makes sense. Overstriding increases stress, so shortening your stride will soften the landing when you run. I think this is also why the recent “barefoot” or “minimalist” craze has taken a string hold. It’s hard to overstride in minimalist shoes!
4. Strength Training Can Help. One thing that has been shown to decrease running injuries is strength training. This is especially true in women. Core strength training twice a week can really help you avoid the doctors office and prolonged time on the couch.
5. Ice is your Friend! See my video on first aid for tendonitis, rest and repeat every time you have an ache or pain. A little rest, ice, compression and elevation goes a long way!
6. The Surface Makes a Difference. Here’s great tip: Don’t always run on the right side of the road facing traffic! It allows you to see the cars coming at you, but here in Texas, it means you always run on a slight slant that causes a functional leg length discrepancy. (And don’t try to make up for it by putting a lift in your left shoe- that’s stupid too!) Also try to vary your surfaces, one day on the road, one day on the track, perhaps a treadmill day or a day on the golf course. Trails are also a good thing to put in the mix. The same thing, at the same speed, on the same surface all the time can quickly add up to an injury.
7. Too Hard, Too Often is a Recipe for Disaster! When I was younger (about a thousand years ago) I used to “race into shape”. Not a great plan unless you are a gifted teenager! Too much speed work or too much racing beats the heck out of your body. Always follow a hard day with an easy one, or two if you are over 35!
8. Stretch. I’m not going to debate the value of stretching. I’ve done that in other articles. I know there are some people who think stretching is bad. I’m not one of them! All I know is that runners that are tight get hurt a heck of a lot more than those that are flexible.
9. Cross training is not a Bad Word! When I turned 40 (yes, about 5 seconds ago), I took up triathlon. Why? Because I knew as a thin female runner, getting older, I needed to cross train to keep up my aerobic fitness and decrease the stress on my body. This lead to a love of swimming and eventually an Ironman. Who says you can’t evolve as an endurance junkie? Seriously though, swimming, biking, the elliptical, circuit weight training….These all help to maintain your fitness and change up the stressors n your body.
10. Shoes Make a Difference! Find the shoe that works for you. Your podiatrist or a good experienced shoe sales person can help you, but bottom line….get a shoe that fits and is the correct type for your foot type. The reason there are a million shoes are on the market, and growing, is that there is not one perfect running shoe (although this doesn’t stop people from asking for it!)
11. Orthotics Can Help! I realize that many people are shying away from corrective orthotic and trying to embrace the minimalist wave. Not everyone can run barefoot and not everyone needs orthotics. If you continue to have similar injuries over and over, what’s the definition of insanity? Doing the same thing over and over, yet expecting a different outcome! If you are one of those biomechanically perfect gazelles, more power to you! But most of us could use a little help in that department. In many cases, you can correct some biomechanical problems with strengthening and stretching, but let’s face it….most of us are too lazy to do the work to correct our biomechanical imbalances. Orthotics can help. Think of them as eye glasses for your feet. The majority of us could benefit from a tire realignment!

Best advice I can give: listen to your body, increase slowly and have a plan! If you are one of those oft injury plagued runners, take a look at these tips. Are you following the guideline? If so, take a spin in triathlon! It has saved a lot of weekend warriors…….

Thanks to Amby Burfoot and his crew. I have liberally borrowed from their content and just put in my two cents worth. If you want to read his article, “The 10 Laws of Injury Prevention” you can find it in the March 2010 edition of Runner’s World.

What are Your Plans for 2012?

2012-01-07T16:10:00.001-08:00

I ran a great half marathon this weekend in Grapevine, Texas. Bold in the Cold Half was put on by the Lake Grapevine Runners and Walkers as a celebration of the 15 year anniversary of the club. Fun was had by all. It’s crazy to me to think that I’ve actually been a member of LGRAW for 14 years!! Love this club! Such a great crowd and it was fabulous to see so many of my patients and even my staff members running one of the races (5K, 15K or Half-marathon).

My time was not memorable since I’ve been a little lazy and working too much during the holiday season, but what was memorable was the joy of running with so many others that truly enjoy the ability to get up early on a Saturday morning and challenge themselves. I was talking non-stop during the whole race (shocking) and cheering for all the other runners as the course had the whole field criss crossing each other several times. The pure joy of running was palpable. It reminded me why I love this sport!!

In the afterglow of such a day, it’s time to sit down and hammer out my athletic goals for 2012. I’m already signed up for Ironman Mont Tremblant in Quebec in August. I also have New Orleans 70.3 in April and Buffalo Springs 70.3 in June. I’m thinking we should sprinkle in some shorter races in the spring then pick a fall marathon. Perhaps New York? Maybe Kansas City? Send me your thoughts.....

Remember, a goal not written down is a mere wish; so take a few minutes and think about what you want to accomplish in 2012. Perhaps a PR? Perhaps a new distance? perhaps your first triathlon? I want to finish a full ironman and not require an IV! I also want to PR at the 70.3 distance. I would also like to run a quality marathon under 4 hours, since I haven’t broken 4 in 5 years!!

Take the time, write it down and make a plan. You will thank me later!

When is a Bunion not a Bunion?

2012-01-03T15:06:00.001-08:00

When is a Bunion not a Bunion? When it's hallux limitis!

To read more on this subject, click here

Reach Your Goals in 2012!

2011-12-23T08:16:00.001-08:00

Let's talk about how to reach your goals in 2012!

Happy New Year! More in 2012!

Video Blog: First Aid For Tendonitis

2011-12-19T09:23:00.000-08:00

Here is another video blog from Dr Marybeth Crane.
Today's topic for RunDoc is first aid for tendonitis.

Thank you for watching.

Video Blog: Does Running in the Rain Make You Sick?

2011-12-14T18:38:00.000-08:00

You asked for more video blogs, so here is the beginning of a new series :)

So enjoy running in the rain! Jump in puddles!! Have fun!

Does Running in The Rain Make You Sick?

2011-12-10T18:20:00.000-08:00

It’s one week after the cold, wet rain permeated the White Rock Marathon. Lots of people, including my mother, have asked me if I caught pneumonia from running “The Rock”?

So, does running in the rain make you sick? This is one of those questions that seems to be doomed to getting inconclusive answers forever. Especially when it comes to the opinion of Mom!

People usually do get sick more when the weather is rainy. That's because they stay indoors more, and indoors is where cold and flu viruses spread because of increased contact between individuals. On a sunny warm day, everybody goes outdoors, where there is (obviously) more space, better ventilation, and less physical contact with large numbers of other individuals.

Catching an infectious disease such as the common cold requires direct exposure to the pathogen (virus). Exposure comes in the form of close contact with an infected individual. Going into cold and rainy weather will not make you sick unless you also get colonized by the pathogen while you're out there.

There have been reports that cold temperature itself reduces the effectiveness of our immune system, but even that's not sufficient alone - you'd still need exposure to the virus.

Bottom Line:

"I'll get sick if I stand out in the rain or go out into the cold without a hat on" - Fiction

"Cold and rainy weather causes virus infections to spread more rapidly than usual" - Fact, due to people staying indoors more

Prevention:

Wash your hands, stay away from people who are sick, and feel free to run and play in the rain, just like we did last Sunday at the White Rock Marathon. Run Happy....and remember to jump in puddles after the 6th mile when your feet are already soaked!

Do NSAIDs Inpair Fracture Healing?

2011-12-02T07:30:00.000-08:00

Do NSAIDs Impair Fracture Healing?

There has been a theory that comes from looking at animal studies that NSAIDs like ibuprofen or Naproxen inhibit bone healing and may cause delayed unions or non-unions in fracture patients. Some doctors even go so far to say that you shouldn’t use NSAIDs in postoperative orthopedic case; but what is the truth?

A recent article in the Journal of Family Practice by Yates, Shah and Blackwell, showed NO, ALTHOUGH THE EVIDENCE VARIES. Nonsteroidal anti-inflammatory drugs (NSAIDs) don’t appear to impair clinical fracture healing. Even though animal studies show delayed healing and nonunion with NSAID use, evidence in humans doesn’t merit avoiding NSAIDs in patients with fractures who need the drugs’ analgesic and anti-inflammatory benefits.

Evidence summaryNSAIDs are commonly prescribed to control pain in patients with fractures. Laboratory studies have found that their antiprostaglandin properties delay callus formation and subsequent healing.1 However, human studies evaluating the effects of NSAIDs on fracture healing have found variable results.

BOTTOM LINE
The majority of physicians agree and recommend using NSAIDs temporarily along with other measures—such as rest, ice, and a steady return to the aggravating exercise—to relieve the pain of stress fractures until the patient is pain-free.

For more info on this retrospective analysis, click here.

Is it OK to Race White Rock Marathon Two Weeks After Ironman Arizona?

2011-11-29T04:23:00.000-08:00

Yesterday, in my Grapevine, Texas office, I had a patient who asked me this very question. He raced Ironman Arizona, which was November 20th and wanted to know if I thought it was OK for him to "jump in and run with a friend" the White Rock Marathon? Really? When I started laughing, he then asked if I thought perhaps a relay leg was OK?

So, after I composed myself I said, "It depends....." So I thought I would give a better, more scientific answer than "Are You Nuts?"

What he really was asking is: How long does it take to recover from a marathon? How long does it take to recover from an Ironman triathlon? How much racing is bad for my body? These are all good questions posed in my office on a regular basis. The problem is that the answer is always, "It depends". Everyone recovers at a different rate. Age, experience and current fitness level are large variables in the equation. I know a marathon runner in town who ran 100 marathons in a less than 10 years; and of course, we have all heard of Dane Rauschenberg who ran 52 marathons in one year for charity and then wrote a book about it! The flip side is that I know runners who can only do one marathon a year without getting hurt and most triathletes only train for one Ironman a year. So what is the magic formula? How much is too much? I think the first thing to think about is what is your goal? If you are just talking about finishing the marathons and not really having a time crunch, then feel free to do up to six a year but realize that having more than two quality runs in a year is very difficult. The Ironman distance should not be attempted more than 2 or 3 times a year regardless of time goals! Now, for those of us who are addicted to the watch, "racing" a marathon is something that should not be done more than twice a year. "Racing" an Ironman triathlon should only be attempted one a year.

Why is this true? Well, simple math. It takes a minimum of 4 months to train effectively for a marathon and 6 months for an Ironman. Then you need at least one day for every mile you ran and three to five days for every hour your triathlon took. That means a month of recovery before you start to train again after a marathon and at least 6 weeks after a 12 hour Ironman. Last time I checked, there were only 12 months in a year; hence, the common recommendation of racing no more than 2 quality marathons or one quality Ironman triathlon a year.
Why do some people recover faster? Age. My feeling is that youth is wasted on the young. I remember being able to run a marathon and get up and go to work the next day. Now I have to take at least one day off and often take two! Experience does help. Your body has been there before, so it knows it will live. Veterans often have a post-race routine down that helps them recover. (Often this includes the anesthesia known as beer!) If your fitness level is high and your nutritional status is good, you will recover faster.

What can you do to hasten recovery? Walk a cool down after the race. Do not sit down immediately even though your legs are begging you to! Take a 15 to 20 minute walk and stretch gently. An ice bath is best, but very few people I know are that tough. A cool bath followed by stretching before you go to bed is helpful. A large amount of carbohydrates and water also helps. Hence the beer phenomenon! A massage a few days after the race will help you recover. More than anything, do not start training again until you are fully recovered. Many injuries occur due to too much, too soon, too fast and too fatigued syndrome!

So how much is too much? Again, the answer is always, "It depends." Listen to your body. Really listen and stop being stubborn or stupid! If you start training and you are exhausted, you are doing too much. If you are spending too much time in my office and less on your bike, you are doing too much. The answer is really simple stupid. Listen to your body and it will tell you how much is too much.

Bottom line: Let your body fully recover from your races and quality times will be recorded. Race only one to two marathons or one Ironman triathlon a year. As for other distances, keep in mind that you need one day for every mile of a running race and at least 3 days for every hour you raced in triathlon. Anything shorter, you better take off your watch and go for the finish instead of the time and prepare yourself to spend some quality time with your local sports medicine physician!

Run Happy! And Recover Well! See You at White Rock!

Can You Name 11 Things to Know About 11/11/11?

2011-11-10T16:16:00.000-08:00

Do You Know 11 Things to Know About 11/11/11?

1. Did you know that tomorrow, November 11, 2011, happens only once every 100 years? Cool! And No, I don’t think anyone is predicting that the world is ending on that date!

2. It’s your lucky day! Brush it off as nothing more than a prime number, but some people look to the number 11 for good luck. What makes 11 more special than, say, 4, 15, or 3,856? Numerologists associate the number with balance and congruency, and math whizzes think it’s interesting because of little facts like this: If a number is divisible by 11, reverse its digits and that will create another multiple of 11 (for example, 1,056 is divisible by 11 — reverse it to 6,501, and that’s also divisible by 11).

3. Or is it your unlucky day? For every person on Team 11, there’s also someone who wants nothing to do with what they believe is actually an ill-fated digit. The 16th-century scholar Petrus Bungus said that 11 "has no connection with divine things, no ladder reaching up to things above, nor any merit" — and because of this, many numerologists of his time considered the number to represent pure evil.

4. Wedding bells will be ringing! You don’t need good luck to make a marriage last — you need love, respect, and hard work. But maybe it can’t hurt to get hitched on 11/11/11. In fact, more than 24,000 couples across the United States plan to wed this Friday, according to WeddingChannel.com — compared to about 1,500 couples who get married on an average Friday in November and 2,667 pairs who tied the knot last Valentine’s Day.

To prepare for the influx of marriage applications, the marriage license bureau in Las Vegas has even announced that it is increasing staffing on Nov. 11, according to USA Today.

5. There could be a baby boom, too. At Baylor Grapevine, there are already quite a few C-sections on the schedule for tomorrow! What’s even better than having an 11/11/11 anniversary date? An 11/11/11 birthday. And back in February, some parents-to-be did their darndest to conceive a child who would be born on the lucky day. Couples who enjoyed a Valentine’s Day romp could be in luck, as a baby who was conceived around February 18 could very well be born on Nov. 11.

6. Nov. 11 is also Veterans Day. It may be getting overshadowed this year by weddings and gambling, but Veterans Day is celebrated annually on Nov. 11. The United States honors its war veterans on this day to commemorate the signing of the armistice that ended World War I, which went into effect on the 11th hour of the 11th day of the 11th month. This 11/11/11, don’t forget to pay your respects to those who have served our country.

7. And it’s Corduroy Appreciation Day! It’s time to don your favorite pair of cords, since Nov. 11 is also National Corduroy Appreciation Day. It’s been celebrated annually on this date for the past few years, as 11/11 most resembles the lines of the fabric. And since this year there’s an extra 11 in the mix, corduroy fanatics everywhere will be celebrating in a big way: According to MSNBC, events include the Chicagoland Corduroy Appreciation Ball in Chicago and the Annual Grand 111111 Meeting in New York City.

8. Break out the origami and heavy metal. Okay, so it’s Veterans Day, Corduroy Appreciation Day, and thousands of couples’ wedding days. But Nov. 11 is also Origami Day in Japan (where the paper crane symbolizes peace), as well as National Metal Day, when VH1 will be honoring heavy metal music (rumor has it, the original lineup of the band Black Sabbath, including Ozzy Ozbourne himself, may reunite for the momentous occasion).

9. It’s a great day to jet set. Come Friday, Americans will be doing more than tying the knot and sporting cords — plenty of people are also going on vacation to take advantage of the once-in-a-lifetime 11/11/11 deals offered by travel Web sites to celebrate the day. Where is everyone headed? According to Viator.com, the Grand Canyon is one of the top destinations, as well as Paris, New York City, and Niagara Falls.

10. The last 11/11/11 made weather history. Though few people are old enough to remember the last 11/11/11, it was also famous for the Great Blue Norther, one of the biggest cold snaps — a dramatic temperature fluctuation — in U.S. history. For many Midwestern cities, this date in 1911 was only time when record-high and record-low temperatures were broken on the same day.

11. 11/11/11? There’s a Facebook group for that. If you’re feeling like the lone 11/11/11 reveler in your circle of friends, look no further than the 11:11 Facebook fan page. This group of more than 643,000 people from around the world is counting down to 11:11 a.m. on this momentous 11/11/11. Cheers!

Crazy, but I’m sure someone is having a special 11/11/11 race somewhere today! Maybe we should’ve planned that! 11 miles on 11/11/11!

Happy November 11, 2011!

Ps. Most of this was taken from a fun article on http://www.everydayhealth.com/ Thanks guys!

Getting Slower With Age? Sarcopenia is Preventable and Reversible!

2011-11-07T17:57:00.000-08:00

So why is it so hard to keep muscle mass when we age? Turns out it is caused by sarcopenia. Really! I'm not making up the term. Sarcopenia is the progressive loss of muscle mass that results from the normal aging process. It has been felt, in the past, that the loss of one to two percent of your muscle mass each year after the age of 40 is inevitable.

Turns out there are lots of things we can do about sarcopenia. One of them is to stop trying to look like a cachectic Holocaust victim and actually build some upper body muscles!! Runners tend to feel like if they bulk up at all in their upper body that it will slow them down. Research actually has refuted this claim over and over, but it is still one of those long-standing running myths. Strength training actually helps preserve muscles and strengthen bones which often improves your running economy and hence makes you more efficient, reducing the amount of energy to run at a certain pace. Win-Win!

Many factors go into the onset of sarcopenia. Chronic disease and environmental factors can accelerate loss of muscle mass, but these are not really controllable. Factors under our control that affect the progression of sarcopenia are motor unit restructuring, protein deficiency, and changes in hormone concentrations. These combine to produce the age related loss of muscle coordination and mass.

Really, it is all about proteins. There are two kinds of proteins; non-essential (those your body can synthesize) and essential proteins (proteins we need to get from foods). Your body seeks a balance between protein production (synthesis) and usage (metabolism) for energy and cell structure. We don't usually lose our ability to metabolize proteins with age, but we do lose our ability to synthesize them. This is where hormone balance comes into play. Things like Insulin-like growth hormone (IGF-1), testosterone and growth hormone. As our bodies age, our hormone concentrations decline. This is why aging baseball players love growth hormone, they think it stops sarcopenia! (Hgh declines after age 40 but there is not good research that proves supplementation will actually help!) What's more, it appears that as we age, we actually require more protein but continue with a similar diet hence we are out of balance.

The hormone decline and protein deficiency one-two punch is largely responsible for sarcopenia, but when you add the most vital aspect - motor unit restructuring - they combine to form a cocktail that results in the physical manifestation of aging. Motor unit restructuring is the product of the inevitable death of neuron cells. Fast twitch neurons (those responsible for precise or quick movements) die off first. When the cell reaches its predetermined life span, it dies. When a motor neuron dies, the muscle fibers that are under its command can deteriorate or atrophy. To prevent atrophy, when a fast twitch neuron dies, a slow twitch neuron nearby attaches itself to the now abandoned muscle fibers, innervating and keeping them alive. This change is known as motor unit restructuring. This is why we become slower and less coordinated as we age.

So how can we thwart this process? Move! Often! Sitting on the couch and leading a sedentary lifestyle is a good way to ensure sarcopenia with age. The best way to cure or at lest slow down the onset of muscle mass loss is resistance training. We recommend our patients participate in daily exercise, but often this is not enough. It will help your cardiovascular system, but resistance training with weights is the only way to reverse muscle mass loss. Couple this with increases protein intake to have the building blocks to redevelop muscles.

So, you want to be able to beat the young pups when you are in your 50's and 60's? Talk to your doctor about any health issues like diabetes or hypertension. Change your diet to higher protein and less carbohydrates. Forgo the pasta dinners and add lean protein! Resistance training with light weights and high repetitions at least 45 minutes, three times a week. Make it a habit you will take into your senior years!

You will thank me when you are still running in your 70's!

Can I Run on a Stress Fracture?

2011-10-30T14:21:00.000-07:00

Lots of good questions in my Grapevine, Texas office and on the website this week. It is definitely marathon time of year! Lots of aching feet and legs from erratic training and “too much, too soon, too fast syndrome”.My favorite is “I have XYZ Marathon in a few weeks, Can I run on a stress fracture?” This was actually asked three times in two days by a patient and once in an inquiring email on www.myrundoc.com

Of course, my answer was, “Really?.....” Ok, so you think you are a tough guy and can run through a stress fracture, but this is a very bad idea!

Hurts like hell!

Probably break it into many more pieces

Probably end up not running for months

May end up on my operating room table for pins, plates and/or screws!

Are you really that stupid???

Seriously? A stress fracture is a small crack in the bone that hasn’t fractured all the way through. Guess what happens when you run on it? It breaks all the way through!

So, if you are running in the Olympic marathon and think you are amazingly tough, then try it; but bottom line: NO! You can’t run on a stress fracture! If you try, you probably won’t be running for quite some time after that race, so it better be worth it!

Learning point: If you even think you may have a stress fracture, an x-ray is indicated pronto! Remember that they often do not show up on plain films for up to two weeks after the injury. The tip of my index finger is usually right! Give us a call and we can squeeze you in. The best part of having 5 doctors at Foot & Ankle Associates of North Texas in Grapevine, is that we can always find an emergency spot with one of our doctors!

Are Custom Orthotics Worth the Investment?

2011-10-21T07:39:00.000-07:00

If you are a frequent visitor to Foot and Ankle Associates of North Texas in Grapevine, TX, you probably already know about orthotics. Maybe you have even purchased orthotics. A foot orthotic is an insole placed into the shoe that helps control foot position.

There are two main types of orthotics: Functional and accommodative. These can be prefabricated; like Lyncos that are popular at Healthy Steps or custom; which the doctor fabricates unique for your feet.

A functional orthotic controls foot movement and helps a person walk in a way that best supports joints and muscles. An accommodative orthotic helps distribute foot pressure evenly over the bottom of the foot. Most patients use a functional orthotic and usually these are custom for long term usage. A functional orthotic can be useful for many problems and are used to balance the biomechanics of your feet. Think of them as an in-shoe tire realignment for your feet. Accommodative orthotics are very useful to distribute stress in the elderly, diabetic and arthritic populations.

In the foot care aisle at your local drug store or grocery store, you may have seen readymade orthotics for sale. Does it really matter whether you buy store bought orthotics or custom orthotics from your podiatrist? Well, some people may be able to get away with wearing store bought orthotics for a period of time. We often even start our treatment plans with these type of prefabricated devices so we can get you on the road to better foot health immediately; but most patients do need custom for long term control of their foot type.

When you think about the long term health of your feet, custom orthotics are the way to go! Store bought orthotics are made to fit many foot problems for a large variety of people; one size fits all usually means one size doesn’t truly fit anyone! To be truly effective, an orthotic must be fitted for YOUR particular needs. Wearing an ill fitted orthotic is not only a waste of time, but it can also make your foot problems worse. Over time these problems can lead to leg, knee, hip, and even back problems. Store bought orthotics tend to not offer long lasting comfort. If you find yourself buying store bought orthotics every few months because of foot pain, it may be time to schedule an appointment to see one of the doctors at FAANT. Your podiatrist will produce orthotics that fit only YOUR feet. The materials used will be those that are best suited for your walking and running needs.

Everyone deserves special treatment! With a real custom orthotic that is exactly what you have. Yes, custom orthotics can be costly, but so can surgery from walking incorrectly over the years. I’m always amazed that many insurance companies will often not cover orthotics, but will pay for surgery! Doesn’t make any sense!! Think of the orthotics as an investment and an investment in your health is one of the best choices you can make for yourself.

Marine Corps Challenge!

2011-10-21T06:49:00.000-07:00

This looks like fun!

Do you have what it takes to pass the Marine Corps Combat Fitness Test?

Join the marines of dfw and put your skills to the test!
· Go over standards of movement
· Go head to head with marines
· Put your fitness skills to the test as you take the cft
· Open to the public and all branches of military

Where: Stripling middle school
2100 Clover lane fort worth, TX 76107

When: Oct 29th, 2011 open registration 900am - 3pm

First heat begins at 930

Cost: free – donations are welcome

For more information contact sgt eaton
– phone: 419 957 9925
– email: Jacob.eaton@usmc.mil – jaceat83@Hotmail.com

PS. Wear long pants and long sleeved shirt since you will be crawling!!

Who needs a Muddy Buddy run! This is real adventure training!

Winner of the Facebook Google Contest!

2011-10-17T06:03:00.000-07:00

Well its been a fun two weeks! Dr Giacalone and I actually ended up in a tie!! I guess we both win dinner! The other docs are having a fit because now we both have more funny and informative reviews than they do. We might have to let them in on the fun???? Maybe....

The winner if the free pair of running shoes was Julie Wolfe! Come claim your prize at Healthy Steps!

More contests to come! This was too much fun!!

Poconos 70.3 A Perfect Storm…and 68.1 Really!

2011-10-03T19:08:00.000-07:00

Crazy Weekend! Wet, Rainy, Cold, Hilly and the most ridiculous course I’ve ever ridden! Let’s be serious. The weather was awful! I had picked a race in the Northeast because I was sick and tired of feeling like I was running on the face of the sun! God has a sense of humor. I was thinking it would be a balmy 65 degrees or so and warm up to 70? No, how about 41 at the start that warms up to 55! Did I mention the rain? Yes, it rained for something like a week before the race so the river was so high we couldn’t swim.

The Delaware River Gap was 7 feet above its banks and had so much debris they were worried one of us would get killed. I get that. Honestly, I was a little miffed until I went down to the river and saw how high and how fast the current was flowing. Then I was glad we weren’t swimming. It was scary looking!

So we started with the bike. Hmmm…how do you get 2,000 people on a bike course without killing themselves in a mass start? Time trial start…sorta. They started the pros with 30 second intervals at 7:25am….yes, a little late. The rain and clouds made it a little dark at 7am. Then they started with the age groupers at 3 second intervals…really! So much for no drafting. We were all bunched up on wet roads that were absolutely scary at times. The first half of the bike course was all bunched up and very, very hilly, with a lot of scary turns. Lots of crashing! At one point I was going 34 miles an hour down a hill and watched the guy in front of me wipe out on the turn. At that point I hit the brakes and thought perhaps a slower ride was the better side of valor. The hills were unrelentless. At 50 miles, there was a 5% grade after turning a corner. I did something I have never done since grammar school. After watching one guy fall off the hill with his bike (no time to unclip), I got off and walked the hill! I was embarrassed until I saw about 10 people after me do the same thing! This course was crazy, sick hilly!

Into T2 I went with completely screaming quads! I put my running shoes on and took off only to find that my legs were dead! Really dead! I jogged a few miles and they seemed to warm up, but then I hit someone’s version of a joke! Crazy, rolling hills on the run. All kidding aside, they were nothing like the hills on the bike, but we were all bitching and moaning. I saw more people walking than any race I have ever run. I pathetically jogged into the finish. Happy to be done. Freezing! Crazy, cold, rainy weather plus sick course makes for a miserable day. Whatever doesn’t kill you makes you stronger.

Perhaps I should venture down to the Longhorn 70.3 in three weeks in Austin and kick some butt, because honestly the Poconos 70.3 kicked my butt! Happy to be alive and smiling! Time was pathetic but I finished. The older you get, the more that matters than the watch!

Facebook Contest For Google Places

2011-09-29T11:40:00.000-07:00

Dr Giacalone and I have a bet at the office about who can get the most Google reviews in the first two weeks of October. Help me win by posting a review to Google Places formerly known as Google Local. If you post a review of the practice and/or review just me and email me a copy, I will enter you in a drawing for a free pair of Brooks running shoes or a pair of orthopedic sandals from Healthy Steps Shoe Store. Yes, I am bribing you. Shhh! Don't tell Giacalone! You can get two entries if you do both the practice and me individually. I will even throw in a third and fourth entry if you review me and/or review the practice on Yelp! Contest starts right now and ends on Saturday October 15th! I will keep all of you updated on how the contest is going so please help me win!!

Knee Woes From Running: Iliotibial Band Syndrome

2011-09-06T09:54:00.000-07:00

I had a great question this weekend at a running forum in Grapevine. One of the runners had lateral knee pain that came and went with no obvious cause. She thought she had ITB (iliotibial band) syndrome (sounded like symptoms her friend told her about) but she had been doing stretching and icing with no avail. What else could she do? Is it possibly from her shoes? Is rest enough?

Let’s talk about ITB syndrome.

The most common cause of lateral knee pain in runners is ITB syndrome, related to repetitive friction of the band sliding over the lateral femoral epicondyle as the knee flexes and extends.

Runners may complain of a sharp or burning pain about 2 cm superior to the lateral joint line (above the outside of your knee); exam may reveal tenderness to palpation there. Swelling and redness are usually not present unless it is severe.

Runners who are predisposed to this injury are typically overtraining. They often have underlying hip abductor muscle weakness; leg-length discrepancies may contribute to ITBS. They also have been found to have either a really high arched foot (cavus foot type) or an extremely flexible flat foot.

Acute phase treatment includes relative rest, ice, and anti-inflammatories. Physical therapy modalities like ultrasound and e-stim can also be helpful to break the inflammation cycle. In cases of severe pain or swelling, corticosteroid injections may be used.

During the subacute phase, stretching of the ITB is emphasized, along with soft-tissue therapy for any myofascial restrictions. Orthotics and shoe gear changes are also often indicated. Many patients actually are running in too heavy or too stabilizing shoes, especially if they have a cavus foot type.

The recovery phase focuses on a series of exercises to improve hip abductor strength and integrate movement patterns.

The final return to running phase is begun with an every-other-day program, starting with easy runs and avoidance of hill training, with a gradual increase in frequency and intensity. Remember: too much, too soon, too fast is what got you hurt in the first place!

Rest alone is usually not enough! This can be a painful chronic injury. Surgery can be considered in refractory cases, but this is rarely indicated.

The Hottest Hotter than Hell Hundred in History!

2011-08-28T15:35:00.000-07:00

Wow! If you ever think about doing the Hotter than Hell Hundred Triple Threat, check the weather forecast! This weekend was absolutely crazy, borderline insane, and if nothing else….HOT!

Janet and I, in our usual fashion, were wandering the office causing trouble, when Janet said, “Hey! Want to do the Triple Threat at the Hotter than Hell Hundred bike ride?” I thought it might be fun, and had missed the ride the last few years due to scheduling conflicts. Janet went on to explain that it was a 12 mile beginner mountain bike ride on Friday night, the 100 mile road bike ride on Saturday, and a tiny little half marathon trail run on Sunday morning. Sounded like a full weekend, but what the heck.

We wrapped up seeing patients on Friday and jumped in the truck, heading for Wichita Falls. We checked into the nicest hotel in the whole city (Yes, they have one Marriott Courtyard) and made our way down to the expo to get our numbers and directions for this madness.

After a little bit of shopping and losing a timing chip, we made it to the mountain bike start with a whole 15 minutes to spare. I had already chickened out (I don’t own a mountain bike, didn’t want to borrow one, and heard way too many crash stories), but Janet was ready to go. A good group of about 10 people from our running peeps, Lake Grapevine Runners and Walkers, had also decided to try their hand at this madness; so group psychosis was also occurring. Did I mention the temperature was 103? The head official explained all the loops and turns and a little water crossing right near the end. The gang took off and I decided that perhaps watching the race at the water crossing might be fun.

Fun it was! Not one person made it across the water crossing without dismounting, either by choice or falling face first into the water! I saw one broken front wheel and one flat tire, but mostly just very graceful water landings. Janet came through and was smart and portaged her bike. I ran to the finish to meet the gang and knew immediately we had a problem. Janet had a bruise the size of a small dinner plate on her shoulder and had her not happy face on. Turns out she challenged a tree and the tree won!

We decided to head back to the hotel for ice, Advil, a shower and of course beer. Beer and a good dinner cure all bumps and bruises. We hooked up with our friend Debbie and had a great steak dinner and more than a few beers. Then it was time for bed. 5am comes early!

The alarm went off at 4:30 am and that was the first time I had the thought, “Why do we do this?” We got our bikes and gear together, shoveled down a little breakfast and we were off to meet the peeps. The three of us were awake and ready to take on 100 miles with 10,000 of our closest friends. The temperature at the start was 80. Not bad, with a little breeze. We saw our LGRAW friends, but they decided to start toward the front of the group called “the Scorchers”. That’s the people who ride from 20-25+ mph. We were in “the Keepers”, planning to average 17-20 mph or so. We positioned ourselves at the front of the Keepers, or the back of the Scorchers; however you want to look at it. We all had our bike lights on because it was still dark and that made an impressive sight with all the blinking tail lights, in fact, I felt like if I stared at them long enough I could hypnotize myself into thinking I was still in bed! The cannon went off at 6:15am (they allowed an earlier start this year for those that wanted it or you could start at the official 7am start but given the heat, why would anyone do that?)

Off we went. The first few miles was slow and had a few stops due to the crowd, but by 10 miles or so it started to thin out so you could ride comfortably. The three of us were riding together and then Debbie dropped her sunglasses. (Yes, it was still dark so they were in her side pocket) She went back for them, but only found pieces.

We all skipped the first two aid stations and stopped at 30 miles. So far, so good. Everyone felt good and the heat was not a factor yet. We then stopped at every other aid station until we got to “Hell’s Gate”. This is the official spot (around 60 miles) that you have to get to by noon, or they turn you onto the 100K route and make you go home. We got there about 10 am, so Hell’s gate was still open and we got our picture taken with “Pyro Pete”, a gigantic devil blow up doll!

Hell’s Gate is appropriately named, because the route passed that point is rolling farmland with very little shade, bumpy roads, and it was getting hotter by the second. We started stopping at every aid station and I started putting ice in my jog bra to try to cool down my core. I actually felt alright as long as I kept drinking, but Debbie was starting to look bad and Janet was getting very quiet. I have to admit, between 70 and 90 miles, it felt like someone had opened the oven door and shoved my head in! Or maybe a blast furnace? Even the wind was hot, so it didn’t cool you down at all. We were all feeling the heat, but were still plugging along. We dropped from 18-20 mph to about 16 mph. The carnage all around us was remarkable. The SAG wagons had tons of people and bikes on them, but you still saw the occasional biker under a tree or passed out on the side of the road. My day was complete when I saw an armadillo and a coyote in the same 5 mile stretch! Gotta love Texas in the summertime!

Debbie and I stopped at the 90 mile aid station to try to get more ice, but Janet plugged on. She said there was beer at 98 miles and she really wanted one! We got to the “Unofficial 98 mile aid station” and I thought I was seeing a mirage. There had to be at least two hundred people hanging out and drinking beer, eating chips and sausages, and having a party in an old machine shop on the side of the road! It was hysterical. We found several of our friends just hanging out there, and made many new friends after a few beers. One guy said he finished at 10:30 am then came back to his favorite aid station. Lots of people were completely hammered! Too funny! After a few beers, we collected our friends and decided it was time to make it to the finish line. Two miles of slightly impaired cycling, we were finally finished!

They had a fire hydrant open and spraying everyone at the finish, so we stripped off our shoes and went dancing in the water. So happy to be done!

Back to the hotel for showers and a long deserve nap. It was the local news that let us know it was the hottest Hotter than Hell Hundred on record, topping 109! No wonder I felt like I was in an oven!

After our naps, we joined our friends for beer and BBQ at their campsite. (Yes, a lot of people bring campers and stay the weekend near the trails) Janet and I like camping at the Marriott better!

Then the alarm went off at 6 am this morning! Again, I was thinking, “Why do we do this?”, but I got up and putting on my running gear. Yes, it was time to do a trail half marathon. On the same course as the mountain bike ride on Friday night! Yes, a water crossing and everything! We met our still crazy friends at the start. Everyone had survived so far with just a few bumps and bruises. Janet decided we should walk run the course given our legs hurt from the previous day’s small endeavors, so we walked. And ran up and down these crazy hills and valleys, singing over the river and through the woods. The two of us finished up together laughing to the point of almost crying because we had both reached fully nuts when Janet almost stepped on snake #3 that we saw on the trails just about 400 yards from the finish! That will get your heart rate going!

Happy to have finished, Janet got a really cool cyprus plaque proclaiming that she had survived the Triple Threat….and yes, it was 104 at the finish! What a weekend!

Ps. stay tuned to my Youtube channel, I made a video of the weekend.....

Spareribs Sure Fire Injury Cure

2011-08-25T14:36:00.000-07:00

Thanks to the shout out from my friend and running peep Spareribs LaMothe in the Dallas Morning News Running Blog this morning. He made a few great points about injury management in his blog. The two best were to seek professional help early in the injury course. The faster you obtain a correct diagnosis, the sooner you will get better! The second point was to find a doctor who runs! As a sports medicine podiatrist who endulges in border-line crazy endurance sports, I speak your language and have a network of other doctors and therapists that are all on the same page! If your doctor thinks that "LSD" is still a drug and not an acronym for "Long Slow Distance", maybe you need another doctor for your running injury! Thanks again Spareribs!

John J. Kelley, May He Rest in Peace

2011-08-21T17:03:00.000-07:00

My heart is saddened by the passing of John J. Kelley, the first true marathon champion who influenced my life. I remember many cold mornings in Mystic, Conn. Sharing soup after a freezing penguin run from Kelley’s Pace, the store he ran after his retirement. He was an amazing man and a true mentor to high school and college students in the area.

I grew up in Ashaway, Rhode Island, just over the Connecticut border. He was a coach to everyone, not just the kids on his team. His store was the closest true running store in the area. I always wondered as a young tenn how he made any money since he chatted with everyone for hours at end. Turns out, he never did. The store was just an outlet for his passion. He always had a New Years party that included a run and a dip in the Atlantic Ocean for the crazy! Many years I joined in during high school.

He died on Sunday in North Stonington, Conn, just a few miles from my hometown. He was 80. I probably saw John for the last time in 2002 at the Boston Marathon. My last conversation was in 1986, just before I graduated from high school and ran away from my little rural hometown as fast as I could. I only wish more young people could’ve been touched by Mr. Kelley. I remember most a day in his store when he told me that I could do anything I put my mind to as long as I developed pain tolerance! He was quite the man!

John J. Kelley will be missed.

Joining the Mile High Club? Tips for Running at Altitude

2011-08-15T08:49:00.000-07:00

Are you a member of the Mile High Club? No, not the one that involves airplanes and yoga poses! I’m talking about running at elevations of 5,280 feet and higher.

I’m on my way to Colorado to spend a week with my kids at Keystone. Of course, I’m excited to get in some trail runs, but a little worried about the altitude. I called a few of my friends who live in the Mile High State and got some tips on running at altitude that I figured I would share.

Running at a higher altitude can make you feel like a slug, and an asthmatic slow one at that. However, if you’re careful, and keep some of the following tips in mind, high altitude running can be very enjoyable and great for racing at lower altitudes!

1. Hydrate. Drink plenty of fluids before, during and after your run. Then drink some more. Dehydration occurs quicker at higher altitudes, so this is good advice even if you won’t be running.
2. There’s less air up there. This is a good news/bad news situation. The bad news is that according to my buddy, Dr Jack Daniels (coolest running coach on the planet!), at an elevation of 6,500 feet you lose 10 percent to 12 percent in VO2 max and at 7,500 feet you lose 12 percent to 15 percent. The good news is that a lower density of air means lower air resistance and better running economy. You just keep telling yourself that when you’re winded like an overweight smoker climbing to the top row in the stadium.
3. Enjoy the view. You should prepare yourself for a slower paced run than you’re accustomed to and you’ll find that focusing on the surroundings instead of your watch will make that easier. Running with peeps also helps! Bring a friend or two and you can be asthmatic together!
4. Wear sunscreen. Putting yourself a mile closer to the sun may seem insignificant when you think about how far away the sun is, but I assure you that it will not feel insignificant tomorrow if you fail to heed this advice. Think ahi tuna!
5. Lip Balm, and plenty of it. When you pass another runner you want to be able to wave and crack a smile, not your lips.
6. Take it easy. Stick to easy runs until you become acclimated; if ever. Wear a heart rate monitor so you can see when you are out of your zones. Don’t look at your watch, just set the heart rate alarm. Time means nothing! Don’t try to go out and run a tough session of intervals on your first run at altitude. If you’ll be racing at a high altitude, plan to spend as much time as possible at that altitude prior to the race.

Bottom line: Take it slow and easy and enjoy your runs!

Really? Invisible Shoes For Running

2011-08-11T16:54:00.000-07:00

I received a really neat package in the mail that included two pairs of “Invisible Shoes”, sent to me by the folks at Invisibleshoe.com to try out. My first thought was, “This is crazy!”, but as most of my readers know, I will try anything once! I have in the last few years embraced minimalism and have transitioned many of my more elite patients to a more midfoot striking natural running style in minimalist shoes. This is only about 15% of my patients, while the rest still need the control of an orthotic due to foot abnormalities and old injuries. (Yes, I know the debate continues on these issues, stop sending hate mail!)

I currently run in the Saucony Kinvara and wear the Saucony Hattori for walking and gym workouts. I am curious to see how the “Invisible Shoe” compares to the Hattori. I am still not a fan of totally barefoot due to the concrete jungle we live in and I have never liked the Vibram Five Fingers; but mostly because so many of my patients have hurt themselves in them and the shoving my toes apart thing I personally find totally annoying. I use my pair of Vibrams for open water swimming. They protect my feet from rocks in the lake!

A little over view for those trying to figure out what I am talking about. There is no other shoe in the minimalist footwear industry as truly minimalist as the huarache. Think a piece of rubber on your foot is as close to barefoot as it gets. Your feet are free to move in the most natural way with no fabric upper to impede or constrict foot movement in any way. Yes, on the surface I still was thinking this is nuts!

The “How to Make Your Invisible Shoes” directions on the website were easy to understand, but took a little longer than expected to put together. A punch tool was needed but I didn’t have one so we improvised.
All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.

My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.

Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.

If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.

Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!

2011-08-07T07:45:00.001-07:00

Wow! This week I had the worst chronic peroneal tendon rupture I have ever seen! My patient had sustained an “ankle sprain” about two years ago and wondered why her ankle looked more like a “cankle” two years later. She had a large lump just behind her fibular malleolus (a.k.a. the bone on the outside of your ankle). She noticed swelling on and off, but it never really went down all the way. She also had intermittent pain and felt like her ankle was unstable. Like most women with several children, she ignored it until it really became a lifestyle issue. She felt like she couldn’t exercise at all because her ankle felt so unstable.

Peroneal tendon injuries often occur with ankle sprains and are commonly overlooked until your ankle pain becomes chronic. The peroneal tendons stabilize the outside of your foot and ankle and allow you to turn your foot outward. There are two tendons which run side by side, behind your outer ankle bone, then split in the foot; one to the outside while the larger one dives under your foot and inserts in the arch just behind your big toe joint.

People with high-arched feet are more likely to experience peroneal tendon injuries.

Peroneal tendon injuries fall into three categories: tendonitis, tears, and subluxation. They are more common in active, athletic patients and can be acute (sudden) or chronic (lingering) in nature.

Tendonitis is inflammation, acute tears are caused by an injury and tendonosis (chronic tears) are usually caused by overuse and repetitive stress or chronic tendonitis. Subluxation usually occurs in an acute injury, like an ankle sprain, where the tendons actually dislocate onto the outer ankle bone and snap back and forth with activity.

The symptoms of a peroneal tendon injury can include swelling, pain, warmth, weakness and instability of the foot and ankle. Subluxation can also include a snapping feeling and sporadic pain with activity.

Treatment of peroneal tendon injuries is often delayed by misdiagnosis. If you are experiencing any of the symptoms of a peroneal injury, seek medical attention from a foot and ankle surgeon urgently. The longer the tendons go untreated, the more damage occurs. X-rays and physical examination usually lead to an MRI to solidify the diagnosis.

My patient’s MRI showed a severe rupture of peroneus brevis with a bulbous scar tissue formation which you can see in the below picture. Peroneus longus was normal.

Treatment include rest, casting, functional orthotics, anti-inflammatory medication or injection therapy, physical therapy, bracing, and in some cases surgery. Obviously, my patient needed a repair. We excised the torn and hypertrophied part of the tendon, then repaired the rest and fixed her ligaments so she would stop being so unstable and finally lose her “cankle”.

Here is the piece of abnormal tendon we excised. Wow! Big chunk!!

Your disability from a peroneal tendon injury can be significantly reduced by early intervention, so if you are experiencing any of these symptoms, call or contact the office and be evaluated. The sooner you have a proper diagnosis, the faster you will return to normal activity levels pain-free. If my patient had come in earlier to have her “ankle sprain” evaluated, conservative therapy might have healed her tendon injury!

Podiatrist Raises Money for Muscular Dystrophy Carrying Patient in Triathlon

2011-07-22T07:43:00.000-07:00

I rejoice every time I see another podiatrist doing great things in their communities. I was so excited when I read an article about one of my colleagues, a fellow sports medicine podiatrist and Ironman triathlete, who raised money for muscular dystrophy by carrying one of his patients, a local 10-year-old boy with MD, for an entire sprint triathlon last weekend.

We have all been inspired by Dick and Rick Hoyt's many adventures in marathon running and triathlon; but to carry another person while competing is actually an extrememly difficult task. Paul Sommer, DPM, a podiatrist in Valparaiso, Indiana, found this out when, after finishing the Valparaiso triathlon last weekend, he was rushed to the emergency room with shortness of breath and a rapid heart beat. Luckily he was OK after his escapade! He did manage to raise over $6000 to help a little boy named Kyle put wheelchair ramps on his home.

If you would like to help Dr Sommer in his fight to help families affected by muscular dystrophy, click here.

Recovery Drinks? What Should I Eat and/or Drink After a Race?

2011-07-17T17:37:00.000-07:00

Ok, I have been joking all week with my triathlon peeps that beer is the best recovery drink! But seriously, I think there are two questions that need to be answered:

1. How much do I really need to drink after exercise, especially in this ridiculous heat?

2. What is the best thing to drink and/or eat?

So, here are some simple answers to what is actually two very complex questions! Remember that individuals all differ and our sweat ratios also differ. A great way to determine how much fluid you need after a race or long run or ride is to weigh yourself before and after exercise and replace fluid losses by drinking 20-24 fl oz water for every 1 lb lost.

What should you drink and/or eat? Yes, I like beer after a race but science shows that you should consume a 4:1 car/protein ratio. (I hear all those fans of chocolate milk cheering).

Research has shown that eating 0.3-0.6 grams of carbohydrate for each pound of body weight within two hours of endurance exercise is essential to building adequate glycogen stores for continued training. Waiting longer than two hours to eat results in 50 percent less glycogen stored in the muscle. The reason for this is that carbohydrate consumption stimulates insulin production, which aids the production of muscle glycogen. However, the effect of carbohydrate on glycogen storage reaches a plateau.

Research also shows that combining protein with carbohydrate within thirty minutes of exercise nearly doubles the insulin response, which results in more stored glycogen. The optimal carbohydrate to protein ratio for this effect is 4:1 (four grams of carbohydrate for every one gram of protein). Eating more protein than that, however, has a negative impact because it slows rehydration and glycogen replenishment.

One study found that athletes who refueled with carbohydrate and protein had 100 percent greater muscle glycogen stores than those who only ate carbohydrate. Insulin was also highest in those who consumed a carbohydrate and protein drink.

Consuming protein has other important uses after exercise. Protein provides the amino acids necessary to rebuild muscle tissue that is damaged during intense, prolonged exercise. It can also increase the absorption of water from the intestines and improve muscle hydration. The amino acids in protein can also stimulate the immune system, making you more resistant to colds and other infections.

Good replenishment food?
1 medium banana and glass of low-fat milk.
A bowl of granola with 1 C low-fat milk.
Low-fat yogurt with 1/2 C of fresh berries.
Almond butter on whole wheat toast.
A bowl of whole grain cereal with low-fat milk.

Bottom Line

If you are looking for the best way to refuel your body after long, strenuous endurance exercise, a 4:1 combo of carbohydrate and protein seems to be your best choice. While solid foods can work just as well as a sports drink, a drink may be easier to digest make it easier to get the right ratio and meet the 30 minute window. Personally, I’m sticking to beer and will add a peanut butter and jelly sandwich!

How Do You Know When You Need Rest?

2011-06-29T11:24:00.000-07:00

Good question. Personally, I err on the side of caution. If I’m tired when I wake up in the morning or I feel like I was run over by a truck…..well, that’s a good indication to take a day off. Many runners and triathletes burn the candle from both ends. The old saying is that it is better to be 15% undertrained than 1% over trained. This is my motto that allows me to take a day off here and there when the fatigue of the mega miles is kicking in. I find that I race way faster when not fatigued! Really!! (Sarcasm)

So, do you get adequate rest? How can you gauge your fatigue if you are a sadomasochist training for an Ironman or marathon? The June issue of Runner’s World has a great article on gauging rest. I had to laugh, because you can actually pay someone to tell you to take a day off! Simple solution: Pay me!! Just kidding, let’s look a little closer at guidelines for rest days.

On a serious note, there is a service called Restwise, which looks at simple biological markers input by the athlete first thing each morning, calculates a daily recovery score from 1 to 100, then trends it over time. (Rest-wise subscriptions start at $119 for six months; go to restwise.com.) You certainly can pay them, or you can look at 10 biological markers and rate yourself.

1. BODY MASS: You lost weight from yesterday
A two percent drop in weight from one day to the next indicates a body-fluid fluctuation. Most likely, you didn't hydrate enough during or after your last workout. Dehydration negatively impacts both physical and mental performance, and could compromise the quality of your next workout.

2. RESTING HEART RATE: Your resting heart rate is elevated
Take your pulse each morning before you get out of bed to find what's normal for you. An elevated resting heart rate is one sign of stress. It means your nervous system prepared for fight or flight by releasing hormones that sped up your heart to move more oxygen to the muscles and brain. Your body won't know the difference between physical and psychological stress. A hard run and a hard day at work both require extra recovery.

3. SLEEP: You didn't sleep well or enough
A pattern of consistently good sleep will give you a boost of growth hormones, which are great for rebuilding muscle fibers. Several nights in a row of bad sleep will decrease reaction time along with immune, motor, and cognitive functions—not a good combination for a workout.

4. HYDRATION: Your pee is dark yellow
This can be an indicator of dehydration, barring the consumption of vitamins, supplements, or certain foods the evening before. The darker the color, the more you're struggling to retain fluids, because there's not enough to go around. You need H2O to operate (and recover).

5. ENERGY LEVEL: You're run down
If your energy level is low, there's something amiss. The key is honesty. Athletes can block out signs of fatigue to push through it, thinking it will make them stronger. It won't always work that way.

6. MOOD STATE: You're cranky
When your body is overwhelmed by training (or other stressors), it produces hormones like cortisol that can cause irritability or anxiety. Stress also halts chemicals like dopamine, a neurotransmitter in the brain that has a big bummer effect on mood when depleted. Crankiness probably means not enough recovery.

7. WELLNESS: You're sick
Any illness, or even a woman's menstrual cycle, will increase your need for energy to refuel your immune system, which is having to work overtime. This means fewer resources available for recovering from training.

8. PAIN: You're sore or nursing an injury
Whether you're sore from overworked muscles or an injury, your body needs more energy to put toward repair, lengthening total recovery time.

9. PERFORMANCE: Your workout went poorly
This is a subjective measure of workout quality, not quantity nor intensity. If you felt great on yesterday's run, you'd evaluate that as good. If you felt sluggish on that same run, you'd count it as poor. Trending workout quality—multiple poors in a row—is one of the easiest ways to identify the need for more recovery.

10. OXYGEN SATURATION: Your oxygen level has dipped
The amount of oxygen in the hemoglobin of the red blood cells can be measured by placing your fingertip in a portable pulse oximeter, a gadget available online for about $40. The higher the percentage, the better: Above 95 percent is the norm at sea level or for an athlete who is fully acclimated to a given altitude. This is a new area in recovery science, requiring more research, but there may be a link between low oxygen saturation and the need for more recovery.

Count Your Red Flags

The restwise algorithm assigns more weight to some markers (e.g., performance) than others (e.g., mood), along with other factors to generate a precise recovery score. But you can get a sense for your ballpark recovery quality by tallying the red flags (left) you average per day in a week.

0-1 GREEN LIGHT
You are clear to train hard.

2-4 CAUTION
You can go ahead with a hard workout if your training plan calls for it, but cut it short if it feels too hard. Better yet, take an easy day, or a day off.

5-6 WARNING
You're entering the danger zone, which could be intentional according to your periodization or peaking protocol. If not, back off.

7-10 DANGER
You require mandatory time off, ranging from a day to a week, depending on the severity of your fatigue and what you've seen over the previous few days and weeks. You may need to visit your doctor.

FEEL Better: Too much rest has its own problems: Your performance stalls. On your recovery days, do something active; go for a leisurely bike ride or swim (I take my 11 year old out on her bike), walk, or do yoga.

Keep in mind that muscles need 48 hours to recover from a hard workout. Always follow a hard day with an easy one. Watch your red flags and rest accordingly. Your times will show improvement!

Patellofemoral Pain Syndrome in Runners: Pain in the Knee!

2011-06-28T09:09:00.000-07:00

Knee Pain Slowing Your Run to a Crawl? You may have patellofemoral syndrome.

What is patellofemoral pain?

Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.

The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the "patella") moves on the groove of your thigh bone (called the "femur"). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been implicated as a cause.

What can I do to help my knee mend and relieve the pain ?

Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.

Physical therapy is the mainstay of treatment. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.

Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease excessive foot motion that causes stress on the knee. Even just a simple arch support insert can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.

Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.

Will I ever be able to run again?

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won't get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability. Remember, you'll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”. Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

2011-06-17T14:18:00.001-07:00

My new favorite sign!

Safety Tips for Running in the Summer Heat

2011-06-17T14:07:00.000-07:00

Hot running is here again this summer. A little too soon for me! It’s 80 degrees at 6:30am, 100 degrees by 1pm; and let’s face it: it’s really hard to get motivated to run!

Goals are important during the summer training months. When you look at your calendar and see the races you have penciled in, getting out of bed is a lot easier. Pick a race in the fall and enter! I have already entered the Ironman 70.3 Pocono Mountains in October and the White Rock Marathon in December. The power of the race calendar gets me motivated to get the workouts done on these hot, hot days.

I also encourage everyone to try to get their workouts in either early in the morning or inside at the gym in the afternoon. Ozone is so high during the afternoon hours and poor air quality warnings abound this time of year. No reason to stress your upper respiratory system; do it early or do it inside!

Just a few tips to keep yourself safe this summer while running in the heat:

1. Hydrate. Sounds obvious, but I don’t mean only when you are running. I keep a water bottle next to my computer and try to drink on and off all day. The heat outside mixed with the air conditioning inside is a recipe for dehydration even before you start running. While you are training, make sure you carry a water bottle. Don’t rely on there being water on a course or water fountains on the trail being in working order. Drink 15 minutes before your run and at least every 15 minutes while running.

2. Dress for the heat. Naked is never a good idea, but I have thought about it. I’m sure the Grapevine police wouldn’t mind! Seriously, this is not the time for cotton t-shirts. Splurge on some moisture wicking shirts and shorts. There are even some new sun repellent, yet surprisingly cool, long sleeve shirts for the fair skinned ones among us who can use the extra SPF.

3. SPF is what it is all about. Sunscreen or you will burn in as little as 15 minutes of sun exposure. Bull Frog makes an SPF 100 water proof sunscreen that rocks! Wear it! No sense being in great shape but dying of skin cancer!

4. Salt Tablets. If you are going long, salt tablets are helpful to keep your systems going. I take at least two an hour when training in the heat, more if sweating like crazy. Hyponatremia (low sodium) can become a medical emergency!

5. Wear a heart rate monitor. You will be amazed in how much your heart rate goes up when it is hot. Stay in your zones, even if that means walking up hills! You want quality miles, not garbage miles!

6. Use common sense. Get heat acclimatized by running short distances in the heat and building up slowly. Don’t go out the hottest day of the year so far and do a track workout at 3pm in the afternoon! If you are pushing the envelope, be aware of the sign of heat exhaustion. If you are feeling light headed, have goose bumps or your heart is racing; time to find a tree or a neighbor’s house. Heat stroke kills too!

Get motivated and get out there, but run safely in the heat so we can all enjoy the fall race season!

National Running Day! Let's Celebrate!

2011-06-01T05:47:00.000-07:00

Today, June 1, 2011, is National Running Day! You may run alone, but on National Running Day, we celebrate together! On this day, runners everywhere share their passion for a lifestyle that is one of the best, and simplest, ways to stay fit—and so much more. You can head out solo to clear your mind, gab with your regular running peeps, or turn an unsuspecting friend into a running fiend. This day is for us!

Pass on the passion! Today is a great day to inspire a friend to start running! Tell us why you run!

Black Toenails are Common in Distance Running

2011-05-26T14:03:00.000-07:00

Over my 30+ years of distance running, I've had many black toenails. In fact, I suffered one at Ironman Texas last weekend! A few of my friends, who also participated, stopped by the office this week for black toenail treatment. The following is my advice in trying to avoid and treat this common problem.

Almost everyone who runs will eventually get a black toenail. Getting your first one is a sign that you are now part of the endurance club. Its kinds like cycling. There are two types of cyclists; those that have fallen and those that will fall. While most runners blame a shoe that is too small, this is often not the main cause. Mine was from the well-meaning volunteers who soaked my running shoes trying to cool off the triathletes with their hose! Squish, squish, squish for 26.2 miles equals blisters and black toenails!

If a toe is under pressure from the shoe or a sock that is too tight or too thick, the sustained pressure, step after step, produces an impact or a friction problem between the toenail and the tissue surrounding it. When the tissue gets damaged, fluid accumulates. This is known as a subungual hematoma. The red or black color is the result of a few blood capillaries that become broken in the process. The more fluid that accumulates, the more pain. The extra fluid, colored by some blood, accumulates below the toenail. When the pressure gets too great, the existing toenail will be separated from the nail bed.

Really, most of the pressure that results in this "toenail injury" is produced by the regular action of the foot coming forward, thousands of times every mile. Each time your foot swings forward, a little extra blood is pushed into the toe region due to the force of the foot coming forward. If you increase your distance regularly and very gradually, your toes will adjust to each new maximum distance and only complain when you extend farther. In a marathon training program, almost everyone gets at least one black toenail. Running faster too soon and too long will increase the chance of this injury.
Hot weather also improves your odds of getting one. When it's warm, your feet swell more than they would on cold days. Because there is more pressure, and more fluid, there are more black nails generated during the summer months. This is especially true when it is humid!

How do I prevent black toenails?

You'll reduce the chance of a black nail if you ensure that you have enough room in your toe area when you fit your shoes. At least half an inch is needed, when you're standing in the prospective shoes (in the sitting position, the toes aren't all the way forward). If you've had a history of black toenails and summer is approaching (or here), you may want more toe room. When you add more room at the end, ensure that the arch of the shoe matches up with your arch. Also, run in the shoe before you buy it to make sure that the shoe isn’t too big and that your foot doesn't slide forward as you're running, which can aggravate the toe more than a tight toe box.

Do all black toenails need to be treated?

Leave black toenails alone and allow them to grow out if they are not painful. About 70 percent of the black toe problems are best treated by ignoring them. The damaged part of the nail is gradually pushed out, and the foot slowly returns to normal. If they are painful, red, or swollen; time to see your podiatrist.

Can I just stick a needle in it to drain it?

Do not attempt bathroom surgery! Many runners will heat up a needle and drain the fluid under their nail. Often this introduces bacteria and now you have a painfully infected toe!
Take any sign of infection seriously. If it continues to hurt or the pain increases, this is a bad sign. Toe infections can lead to cellulitis (blood poisoning), gangrene, and worse, especially if you have diabetes. See your podiatrist first, not last!

Will I lose my toenail?

The short answer is - yes. It will take a few weeks or months, but as the toenail continues to grow, eventually it shoves out the damaged, blackened toenail. The black toenail is raised off of the toenail bed, and underneath it is often the healthy remainder of your toenail. Your black toenail will gradually loosen from the sides and you will be able to trim it away.

When will my toes be pretty again?

If pretty toes are important to you, you can paint the black toenail or even the thin new toenail, or the bare skin. You can also stop by Healthy Steps and have a prosthetic nail put on by our licensed medial nail technician. Most people won't notice the difference if you use a darker shade of polish. Full replacement of your toenail takes about 3 to 6 months, and the new toenail will often be a bit wavy, thin in some areas and thicker in others. After 8 to 10 months your toenail should be back to normal (unless you get a side infection of fungus….another topic).

Black toenails are part of distance running, but take them seriously or they can stop you in your tracks!

The Last Road to Ironman Texas: FAANT Style!

2011-05-25T10:51:00.000-07:00

Follow Dr Crane and Janet on their journey to Ironman Texas 2011!

Comment freely :)

Thoughts on the Eve of Ironman Texas

2011-05-18T15:58:00.000-07:00

I'm leaving with Janet in the morning to drive down to outside of Houston, Texas, to check in for our first Ironman. The Inaugural Texas Ironman. Six months ago I felt like I had all the time in the world to train for this event. Three months ago it felt like time was standing still and it would never come. Last week I started freaking out that I hadn't done enough training and I may perish on the streets of The Woodlands, TX. Wow! The journey really is the destination. No matter what happens this Saturday morning, I know that Janet and I have grown as athletes, bonded as deeper friends, pushed our personal barriers past even our own imagination and really enjoyed all the miles we have covered together and apart over the last few months.

My thoughts turn to 30+ years of distance running and all the marathons I have done in the last 12 years; and I realize that they have prepared me for the race ahead by allowing me a glance into the depth of my soul. Let's face it, the race really happens in your head. It is a constant battle between the urge to stop so your pain goes away and the mental push to keep going because pain is temporary and the finish line is forever!

Good Luck to everyone who is racing this weekend. I will leave you with two thoughts and a short prayer:

Two Great Quotes for Endurance Athletes:

The race is not only to the swift, but to those that keep on running....Anonymous

Beyond the very extreme of fatigue and distress, we may find amounts of ease and power we never dreamed ourselves to own; sources of strength never taxed at all because we never push through the obstruction.... William James

The Triathlete’s Prayer

Oh God, you have taught us to compete with perseverance the race that is set before us.

Give me good courage to run this race to the finish.

Be with me when I am in the water and on the land, so that I may feel your presence in all things

In wind and in weather, in the beauty and the magnificence of nature in the passing scene and in the health and rigor of my body straining to meet this challenge.

May I compete in this race in a way that brings honor to You, myself and those with whom I compete.

When I finish the race, may I do so humbly and should I not finish may I accept it with equal grace knowing that I have done my best.

Thank you Lord for giving me the courage to tri.

Amen.

Tips for Your First Ironman

2011-05-11T19:00:00.000-07:00

Tips for Your First Ironman

Since I am officially freaking out about the fact that we are one week from Ironman Texas and Janet is Miss Calm, Cool and Collected; I figured I would compile a list of all the tips for a first Ironman that I could find. Most of these are actually really good advice.

1. Simplicity trumps everything for race nutrition plans. The simpler it is, the more likely you'll stick to it. For example, consider having all your bike calories in a single water bottle.

2. Pack all your bags and race stuff on Thursday afternoon so you have all Thursday and Friday to think through it, make sure you have everything, and aren't rushed. In general, do things early. No rushing equals no stress.

3. Consider taking melatonin or another sleep aid (assuming you've used it before) on race night. Even without the anticipation, it's hard to go to sleep at 9.

4. Bring some spray on 50+ SPF sunscreen. AFTER you get body-marked, put this on every square inch of skin that might be exposed. Enough of it will stay on to save you in case you miss sunscreen later. (Good tip for me since I have been known to look like an ahi tuna after a race)

5. Try to get to transition right when it opens. An extra 15 or 20 minutes of sleep isn't worth rushing. You want plenty of time to deal with anything unexpected (flat tire on bike, long toilet lines, etc.).

6. Make as much of your pre-race breakfast as you can the night before and start eating as soon as you can when you get up. Better not to be hurried and then having to force-feed yourself or, worse yet, skipping cals. It's darn early and eating isn't what your body wants to do, so get it done early.

7. Stay relaxed and enjoy the experience. Don't let race anxiety rule you before race day. It's wasted energy. Remember how much you SACRIFICED to get there, the TOUGH part is behind you, have FUN! It’s all about the finish line, time is irrelevant!

8. THANK the volunteers at every chance you get, from registration through the finish chute.

Swim:

1. The far outside/inside sound like the best place, but they may not be, because everyone else is thinking the same thing.

2. Wear your goggles under your swim cap or double cap so they won't get kicked off. It can be hard to get them sealed like this though, so have someone check to make sure the cap isn't interfering with the seal.

3. Sight regularly. After you get out of the scrum it's tempting to put your head down and swim. Keep sighting or you'll swim extra yards.

4. You will likely be very lightheaded and loopy coming out of the swim. Be ready for it and ask volunteers to help with your wetsuit if you are wearing one. Don't get into a wresting match with it. (IM TX is probably speedsuit not wetsuit so practice getting out of it!)

Bike:

1. Don't forget sunscreen in T1. Trust me. Again the tuna thing!

2. Be steady with your cals. Just do water for the first 30-60 minutes out. A good nutritional system on the bike is using the “super fuel” system. Take one or two water bottles and super concentrate it with salt tablets and mix so when getting a “hand up” the only thing needed is water. Poor the water into the front aero bottle and mix in a small ratio of “super fuel” to make a drink until the next “hand up”. This is handy in that if you get caught in between aide stations in a dehydrated state you have a highly concentrated mix that can help you out fast if you need it. This also keeps you away from having to drink something provided by the race that you are unfamiliar with and may upset your stomach.

3. STAY AWAY from other riders as much as you can. First you'll avoid drafting penalties, and triathletes are often horrible bike handlers, especially when they get tired. Be especially careful around aid stations. Try to stay upright as much as possible.

4. Stay aero as much as you possibly can, except steep hills and corners. Riding out of aero is just wasted time.

5. At about 90 miles you'll probably want off your bike like you can't imagine. Stay focused, you're almost done. Keep your attention on your nutrition and pacing.

Run:

1. Just run aid station to aid station. Don't let the total distance scare you, you'll get through it. Break it into small segments in your mind.

2. Be steady with your nutrition, but keep it simple. Do the same thing at every aid station if you can.

3. Most likely when you get to the marathon you start to feel the day getting to be very long and this is the most critical time to focus on getting to the finish line. The day’s workout starts to compound and it might be time to give yourself a treat. On the marathon the volunteers in the aid stations will have two very important items. DRINK THE COKE! Straight shot of solid carbs and tastes heavenly also because most likely you have been drinking Gatorade until your blue in the face. The volunteers will also offer warm chicken broth. TAKE SOME CHICKEN BROTH! It is heavenly as well. The salty taste is something a little different as well and will give you a boost to the finish line.

4. Do your best to smile and wave to your family and friends. They want to see you having a good time. Fake it if you have to until mile 18 or 20. At that point, they'll probably understand.

5. And remember, a Shiner at the finish is the best recovery drink (or a 12 pack) ha ha.

If you have any other tips for us, the race is in a week! Please comment!

The Race In Your Head

2011-05-10T07:35:00.000-07:00

Ryan Hall said about running a marathon, “It's a long, hard road and it's going to have its bumps; there are going to be times when you fall and times when you don't feel like going on anymore, times when you're just crazy tired but it takes focusing on that one step you're taking. That's what I'm trying to do with the marathon; I don't think about the miles that are coming down the road, I don't think about the mile I'm on right now, I don't think about the miles I've already covered. I think about what I'm doing right now, just being lost in the moment.”

I feel this is even truer about endurance triathlon and Ironman. Focus on the moment and don’t think about the miles and hours to come. Most of the battle in the race is going on in your head!

Disregard the negative self talk! Remember your mantras. It's all about the finish line. Pain is temporary and quitting is forever!

The Ironman Taper: Art or Science?

2011-05-08T15:22:00.000-07:00

It’s two weeks to Ironman Texas and I can tell you that all my peeps are ready for tapering or are already in taper mode! Is there a science to Ironman tapering? Or is it really an art? I combed the internet looking for guidance, called all my veteran friends and coaches, and guess what? No one agrees - as usual. It seems that tapering is as much art as science and there is no one plan that works for everyone.

Here are some tips on Ironman tapering. (And no, doing nothing for two or three weeks before the race and drinking beer to carbo load is not one of the tips!)

I did read some great advice in an article by the legendary Dave Scott wrote on tapering and then he was instantly contradicted by another, more scientific article, by Alun Woodward. Here are some of their thoughts and my personal commentary (can’t disappoint the fans of my pathetic humor).

Despite clear evidence that a shorter taper is most beneficial for endurance athletes, many Ironman training plans today include a full three-week taper. This is actually due to looking at marathoners and their habitual over training. If you are over trained, and on the brink of exhaustion, then a three week taper is for you. If you are more like an ultramarathoner and bounce back from your long rides and long runs quickly, your taper may only be a week or so. The hardest part about giving an answer to the question, “How long should I taper before an Ironman”, is that each athlete is so different. Some athletes repeatedly bounce back from 6+ hour rides and 2+ hour runs as if they were nothing (these folks can taper less, not me - and I hate those people), whereas others are sidelined for 2-3 days in a haze as they recover (these folks can taper more - more like me). So the first place I suggest you start is with your own athletic history. How have you recovered from you longer efforts in training? That will give you an idea of how much time you need. (Guess I need a month, oh no! I only have two more weeks….)

Everyone agrees that no matter how long your taper, it should be a fine balance between these 10 components:
1. Reducing volume (Yea!)
2. Maintaining intensity while reducing the length or volume of the workload (That means don’t turn into a turtle)
3. Allowing the body to rebuild quickly (one to two days) after higher intensity workloads (Sleep more, rest more)
4. Reducing the stress hormones that affect muscle performance; ultimately eliminating muscle soreness and heaviness (Rest, stretch, massages)
5. Maximizing muscle and liver glycogen stores (Eat, Eat and Eat)
6. Allowing the body to repair and rebuild so the power output is maximal on race day (That’s more sleep again)
7. Performing recovery workouts (Active rest, not couch potato)
8. Maintaining "normal" number of training sessions per week (Please, no…)
9. Fueling properly (More eating)
10. Preparing mentally (Stop freaking out!, find your zen)

Every individual taper is unique. Your age, preparation and personal history of your previous tapers should all play into the final formulation. Rest is key, but not too much rest. I recommend that you do something every day and just maintain your schedule. I have gone into a marathon too rested and bonked. I’ve also gone in exhausted and bonked (lots of bonking history) I have learned to listen to my body. Do regular self check every morning and rest as needed. Better to be 15% under-trained than 1% over-trained. Be confident that your body will rejuvenate and respond to resting.

The Gods of Ironman have conflicting stories about tapering, but the truth is in your own history of recovery. If you listen to your body, and are honest about your bonk history; you will know how long of a taper you need. Keep these tips in mind and be ready to rock your next Ironman!

See you all in Houston Texas May 21st!

Next article series is on recovery!

You Know You Are A Triathlete When?

2011-05-02T18:32:00.000-07:00

I have a running gag going for the last few years on and off on my website and it makes up the last chapter of my book. “You know you are a runner when….” Lots of my friends contributed to the list from 2008 to late 2009, when we published the first book…. I felt it was fitting to add this year, especially since Janet and I are less than three weeks away from Ironman Texas, “You know you are a triathlete when…” Feel free to send comments back and I will add them to the list. This inaugural list was compiled by Janet and I emailing each other and drinking wine at the same time. Please do not be offended and you are required to laugh. If you do not get it, you need to ask a triathlete……

You know you are a triathlete when…

You think it’s normal to wear spandex 24/7.

You can blow your nose while on the bike without using tissue. (runners call this a snot rocket)

You know the psi needed for your tires, yet can’t remember the garage door code.

You have found even more areas to apply body glide you didn’t think were possible.

You have no problem loaning body glide or chapstick to a triathlete you don’t even know.

You come to the realization there is justification for public nudity in transition, and you are OK with it.

You feel that receiving a drafting penalty hurts worse than a tax bill.

You think swimming through pee is not so bad, and you pee often in your wetsuit and/or in the lake.

You contemplate how to pee on the bike when riding, and you are a girl.

You can speed on your bike, eat a gel and yell “on your left” to a pedestrian or other cyclist, all at the same time.

You put your helmet on backwards leaving transition and don’t want to stop and fix it because it takes too much time.

You think it’s sexy to have your race number sun burnt into your calf and show it off like a badge of honor.

You have worse tan lines than a farmer’s tan.

Your cycling race wheels are worth more than your neighbor’s car….or your car.

You realize flatulance is pretty funny in a wetsuit and warm on cold swim days.

You plan for your first Ironman tattoo before you even sign up for the race.

You press your race bibs with an iron and file or display for future admiration.

You find yourself yelling “on your left” as you pass other carts in the grocery store.

You find that a six hour bike ride is a warm up.

You wash your bike more than you wash the dog.

You look forward to aging as this will be your only way to stand on the podium in an older age group or qualify for Kona.

You realize you look like a squid or a sperm in your aero helmet and kinda like it.

You realize salt tablets on hot race days are like crack for triathletes.

You conveniently happen to have your race medal on you at work for “show and tell”.

New tri gear websites make you salivate.

You’ve been known to check your Training peaks log even more often then your email on your IPhone.

When you start to think it is normal to go to bed before 9pm and get up at 5am.

You can’t remember the last time you slept in past 6 am on a Saturday.

You rationalize that somehow it’s not completely crazy to try the first open water swim of the season when the lake water is only 58 degrees.

You own at least ten swim suits, five pair of goggles, a dozen bathing caps, swim fins, a pool buoy and at least a wet suit and speed suit if not two.

You have an entire chest of drawers full of running and biking clothing; but still shop for more practically weekly or even daily.

You have more pair of athletic socks with “wicking action” then you have pantyhose or dress socks.

You own more than a dozen pairs of running shoes and can justify why you need each and every one.

Your inventory of hats and visors equals your running shoes or greater.

You have at one time documented and tallied everything you eat or put in your mouth, even a tic-tac, in order to evaluate your nutrition even though you are at least 20 pounds under your “ideal weight”.

You have a plan “A”, plan “B”’, and a “try not to die” race plan.

You start to think an Ironman is not such an insurmountable challenge and start figuring out how you can qualify for Kona.

You regularly have to explain that you are not a victim of domestic violence, those are just your “crash bruises”.

Your biggest fear is skin cancer even though you practically bathe in sunscreen.

Even your kids start to think they have to swim, bike or run just to spend quality time with Mommy.

You have more water bottles than wine glasses in your cupboards.

Your refrigerator has more protein shakes and Gatorade in it than milk or soda.

You have a following on Facebook that lives vicariously through your training and racing ups and downs.

You have peeps that you feel like you have known forever through training, but they may not even know your last name (or your first, come to think of it).

Blisters, chaffing, road rash and sunburn (an the occasional broken toe) are just a minor annoyance.

You show off your peeling sunburn and chip holder tan line on your ankle with pride on the Monday after a race.

All of your t-shirts say things like 70.3, 140.6, etc…and you have at least 100+ you can’t part with.

When you wake up in the morning with every muscle and joint in your entire body hurting and think, “I had a great work out yesterday”.

When you know the exact distances that make up a sprint, Olympic, Half-ironman, and ironman race segments by heart and keep explaining to your friends that they are not all an Ironman and not all in Hawaii.

When your workouts have taken the pace of any kind of social life.

When you cross the finish line of your first triathlon.

Smile…..and add to the list!

Triathlon Tips For Newbies!

2011-04-26T08:25:00.000-07:00

The triathlon bug has now taken over at the FAANT office. Janet and I have been training for the Inaugural Texas Ironman on May 21st for the last 6 months and Janet has done a great job of blogging about our adventures. (click here to read her blog) The women in our office have now been inspired to “tri” their first triathlon. Grapevine recreation is having a sprint triathlon on June 4th right here in town, so many of the ladies have signed up! Even more are taking the role of Sherpa or cheerleaders to encourage their co-workers. I am so excited to see the enthusiasm for the sport. So here are a few tips for getting ready for your first tri!

Have a Plan. It’s not like you just wake up one morning and decide you want to do a triathlon. Or maybe you did and then realized you have no idea how to get ready for one! There are lots of on-line plans and relatively inexpensive coaching available. Having a plan is like having a recipe for success. Make a plan and stick to it!

Be Consistent. If you have ever jumped into a race very undertrained, the experience is not pleasant. You want your first triathlon to be an uplifting experience, not a painful blur. Stick to your training plan and be consistent with your workouts. After the first three weeks it gets a lot easier!

Review the Course. Knowing the course is very helpful in getting through rough spots in the race. You can anticipate the harder spots and know that the finish in near. Also, occasionally the course is not well marked and you can go awry. Knowing the course ahead of time is always a bonus if the going gets rough.

Watch Your Nutrition. Training for your first race is not the time to try a new diet or new foods. Consistent and normal good eating habits will ensure a stable stomach during the race. You don’t want to spend half the day in the porta-potty!

Sleep is Important. Training is taxing on the body and the mind. Getting plenty of rest will help your body recharge and be ready for the race. The sleep you get two nights before is more important than the night before, so if you have pre-race jitters and don’t sleep well….no fear if you have adequate rest in the weeks before.

Pack the Night Before. And use a List! I always set out my transition and all my gear the night before. The morning of the race is always full of chaos and usually starts a 5am, so packing your bag the night before using a checklist will ensure you have necessary tools like goggles and sunglasses!

Visualize Success. Get a mental image of yourself not only crossing the finish line, but being happy with your finish. Your body tends to follow your mind.

Pace Yourself. Many newbies go out way too fast on the swim or start to hammer the bike, only to find themselves walking the run. Pace yourself. The first one is about finishing standing up!

Don’t Freak Out! Janet can tell stories about panicking on the swim. I can tell stories about crashing on the bike. Neither one of us has ever had a flat tire in a race, but we’ve seen enough of them! Relax. Things happen. Your goggles can fall off, you can crash your bike, and you can forget to put sock on with your running shoes.

Relax and Execute Your Race. We have all had stuff happen that didn’t fall into our “perfect race” plan. Go to plan “B”!

Have Fun. Don’t be so serious about the challenge that you don’t enjoy the day. I remember finishing my first sprint triathlon after years of marathon running and feeling. “Wow! That was fun!” Let’s face it, most of us won’t win our first time out, so our reward is the sense of accomplishment (and the beer at the finish!)

Hopefully these tips will help any newbies and all the staff in my office who are training for their first tri! You will get addicted! Triathlon gets in your blood and you will be hooked!

Step into Minimalism Slowly at the Boston Marathon

2011-04-18T16:38:00.000-07:00

Wow! What a great panel discussion put on by Saucony in Boston last Thursday night. I love going to Boston during marathon week. It's like Marathon Mecca! The whole city seems to buzz with running excitement. Boston will always be my favorite marathon.

I had the privilege to be part of the discussion of the evolution of minimalist running and how to transition from stability or motion control shoes to a more minimalist shoe.

The panel consisted of Michael Sandler, who wrote a fabulously crazy but poignant book on Barefoot Running and how it saved him after a severe accident; myself discussing how to strengthen your feet in order to even attempt transition from minimalist shoe gear or barefoot running as well as reminding runners to proceed with caution; Spencer White, head of the Saucony human performance lab, discussing in depth the biomechanical basis for the development of minimalist shoes and how they actually strengthen your feet over time; the legendary coach Dr Jack Daniels, doing coach chalk talk on a white board in order to discuss how to integrate minimalist running as a training tool; and last but not least, Collin Dibble, the owner of Marathon Sports in Boston discussing how to fit runners into the correct minimalist shoe and how retailers have a responsibility to caution and educate consumers on how to slowly integrate these shoes. Whew! What a panel! A fabulous educational experience for all present. I could listen to Dr Jack Daniels telling stories for hours.

After the panel spoke individually for 10-15 minutes each, then it was time for Q&A. Great questions from the audience showed they were actually paying attention. Even Amby Burfoot from Runners World asked a biomechanics question!

Then it was time to separate into small groups and talk with the runners’ one on one. I was happy to see that I drew a small crowd that wanted to discuss everything from how can I strengthen this muscle or that area to how can I transition safely or can I even think about doing this? Great discussion with a local pedorthist who will probably send me hate mail because I told him he was crazy to be running in a graphite orthotics. A few local podiatrists were also in attendance and I was surprised but delighted that they actually agreed with me that everyone does not need to be in orthotics permanently if their biomechanics can be rehabbed instead of permanently braced. We had a lively discussion about this highly controversial subject in our industry.

Let's briefly discuss this alternative thinking. A runners does too much, too soon, too fast and ends up with let's say plantar fasciitis. Traditional thinking is PF is most likely caused by abnormal pronation. Treatment is to put him in a more stable shoe with orthotics to brace his foot, start stretching, anti-inflammatories, rest and lots of ice. Now what? He's better in 6-8 weeks. Now he wants to start running again. Traditional thought is that his underlying biomechanics predisposed him to have the injury so we should leave him in the stiffer shoes with orthotics. What if he really doesn't have a significantly jacked up foot? Maybe just a slightly over pronating foot? Do we have an alternative to offer him? Yes! Now the hard work starts. Lots of strengthening exercises for the medial and plantar foot and lower leg musculature coupled with balance and proprioceptive training followed by lots and lots of stretching. Then slowly wean him off his orthotics and stability shoes over a period of 3-4 months and transition to a more minimalist shoe gear.

Easy? No! Worth it? Yes, if he wants to find his inner gazelle. No, if he really doesn't care about changing the way he runs to be lighter, faster, and in the long run, less pounding. Can everyone do this? No way! Only about 15% of runners will work that hard to change their running style after an injury, so I don't worry about the orthotics labs going out of business.

That's just the tip of the discussion going on in sports medicine today about the trend of minimalism that is sweeping the running world. Hmmm. Sounds like more blogs to come.

Six Simple Exercise For Stronger Strides!

2011-04-07T19:16:00.000-07:00

Are you thinking about embracing minimlaism or barefoot running? These can be good adjunctive training exercises to make you stronger, fitter and faster! All in is not the way to go. I feel a better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Here are six simple exercises to stronger strides

Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.

1. Towel crunches. Your foot has tiny intrinsic muscles that stabilize your toes called the interossei and lumbricals. A great way to strengthen them is to put your foot on a towel and crunch your toes. Do this ten times, then take a 30 second break and repeat to complete three sets of ten. When you get good at this, replace the towel with a pen or marker and grab it with your toes.

2. Heel walking. Heel striking is what we are avoiding, but heel walking is a great way to strengthen your anterior lower leg muscles (muscles in your shin). Roll back on your heels and walk forward balancing yourself on your heels for about 30 seconds, then take a 30 second break and repeat two more times.

3. Deep squats on your forefoot. Roll up onto your forefoot then squat down into an almost sitting position, trying to keep your balance and avoid shifting back onto your heels. Hold this pose for 30 seconds then stand up for 10 seconds and repeat 5 more times. When you get good at this, try holding a weighted bar at you shoulder level and then squat.

4. Inner foot strengthening with a resistance band. (This targets the medial muscles; the posterior tibial muscle and abductor hallucis) Tie the resistance band on a chair leg then use your medial muscles to pull the band toward the center of your body. Other option is to hook the band around your foot, then use the other foot to stabilize it. Pull your foot toward the midline of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the inside of your foot and walk for 30 seconds, following the pattern of heel walking)

5. Outer foot strengthening with a resistance band. (This targets the lateral muscles; the peroneals) Tie the resistance band on a chair leg then use your lateral muscles to pull the band toward the outside of your body. Other option is to hook the band around your foot, then use the other foot to stabilize. Then move your foot towards the outside of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the outside of your foot and walk for 30 seconds, following the pattern of heel walking)

6. Proprioceptive/Balance Training. Balance on one foot with other leg bent. Hold for 30 seconds. Repeat 5 times. When you get good, then roll up onto your forefoot. If you are a pro, then put a 5 pound weight in the opposite hand and touch your toes while balancing on your forefoot. (An alternative progression is to go from one leg on forefoot on level ground, to a foam mat then a Bosu ball or wobble board)

These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down. Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.

Watch the video for help with these exercises! Click here

What's Up With Minimalist Shoes?

2011-04-03T18:17:00.000-07:00

Stronger Feet Can Lead To Running Zen

Why embrace minimalism? Minimalist shoes can help you achieve a more natural running stride. Why is this important? Many biomechanics gurus are finding that a more natural running stride can decrease your impact by over one third and therefore, in theory, decrease running injuries. What I have found is that it can help you find a faster, more balanced, stream lined version of you or what can be described as your running zen.

Running zen is a total state of focus that is a fusion of body and mind while running. Your goal is to develop your natural stride, which in most experienced runners, leads to being fitter, faster and staying injury free.

Your most efficient foot strike is one that lands exactly below your center of gravity, which is usually right below your hips in a mid-to-forefoot fashion, slightly towards your fifth toe. As you land, your foot rolls slightly inwards and propulses off your big toe. This slight roll is NORMAL pronation and is meant to cushion the running stride. Excessive pronation is the effect of weak foot intrinsics and lower leg muscles and is the main cause of many overuse injuries common to runners. This abnormal pronation is often mitigated by stability running shoes and orthotics, but a better long-term approach in healthy athletes should be to strengthen the underlying muscular weakness. Stronger lower leg and intrinsic foot muscles coupled with a stronger core, flexibility and better proprioception can diminish many of these abnormal forces and reduce injury recurrance.

A motion control shoe works to alleviate abnormal pronation and does a great job stabilizing your foot, especially after an injury; but it does little to strengthen the key muscles and ligaments of your feet.

A highly cushioned shoe may overprotect your foot from the stress of the road, preventing natural strengthening while you build mileage.

So, should we all go back to the ballerina flat looking shoes we wore in the seventies? Unfortunately I remember them well and the tibial stress fractures that occurred while I was in high school. No, old school is not the answer; but perhaps a happy medium.

A minimalist shoe guides your foot into a more natural stride by providing cushioning and flexibility, but does not elevate the heel to increase pronatory forces. It allows a shorter stride and softer landing, while encouraging mid-to-forefoot striking to help you manage your impact. It also allows for intrinsic strengthening while you build your mileage and hopefully puts you on the road to finding your sweet spot in your stride.

Who shouldn’t try a minimalist approach? Those runners with severe foot deformities or significant arthritis. As well as people with nerve issues like diabetic neuropathy. As for the rest of the running world, a caution sign should go up here.

A side note of caution to anyone trying to go “less is more.” When you begin to run with less shoe than you have been in years, it is important to realize that your stride is now very different and you have to relearn the fundamentals of running. Please avoid the “too much, too soon, too fast” syndrome that can sideline even the most cautious of runners.

A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Watch for my next post: Simple Six to Stronger Strides: exercises to strengthen your feet and find the sweet spot of your stride!

11 Reasons Why Pool Running Doesn't Suck!

2011-03-20T18:51:00.000-07:00

As a sports medicine podiatrist, I often encourage injured athletes to cross train and keep up their cardio fitness during their “rest period”. Pool running can be very helpful, but is frowned on as extremely boring and down right tedious by most runners and triathletes alike.

I also had to enter the conversation in our series “The Journey to Texas Ironman” with a shout out to everyone who has a little ache or pain in their foot or ,God forbid, a stress fracture, but still wants to join us at the starting line of the Texas Ironman in May. This was taken and liberally adapted from an article in the December 2010 issue of Triathlete magazine:

11 Reasons Pool Running Doesn't Suck
Completely stolen and altered from Holly Bennett, please forgive me….

1. It gives the barefoot movement a whole new angle -- and spares the wear and tear on your running kicks. Better than a pair of Vibrams!
2. You earn sympathetic looks from the cute boy-toy lifeguards. And at 40+, let’s face it – we like to look and dream, but would have a heart attack if they were serious!
3. Until now you thought breastroke was the slowest way you could possibly travel from one end of the pool to the other. Or my pathetic looking side stroke!
4. Hello, six-pack! Water running recruits those pesky, oft-neglected core muscles. Even your arms will exhibit extra buffness, strengthening with the resistance of the water. Let’s face it; most of us girls would be happy with a two pack after 4 pregnancies’!
5. If ever you long for a surrogate granny, there are plenty of gentle, smiling faces in the therapeutic lap lane. And most of them are my patients!
6. From your vertical vantage point, you can observe, admire and critique the swim strokes of the nearby lap swimmers. Maybe you'll learn something. And often times, you will realize your stroke is not so bad!
7. There are no rocks, stumps, curbs or other obstacles in the pool. In the water, you're no longer a danger to yourself. You can try running with your eyes closed. (Note: Resist the urge to fall asleep.)
8. One rarely encounters rattlesnakes while pool running. Or any kind of creature commonly seen while we practice open-water swimming on Lake Grapevine. And it’s not 60 degrees!
9. If you hop in immediately following a bike session, you get to call it a "P-run."
10. If you can mentally endure two hours of water running, your next Ironman marathon will feel short. I highly encourage a swim man IPod…..I could never even train for the Ironman swim without it.
11. And of course, the most important reason pool running doesn’t suck: Dr Crane won’t completely bust you when she or Janet passes you on the trail when you are still supposed to be in the walking cast!

Bottom line, pool running really doesn’t suck if you have the right attitude and tunes! Embrace the change and come out of the “rest period” that much stronger so none of us will be carried off by the ambulance come May!

Chronic Heel Pain Responds to Night Splint

2011-03-16T17:49:00.000-07:00

Plantar Fasciitis a.k.a. Plantar Fasciosis (PF) is an extremely common foot injury usually described as heel pain. The pain is usually first thing in the morning and after rest. PF is by far the most common injury I see in my North Texas sports medicine clinic. PF is seen in most athletes, and is one of the most common running injuries. One study described PF as affecting 8% of habitual runners. 8%! When you calculate that approximately 2% of the US population runs on a regular basis (based on a survey of how many people ran a marathon in their lifetime). That is a lot of people. Actually the rough estimate is 6.2 million runners in the US alone with about a half a million suffering from heel pain. Wow! Oh my aching heel!

Why is there so much heel pain in runners? Too much, too soon, too fast syndrome. In other words, we want to be in shape way before our bodies are ready. The rule of adaptation states that our bodies become stronger with small incremental increases inn stress, but we break down with large incremental increases in stress. This is why PF is described as an overuse injury.

So how do we treat is? A protocol approach that starts with simple, stupid and follows a stepwise pattern that ends with 85% of runners having complete resolution with conservative therapy and 15% going on to move invasive surgical procedures.

Mainstays of treatment: orthotics, better and/or different shoes (that is an entire article in and of itself), lots and lots of stretching, night splint, anti-inflammatories, physical therapy, extracorporeal pulse activated treatment (EPAT), and in some cases, injection therapy (always a debate in athletes).

Simply reducing pain and inflammation alone is unlikely to result in long term recovery. Rest is usually not enough. The minute the runners gets back to activity, their pain is back! I find that most runners, especially over the age of 40, desperately need to stretch their Achilles tendon and plantar fascia. The plantar fascia tightens up making the origin at the heel more susceptible to stress. The best way to do this is a combination of dynamic stretching throughout the day (see my video on Youtube) and a night splint. A plantar fascial night splint is an excellent product which is worn overnight and gently stretches the calf muscles and plantar fascia preventing it from tightening up overnight.

Why does a night splint work, especially in athletes?

The plantar fascia is the ligament that holds up your arch. It is a thick band of fibers that go from the heel of the foot across the bottom of the foot to the toes. Plantar fasciitis is considered to be an inflammatory process following micro tears in the fascia. Plantar fasciosis is a degenerative process that occurs after several months of chronic plantar fasciitis. The reason PF causes so much pain in the morning, is that during the night the foot is relaxed and drops so the toes are pointed downwards. In this position the plantar fascia is relaxed, healing of the micro tears occurs overnight, but when the foot is put to the floor in the morning the fascia has to stretch to a longer position and this tears the new healing. Think of ripping a scab off every morning! Ouch! The idea of a night splint is that the foot is held overnight with the toes pulled upwards and thus the healing occurs with the fascia in its stretched position.

Many research studies have looked at night splints and the treatment of plantar fasciitis. There have been some mixed results due to the construct of the studies, but overwhelmingly the whole body of evidence suggests that night splints can help ease pain and assist healing, and this is especially true for people who have been suffering from plantar fasciitis for several months or more (truly plantar fasciosis).

Night splints do generally have to be used consistently for at least one month or more before significant improvement is seen. If you are a light sleeper, just make sure your wear it at least 4 hours a night.

A number of good night splints are available, and the fit and comfort is important given you will be wearing it for at least 6 weeks AFTER your symptoms resolve. A dorsal night splint will allow you to walk to the bathroom in the middle of the night without taking it off. A posterior night splint usually is better tolerated long term.

Got an aching heel, seek out a running podiatrist to get you back on the roads in better shape than you left them!

EPAT Treats Chronic Heel Pain

2011-03-01T12:06:00.000-08:00

EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.

The Top 16 FAQ’s About EPAT Therapy for Heel Pain:

1. What Is EPAT?

EPAT is an acronym for Extracorporeal Pulse Activation Technology. It is a highly effective non-invasive office based treatment method that accelerates healing of injured tissues.

2. How Does EPAT Work?

The treatment utilizes a unique set of acoustic pressure waves that are delivered through the body and focused on the site of pain/injury with a special applicator. These pressure waves stimulate the metabolism, enhance blood circulation and accelerate the healing process.

3. How is the Treatment Performed?

Ultrasound gel is applied over the skin of the treatment area to enhance the transmission of the pressure waves. The pressure waves are applied using a special applicator tip. The tip is moved over the injured tissue using circular motions.

4. How Long Does the Treatment Take and How Many Treatments are Required?

Treatment sessions take approximately 15 minutes per site and vary slightly depending on the site to be treated. Generally 3 treatment sessions are necessary and are performed on a weekly interval. If you are improving, but not completely better; up to 5 treatments can be performed.

5. What Conditions Can Be Treated With EPAT?

EPAT can be used to treat many painful soft tissue injuries. Including: plantar fasciitis, Achilles tendonitis, tendon insertional pain, acute and chronic muscle pain, and myofascial trigger points.

6. Is EPAT Safe?

EPAT is a safe treatment with virtually no side effects. It was originally developed in Europe and is currently used around the world.

7. Is EPAT Safe for Pregnant Patients?

EPAT is a safe treatment, but has never been tested on pregnant patients. Patients are advised to wait at least 3 months post partum before treatment, as many foot pains subside after weight loss and hormonal equilibrium is reached.

8. Is EPAT FDA Approved?

Yes, the machine is FDA cleared for usage.

9. What are the Expected Results?

Most people will experience pain relief after 3 treatments. Some patients report immediate pain relief after the first treatment, but maximum relief can take up to four weeks after the last treatment to begin. Over 80% of patients treated report to be pain free or have significant pain reduction.

10. Are There Any Special Aftercare Instructions?

All patients receiving EPAT therapy should be off all anti-inflammatory medication for a minimum of 2 weeks prior to the procedure and 4 weeks after. This includes common over the counter medication such as, ibuprofen (Motrin, Advil), naproxen (Aleve) and aspirin. Your doctor will provide you with detailed after care instructions.

11. What are the Possible Side-Effects or Complications?

EPAT is a non-invasive treatment and has virtually no risks or side effects. In some cases patients may experience some minor discomfort which may continue for a few days. On rare occasion, the skin may become bruised or red after the treatment.

12. Who Should not Have EPAT?

EPAT should not be used in people who have deep venous thrombosis or malignancy. It is also best to avoid the procedure if you are taking blood thinners.

13. Why Consider EPAT?

EPAT has a proven success rate equal to or better than traditional treatment methods (including surgery) without the risks or lengthy recovery time. It is performed in your physician's office without the need for anesthesia.

14. Does My Insurance Pay For EPAT?

No, unfortunately insurance companies do not pay for EPAT, though the cost of EPAT can often be reimbursed from a qualified health savings account. Non-covered services and/or procedures without billable terminology are paid to the office by the patient at the time of service; a claim will not be submitted to the insurance, though our office can provide receipts for reimbursement accounts to consider.

15. How Much Does it Cost?

EPAT is an affordable alternative to invasive surgery, lengthy physical therapy and other costly treatments. The first 3 treatments are bundled at a cost of $500 for the procedure, but you are still responsible for any co-pays or costs associated with the initial and/or any follow up office visit. If a 4th or 5th treatments are deemed necessary, these cost $150 per treatment.

16. How Can I Get More Information About EPAT?

The physicians at FAANT all have experience in providing EPAT treatment and are the best people to speak with if you have additional questions regarding the procedure. Call or contact our office for a consultation.

There is also much more extensive information available at http://www.curamedix.com/

The Top Nine Questions Parents Have About Kids Sports Injuries

2011-02-11T14:53:00.000-08:00

1. How can sports injuries be prevented? Many sports injuries are caused by stress from overuse and from the strains or inflammation around tendon insertions. A few tips to help avoid injuries include:
An athlete should have good nutrition and hydration prior to a practice or a game
An athlete should be well rested and alert.
Most importantly, the athlete should have good pre-season/pre-game training that includes stretching and flexibility skills, strengthening skills for the entire body, balance and coordination skills, plyometric skills and agility skills.

2. How many hours a week should young athletes train? This answer is age and sport specific. The greater the intensity of the sport on the muscle and joints, the more rest is needed. Here is a general guideline:
3-4 years old: 30-45 minutes, two times a week (including games)
5-7 years old: 45-60 minutes, two to three times a week (including games)
8-12 years old: one to two hours, three times a week (including games)
13-18 years old: one and a half to two hours, four to five times a week (including games)
Remember that participating in different sports, instead of the same sport year round, will decrease the risk of overuse injuries. It is recommended to vary practices and strength programs to rotate the different muscles throughout the week. In other words, don’t just run all the time. Mix in weights, jumping and stretching.

3. What can I do after an injury to decrease the severity of the injury? P-R-I-C-E
The best thing to do after an injury occurs is to ice the injured area 15-20 minutes with elevation and compression. Repeat 15-20 minutes of ice every hour to the injured area. Keep the area protected, elevated and use compression in between icings. This should be continued every hour while awake for 48-72 hours.

4. What can I do for my child who is in pain? Ice like described. OTC pain mediciation like ibuprofen or Tylenol (if not allergic) 10mg/kg of nody weight.

5. When do I apply ice to an injury? When do I apply heat to an injury?
Ice: Ice is applied for the first 48-72 injuries. Use ice when there is swelling or as prevention after a workout or game. It is never recommended to use ice before practice or a game. The numbness from the ice may cause the athlete to injure themselves more.
Heat: Heat is beneficial pre-practice or pre-game to an area that is stiff, as this will warm-up the muscles decreasing the risk of muscle strains. Heat is also beneficial when an athlete has dull/achy pain. Never use heat when swelling is present.

6. How long should my child rest before returning to activities? Your child should rest from physical activity until he/she is able to demonstrate pain-free activity. The athlete should be able to walk and run without a limp or pain. There should be no physical evidence of a functional deficit while the athlete is participating in their sport.

7. What is the role of bracing or taping an injured area? An injured area should be protected when there is an unstable joint that needs proprioceptive (body awareness) input and stability. Bracing is a better option than taping, as taping often becomes ineffective after 5-10 minutes of vigorous activity. It is not recommended to brace a joint that has not been previously injured. The brace can “take over” the role of the supporting muscles and in return, the muscles become weaker allowing the joint to be at higher risk of injury. If an athlete is in need of some form of bracing, it is recommended to do a strength-training program to the area to wean off of the brace.

8. Under what conditions should an athlete seek medical attention for an injury? It is never wrong to seek medical advice for your child’s injury. Immediate medical attention is needed when the athlete has:
Inability to bear weight on the inured area after 30 minutes of ice and rest
Obvious deformity of the joint (fracture, dislocation)
Persistent swelling or pain
Inability to return to sport or physical activity without pain
Repetitive injury to the same location
Any doubt about the severity of their injury.

9. How do I know if my child needs orthotics? Children need orthotics when they have a significant underlying congenital foot problem like significantly flat feet or extremely high arches; AND this foot deformity is causing repetitive injuries. Repetitive stress injuries are often caused by faulty biomechanics and can be controlled with functional foot orthotics. You want to discuss orthotic therapy with your physician if your child seems to be getting injured over and over. Other reasons for your child to need orthotics are kinetic chain disorders. This means that their foot type is causes stress injuries in other parts of there body; like their knees, hips or lower back. Orthotics are often prescribed to “perform a tire realignment” on a child’s foot to decrease stress in other parts of their body. The best way to determine the need for an orthotic is a comprehensive biomechanical exam at your podiatrist.

These are the top 9 questions parents ask about their child’s sports injuries. Hope they help keep your kids safe and enjoying all their sports!

Avoid Falls Running on Ice and Snow

2011-02-01T11:20:00.000-08:00

Winter has decided to visit North Texas today. Two inches of ice covered by snow, and just in time for the Super Bowl. Time to think about trying to prevent slip and fall injuries. Lots of people fall on ice and snow every year-without serious injury. Not so fortunate were some 16,000 Americans who die each year from falls, according to the National Safety Council (NSC).

I wonder how many of them were runners? I watched from my window this morning as one of my crazy neighbors fell running on the sidewalk in front of my house. The snow had not even stopped coming down yet! Crazy! Even I ran on the treadmill this morning, and most of my peeps will tell you: I Hate Treadmill Running! Better the treadmill than the emergency room!

Falls rival poisoning as the number one home accident in the U.S. The number of injuries or deaths from falls due to winter conditions is not recorded by the NSC. But, safety experts agree that many injuries result from falls on ice-covered surfaces.

Safety Tips

It's important that individuals recognize the hazards of slippery surfaces. Here are helpful hints from winter-safety experts that will reduce the risk of falling when slippery conditions exist:

Wear boots or overshoes with soles. Avoid walking in shoes that have smooth surfaces, which increase the risk of slipping. Trail running shoes are better than your regular road shoes.

Run or walk consciously. Be alert to the possibility that you could quickly slip on an unseen patch of ice. Avoid the temptation to run quickly. Run in high alert!

Run or walk cautiously. Your arms help keep you balanced, so keep hands out of pockets and avoid carrying anything that may cause you to become off balance. This even means leaving your precious water bottle at home

Run or walk "small." Practice your "Chi" running and throw your center of gravity forward. Avoid an erect, marching posture. Look to see ahead of where you step.

When you step on icy areas, take short, shuffling steps, curl your toes under and run or walk as flatfooted as possible.

Run where the path has been cleared. Even in your own yard, remove snow immediately before it becomes packed or turns to ice. Keep your porch stoops, steps, walks and driveways free of ice by frequently applying ice melter granules. This is the best way to prevent formation of dangerous ice patches. Don't be stupid like my neighbor and try to run while snow is still flying!

Falling Safely

Even when you practice safe running and walking habits, slipping on ice is sometimes unavoidable. It takes, on average, less than two seconds from the moment you slip until you hit the ground. That's precious little time to react. In that instant, the risk is an injury to your head, a wrist, hip, ankle or shoulder.

When falling, it is best to use a tuck-and-roll principle. It's important to tuck your body, lift your head and avoid trying to break the fall with a hand, which can cause a wrist injury. Ask Dr Karpati about her broken wrist from skiing the next time you are in the office. The idea is to make yourself as small as possible by rolling up into a ball.

People in North Texas hardly ever think about falling on ice and snow, but serious injuries can occur. If you are a klutz or are planning to spend a lot of time in the cold; following these guidelines may help protect you from serious injury this winter. If it is not a choice to hit the treadmill, practice caustion while running in the snow and ice. If you do happen to fall and sprain your ankle or foot, call the office. Help is just a phone call away! And remember, just because you can walk on it doesn’t mean it is not broken.

Do Functional Foot Orthotics Work? Yes!

2011-01-24T17:02:00.000-08:00

Dear RunDoc: I read in the NY Times that orthotics often don’t work and I should try running barefoot to strengthen my feet. I tried and my feet got a lot worse. I know you wear orthotics and make a lot of them for your patients. Why do you think custom foot orthotics work in your hands?

RunDoc answers: Hmmm….Good question! I read the article in the New York Times and laughed then cried. They are so biased against orthotics that this is bout the tenth time in the last few years they are trying to make them voodoo. Fortunately, they are wrong and there is science behind it.

Many tens of millions of patients have been helped by custom-made foot orthotics over the past 50 years.

There are many studies published in peer reviewed medical journals showing the effectiveness of orthotics in reducing injury and relieving pain.

One of the most important factors creating the need for orthotics is that we usually walk on essentially hard, flat surfaces that do not exist in nature.

Walking or running barefoot does not change the above.

The science of biomechanics relating to orthotics is complicated and requires years of study. This is why you should have your orthotics made by a well-trained podiatrist in biomechanics and even better, one who has an understanding of your specific sport.

The process of getting an orthotic to be most effective is iterative, often requiring serial adjustments. This is because everybody is different and may not tolerate “perfect” biomechanics.

The conditions for which orthotics are prescribed often take years to develop. They are not going to disappear overnight with the use of orthotics.

Orthotics should not be chosen by how comfortable they feel. Often, they are uncomfortable at the beginning because they are “correcting” your biomechanics with an external device and you have to get used to them.

The reason foot impressions (casts) are taken off-weight-bearing is so the foot can be positioned in an optimal shape that will allow it to naturally bear weight on its own. A three dimensional scanner can also be used to get a “true” picture of the foot without a cast.

Orthotics are not arch supports. They guide the foot through a proper gait cycle, allowing the foot to achieve various optimal positions at the correct time and creating a means for shock absorption, weight bearing, and propulsion.

A flat foot by itself is not good or bad. A high arch by itself is not good or bad. How the patient functions with those features is the issue.

If you have been told you need orthotics and you’re in doubt, get a second opinion. If you have orthotics and they are not working, get them adjusted.

Correctly made functional foot orthotics work! I have built my reputation with them.

Run Happy! And in orthotics if you need them!

Acheive Your Fitness Goals!

2011-01-03T07:32:00.000-08:00

The most common New Year’s resolution in the United States is to lose weight or improve your fitness. Let’s face it, even for the veteran marathoner or triathlete, the New Year gives us an excuse to refocus or give us just a little kick in the butt we need. We all need a plan to achieve our fitness goals or race success. I woke up on January first and realized it was 21 weeks until Ironman Texas. Wow! That crept up on me! Janet has been blogging for months about the road to Ironman Texas. I’ve been so busy working my butt off and being Mom, it crept up on me. Now it is time to refocus on my fitness goals, so I don’t perish on the streets of Houston on May 21st.

Maybe you are like me, a race is creeping up on you, or maybe you have just gained a few extra pounds from the holidays, or maybe you are like some of my friends who realized running up their stairs they get out of breath. This is a great time of year to refocus on your fitness goals. We all have obstacles; time, energy, financial, and our own self-defeating voice in our heads! Here are some tips that will help you focus and reach your fitness goals in 2011!

1. Know your goals: You need to start with the end in mind. What are your goals? Lose weight? Get faster? Get fitter? Get stronger? Body sculpting? Finish your first marathon? Finish your first Ironman? Whatever they are, start with small focused goals and build to larger ones.
2. Start Simple: Begin with a basic program. Make it a habit, and then you can build from it. Maybe you run for 30 minutes every morning at 5:30 am. Maybe you add a strength work out twice a week. Maybe it is as simple as adding a tempo run once a week. By starting simple, after 21 days you have now made a new habit to build on.
3. Write it Down: A goal not written down is a mere wish. Also, logging your workouts make them more real. It also makes any blank spots much more glaring! There are lots of logs or even phone apps to log your workouts and your nutrition. Use one! Include your goals at the top of each page of your log. I also find it helpful to leave myself sticky notes around the house. When you find a note that says “20 weeks to Ironman” on your bathroom mirror when you get up in the morning that is powerful motivation!
4. Enable Yourself: Make sure your equipment is working well. Time to get that new pair of running shoes. Time to tune up the treadmill and work on your bike. Buy yourself a new toy like a chin up bar or power meter for your bike. New toys make fitness goals even more fun!
5. Make it Fun: Find some workout peeps. Make sure you are having fun even when your muscles are screaming at you to stop. I find a weekly group run or ride, coupled with a weekly mostly social weight workout at the gym, makes the many solitary miles on my bike, treadmill or road a lot more tolerable.
6. Confuse your body: Mix up your workouts. Your body gets stronger and faster with small incremental increases in stress. This means changing speeds, changing routines and scenery to confuse you muscles to get stronger. Throw in a crazy yoga workout, a new routine or just a bunch of hills when you usually avid them. Change your energy levels for better success.
7. Be Committed and Consistent: Every year I see a whole gaggle of new people at the gym in the first week of January, and then they are gone by Valentine’s Day. Fitness goal cannot be reached in a month or two. You have to commit to your goals and work towards them. It may take a year to reach your goals. I started working towards my first Ironman two years ago. Now I am less than 5 months away. Rome was not built in a day. When you feel like quitting, pull out your goals and read them again. Start a mantra, “Pain is temporary and quitting is forever” is the one I use with my middle school cross country running daughter. I personally like, “It’s all about the finish line”. Find one that works for you. It really is true that the hardest part of a marathon is the first three steps out of bed in the morning! You will find that once you get up, the rest is easy!

If you follow these few tips, I promise you will reach your fitness goals in 2011! You will thank me! And I will live though Ironman Texas this year! Run happy and towards your goals!

Carroll Middle School First Cross Country Meet For Alex

2010-12-17T09:58:00.000-08:00

This week my 12-year-old daughter, Alex, had her first cross-country meet. Wow! 7th grade. Where did the time go? The States of Texas is so weird with their sports timing. Middle school cross country is December to February. Very strange and I figure we will be freezing for many of the meets, so it will feel just like Rhode Island in November! All joking aside, when she put on her uniform, I almost cried. My heart was so full of joy that my daughter would hopefully experience the same positive affect that competitive running had on my teen years. Most of my happy times as a teen revolved around running and running is so much a part of my life still today.

As for Alex’s first meet, true to form, she found the only gopher hole in the first 100 yards of the race and fell flat on her face (all my Facebook friends that ran with me are laughing, my nickname was “Crash Crane” because I fell so much!), but got right back up and proceeded to pass about a hundred people. She finished 83rd (out of about 300) and did her best time to date. She was very excited and happy. Energized to do it again after the holidays!

So here is a shout out to all Moms who infect their kids with the running bug. Keep it up!
It is a great way to occupy them as teens and positively influence their health choices for a lifetime!

Why Is The Ability To Be Truly Thankful and Happy Elusive To So Many?

2010-11-27T12:24:00.000-08:00

This Thanksgiving weekend I sit back and reflect on how thankful I am for all the blessings I have in my life. I have a wonderful family with three healthy and happy girls. My oldest two even did their first triathlon this fall with me. I am blessed with healthy and happy 70+ year old parents who support me and my girls in all our crazy endeavors. I have siblings, who think I’m nuts, but would cross the globe to help me. I have amazing and creative friends who have circled the wagons every time I needed them. I am blessed to be loved by a caring, thoughtful and selfless man who treats me like a princess. I have an unbelievably rewarding and fulfilling career in a profession that not only supports my family, but fulfills my need to be needed and useful in other people’s lives. And I enjoy the ability to run, jump and play (as well as swim and bike) with all my friends and the rest of the crazy marathon running, triathlon trying community. I am truly blessed and remember that daily.

Why is that peace so elusive to so many? I think Blake Mycoskie, the founder of TOM’s shoes and one of my personal heroes, hit the nail on the head in his Thanksgiving blog post, “This Thanksgiving, try to really stop. Sit still. Hold a loved one's hand, and simply be thankful. No matter what your situation, positive or negative, sad or joyful, take the opportunity to truly experience this moment. The stillness. The mystery of this life. For this, and no other reason, I'm thankful.” If you are not familiar with TOM’s shoes, take a look at their website. He gives a pair of shoes away to a needy child every time they sell a pair of shoes. They have given out more than a million pairs of shoes already! Changing lives one pair at a time. Not bad for a 30-something guy from Arlington, Texas!

Happiness and peace of mind does not need to be elusive. Enjoy a still moment. Revel in the people and places around you. No matter what is going on in the circus that is your life, we all have something to be thankful for; even if it is just breathing another day. And for all the runners and triathlete’s who follow my blog, we should all be thankful for the ability to enjoy our sports activities. Always answer the question, “Why do you run?” with the answer, “Because I am blessed that I can!”

Happy Thanksgiving to all! Run happy!

Losing Your Motivation to Run?

2010-11-20T04:24:00.000-08:00

Let’s face it. The alarm goes off at 5:30am and there are many days I don’t want to get up and run or bike. My bed is warm and the air is cold. My pillows are so comfortable and missing one work out won’t matter that much. I’m in great shape! STOP! The negative self talk is waxing away at your motivation and suddenly those fitness goals are sliding away.

It’s not hard to stay motivated during the season. There is always a 5K or sprint triathlon every weekend and they fill your calendar. Your “A” and “B” big races are in red on the schedule and that motivates you to get out of bed and even do two-a-days. But now it’s off season for triathlon, and even the fall marathon season is slipping away. The days are getting shorter and colder; and in some areas the snow has begun to fall. Even in North Texas, the mornings are dark and the winter running gear is coming out of the moth balls. Motivation is hard to come by. I’m tired and cold and my morning run has lost its appeal.

What’s an athlete to do? Well, the winter off-season is a great time to mix it up a little. Training has to change from time to time to be effective. We all get stuck in ruts, so the off-season is a great time to try out some new tools. This is the time to build some strength, allow other muscle groups to become more balances and especially allow for recovery from a hard season. It’s the time to build on the hard work of the season and prepare for even greater success in the future! Motivated yet? Me neither, but I find two great tools do help me shake the winter doldrums and get motivated to work towards the next season: goal setting and visualization.

Everyone yawns now; it’s the goal setting lecture…..Wake up! Most of us have goals in our head, but very few have written concise, realistic, timely goals for the next year. A goal not written down is a mere wish! Teaching yourself to write realistic, yet challenging personal performance-oriented goals will allow you to do the work necessary to achieve those goals, allow you to see improved performance, lead to increased confidence, and ultimately lead to greater success as an athlete.

Goal Setting 101
1. Define what you want to accomplish in 2011. It is important to begin with the end in mind. My goal for 2011 is the finish the Texas Ironman and not perish. Good goal! Time goals or a new distance should be realistic. I once had a patient that told me her goal was to finish a marathon a month in the next year. I asked how many marathons she did last year. None. Not a realistic goal!
2. Know where you are right now. How strong are you? Do you have any nagging injuries?
3. Be honest about what you need to develop. I need to get stringer on the bike. What are your weaknesses? Be objective and painfully honest with yourself. Put your ego aside. This is an important step.
4. Set sub goals and segment them. Perhaps you have a time goal, but you also probably have a weight goal, a nutrition goal and a mental goal.
5. Write performance goal for all the sub categories. Be specific and measurable. Don’t say, “I’m going to stop drinking so much beer,” a better goal is to say, “I’m only going to have one beer a night and only on days that start with S.”
6. Commit yourself completely. A goal should be something that leaves you with a burning desire to reach it! I post my goals on a sticky note on my bathroom mirror so I look at it daily. This motivates me. Have a goal card in your pocket and look at it. Keep a training log and make interim goals. This helps you stay focused.
7. Monitor your progress. Listen to your body and do not become obsessed with your goals. Your body will tell you if you need more rest! Injuries happen when we push ourselves too hard. This does not help us meet our goals.
8. Visualize yourself meeting your ultimate goal. I have watched myself cross the finish line of a full Ironman many times in my head. Close your eyes and visualize the starting line and you are feeling great and in the best shape of your life. Go through the race in your head, feeling confident and relaxed. Watch yourself finish strong and feel the rush of achieving you goal. Practice this weekly and your brain will be mentally prepared for success.

Motivation and drive come from constant focus on the destination and then seeing you move through the process to get there. Having a purpose is important or it is really hard to consistently train during the off season. Take some time and work on your goals. Visualize success, and then get out of bed!

‘Tis the Season to Have a Bunionectomy Fa-la-la-la-la-la-la-la-la!

2010-11-12T09:39:00.000-08:00

Seriously! The holidays are upon us and it seems like everyone in Grapevine, Texas, is on my operating schedule or is having some kind of elective surgery with one of my surgeon friends. My family always wonders why my schedule gets completely crazy just when the rest of the world is taking a vacation? Why is it that we do more bunionectomies in November and December than the first two quarters on the year? You may think it is because they have family around to help them, but that’s really not the main reason. It is a little invention of the insurance companies called the deductible.

It used to be that no one wanted surgery over the holiday season. That was when deductibles didn’t exist. Now, policies are written with high deductibles and co-pays. Imagine that if you have met your deductible and your out-of-pocket for your health insurance, any elective procedure is free until the end of the year. January 1, you have to pay again! This has caused the mad rush to the podiatric surgeon as well as any other surgeon in town. Even the plastic surgeons are affected, because people have money in their flex spending or health savings accounts that they lose if they don’t use it before the end of the calendar year. Crazy!

So, you decide to join the masses and have your foot fixed that has been annoying you or out-right crippling you for years. What should you do to survive the holidays and not end up with a bad outcome?

Listen to your doctor. Non-weight bearing or partial-weight bearing means just that. Stay off your foot! A short trip to the mall or football game is not a good idea.

Ice, ice and more ice! Ice and elevation are your friends. They will decrease your swelling and ultimately keep your pain under control.

Limit holiday parties. Just because you are invited to a billion parties does not mean you have to go. Pick one or two small parties and send regrets to the rest. People will understand, even your boss!

Shop before surgery or embrace the internet. I did all of my holiday shopping in one night on the internet last year. A quick side tip is that if you do binge shop, don’t be surprised if you get a call from your credit card company. They just want to make sure it’s not fraud. Using Pay-pal will avoid this.

Order a catered holiday meal or teach your children to cook. Almost every nice grocery store can cater a meal your family will love. As for cooking classes, do it from the couch and turn off the smoke alarm!

Don’t over eat! You are resting, so your portions should be smaller. Most people gain 2-5 pounds over the holidays. Inactivity makes this worse, so be diligent about what goes in your mouth!

Rest and relax. You have taken care of your family for years. Pull out the tiara and a little bell. It’s time some one waited on you. If you live alone, invite a friend to stay for a few days after surgery so you have some help.

And last tip, listen to you doctor! Patients who follow their post-operative instructions are much more likely to have good to excellent outcomes!

‘Tis the season to have a bunionectomy or an arthroscopy or a rhinoplasty….Fa-la-la-la-la-la-la-la-la!

Celebrate the Holidays Without Gaining Weight

2010-11-08T09:46:00.000-08:00

It’s that time of year again. Whether you celebrate Thanksgiving, Hanukkah, Quanza or Christmas; all of these holidays have one thing in common: Lots and lots of food! The average American gains between two and five pounds during the holiday season. Why? Fork to mouth problem! Here are some tips to keep from gaining that extra poundage and start the New Year off without having to make a resolution to lose weight.

Don’t Skip Meals. During the holiday season, a lot of people will skip lunch in anticipation of a holiday party or get so caught up in the festivities that they don’t take time to eat. When you go to a party really hungry, you tend to eat quickly and overeat.

Slow Down. Take breaks while you are eating to give your stomach a little time to discus with your brain how full it is. Amazingly, those that ate slowly and joined in the holiday conversation tend to eat less.

Watch your portions. We all know that holiday portions can border on enough to feed a small African nation. Use a smaller plate or just take one scoop of your favorites. That way you enjoy them all but eat less.

Pack up your leftovers right away. Especially if you are one of the cooks, grazing the leftovers in the kitchen can be a social over eating fest! Send leftovers home with your guests so you won’t be tempted to have a midnight snack.

Limit alcohol. Face it, the more you drink the more you eat! Save the calories for that sliver of pie you are craving.

Exercise as part of the holidays! If you can’t convince the family to run the Turkey Trot, take the clan for a walk after dinner. Enjoy the day and work off a few calories. If the weather is bad, Wii bowling as a family can be hilarious and help burn some calories.

Be Realistic. Starting a diet plan during the holidays is setting yourself up for failure. Try to maintain your current weight and plan for a weight loss goal in January.

Shop ‘til you drop. Not only will you be stimulating the economy and helping the recession, but you will be exercising! Have a healthy snack before or carry some granola bars so you won’t be tempted to visit the food court.

Fight the holiday blues. Many people get depressed around the holidays and tend to use food as an anti-depressant. Spend time with friends and count your blessings. Writing them down can help you realize even in down years, you have a lot to be thankful for.

Think of how happy you will be in January if you navigate the holidays without all those excessive pounds! Follow these tips and be diligent. You will thank me later!

Is Brett Farve Insane to Play Tomorrow?

2010-10-30T12:19:00.000-07:00

I normally do not comment on football in my blog, but I have been asked this question so many times this week that it is comment worthy. For the record, even though I have allegiance to the New England Patriots and the Cowboys, I have always been a Brett Farve fan. He is the epitome of the endurance athlete as a football player, just like Cal Ripken was an example of the ever present endurance baseball player. (Yes, I love Cal too!) That aside, I think Brett is crazy to play tomorrow!

Why? First, he has two fractures in his foot and ankle. A stress fracture in his ankle and an avulsion fracture of his calcaneus (the heel bone). His ankle is already a disaster in which he has had at least 5 surgeries that we know of and has significant degenerative arthritis! Why make it worse? The season is a disaster and the Vikings are losing confidence in him. If he can’t move tomorrow, he is either going to get seriously hurt or get pulled by the coach. Why not sit voluntarily?

On the flip side, he probably needs an ankle replacement already. He could numb up his ankle, play, then risk crushing whatever cartilage was left. Stupid! And a bad example to younger football players. Face it: the season should be over and he should call it a career. (Which he should’ve done at the end of last season anyway!

Brett, don’t play. You risk hurting yourself more or at the very least looking more stupid that your antics have been in the last two years!

A Halloween Triathlon as the "Tri-Fairy"

2010-10-24T14:50:00.000-07:00

Whew! What a weekend! The Dallas Athletes put on a great Halloween party at the Monster Triathlon in Keller, Texas this fine Sunday morning. After severe weather yesterday afternoon, the weather had cleared up to be perfect for racing. The start was in the beautiful Keller natatorium where the water is always a balmy 81 degrees. A lovely hilly ride (hills for Texas) through Bear Creek and finished with a run through the nature trails. What more could you ask for? (Maybe next year we could start at 9am instead of 7? Ha ha)

This year, I have been running long course triathlon and concentrating on the 70.3 distance, so frankly I was in no shape to race a fast sprint. I decided to have fun with the day and put on my costume. I was the “Tri-fairy” because it turns out they don’t make a Tinkerbelle costume in my size. I borrowed wings, a crown, and a magic wand from Sasha, my 4-year-old, and got a black tutu from Target. Add to that some ribbon on my hot pink bike and my costume was ready!

Tom was the race starter in his Burger King costume and we were officially under way. It’s amazing how triathletes really do come in all shapes and sizes! The youngest one I saw was 10 and the oldest at 78. Tall, thin and muscular all the way to looking like a small Sumo wrestler. It’s great to see so many people (almost 700) celebrating fitness and pushing the envelope.

The race is a favorite among the local tri-heads, but it also tends to draw a lot of first timers. My office administrator, Lori, was a newbie this morning. Not only did she push herself hard and do fantastic, but she finished in a virtual tie with me! I see many more triathlons in her future!

As for my race, I had a nice swim and was only run over by three guys. Got my costume on and went for a nice bike ride with 700 of my closest friends. Lots of comments when you are biking in a tutu with a crown affixed to your helmet and pink wings on your back!

Off the bike and on to the run! Tom announced as I went by the finish line that “This is Dr Crane, she treats feet and halitosis”. Very funny Tom! I only treat halitosis if your foot is in your mouth!!

Lori passed me on the run as I was jogging along giving lots of fairy dust to other runners with my magic wand. I sped up as she past me and finished just a few steps behind her! A good time was had by all!

Now it’s time to get busy and build some base for the winter s we can tackle the Inaugural Texas Ironman in May 2011. Tune back for updates from Janet and I on the road to Ironman Texas!

Run Happy!

My Kids Had Fun Doing Their First Triathlon!

2010-10-23T08:23:00.000-07:00

Amazing fun this morning at the Monster Kids Triathlon in Keller, Texas. I am so proud of my daughters, Alex (12) and Caitlin (10). They worked hard, didn’t give up and finished with a smile! Donuts were the finisher prize this morning. The look on their face when they finished was priceless. They can now call themselves triathletes!

Dallas Athletes did a great job putting on the event and the volunteers were awesome. Imagine over 300 kids ages 4 to 13, separated into three groups; 4-7, 8-11, and 12-14. It was like herding cats to get them all to the starting line and then in the pool!

The littlest kids were adorable. Life jackets and a parent in tow are legal for under 7. Then they got on their tricycles or little bikes with training wheels and off they went for a one mile bike, then off the bike to run a half a mile. Just adorable were the smiling faces when they crossed the finish line and got their medals.

The older kids were much more serious and nervous, pacing the pool deck while the little kids got started first. Ages 8 to 11 had to swim 50 meters, and then bike 2 miles, then run a mile. Ages 12 to 14 had to swim 100 meters, then bike 3 miles and finish with a one mile run. The serious looks on these kids’ faces said they were not there just to have fun, but to compete!

The parents were an absolute treat to watch as well. It was very obvious that most were either runners or triathletes who had dragged their kids out of bed at 6am and were trying to infect them with the love of triathlon as well.

Tomorrow morning there is over 700 adults signed up to race in the Sprint triathlon version of the Monster Tri. I hope we all have as much fun as our kids did this morning. Run Happy….and Bike and Swim when you can!

I've Infected My Kids and They are Doing Their First Triathlon!

2010-10-22T18:37:00.000-07:00

Wow! What an afternoon. My two oldest girls are doing their first triathlon tomorrow in Keller, Texas. We spend hours this afternoon running around, picking up their packets, getting new bike helmets (can’t bike with our skate board or horse back riding helmets according to the rules!), and finding appropriate gear. Luckily my 10 and 12-year-old can fit in my triathlon unitards (good thing I’m a midget ha ha). We even had to find swim caps.

Whew! Gear is all together and ready to go at 6am tomorrow morning. I’m excited. My first tri was at the age of 40! I’m glad my kids can get a taste of the sport I’ve come to love. The race is called the “Monster Kids Triathlon” and looks to be a lot of fun! They have competitors as young as 4 and as old as 13. Picture little kids on tricycles up to early teenagers. What a mix!

The adult sprint triathlon is Sunday, so we get to get up before dawn both days this weekend! I think I’m more excited then the girls, but my 12-year-old was telling everyone in school she was doing a tri and they were all impressed! Wish them luck! Will update with results and even pics!

I just hope they both have fun and maybe even want to do it again!

Run Happy! (and Bike and Swim if you please!)

Strategy + Execution = Success For Life!

2010-10-19T16:32:00.000-07:00

Like many people in Southlake, Texas this afternoon, I was reading the new edition of Southlake Style magazine that came in the mail today. After the usual local nonsense, I came across an article by Harold Wilson of Multisport Coaching Systems about weight loss exercise programs for truly obese people. He talked about the fact that most articles spend so much time talking about the overwhelming numbers associated with obesity and of course the associated health risks, but almost never spend much time on how an obese person can actually lose the obese tag.

Harold spent some time talking about the people in the news that have successfully lost the weight (Think “The Biggest Loser” or Jared of Subway…heck, he is even going to try to run the New York City Marathon next month!).

The meat of the article discussed the keys to successful weight loss: strategy + execution = success! Wow! Isn’t that the key to just about everything? But wait, maybe Harold is on to something. I have runners that get so caught up in planning their training program that they have little energy left to execute it. Same goes for weight loss programs. Many people spend all their available energy in the planning, so they never get around to executing it!

So, I will reiterate to you Harold’s tips for weight loss and you will see that they hold truth in all exercise programs!

1. Save most of your energy or effort level for execution
2. Choose workouts that are smart and simple
3. Build your day around your workout and plan ahead
4. Educate yourself on the science of nutrition
5. And Remember these absolute truths:

Discipline is necessary
Consistency is key
Prepare your menu in advance
Do not skip workouts

Like many things in life, profoundly simple, yet simply profound! Thanks Harold!

PS. Since I shared with you Harold’s article, if you find yourself needing more advice you can find him at http://www.getfitgetfast.com/ or at the Southlake Larry North Fitness.

Seems Like Everyone is Running a Fall Marathon, Even Amani Toomer!

2010-09-11T11:52:00.000-07:00

I was running around Grapevine Lake this morning at 5:30am and was amazed how many people were out and about. Seems like everyone was going around 20 miles today, so they all started really early. Everyone had a fall marathon on their schedule; some going to Lake Tahoe, some Chicago, some New York. And of course, a lot of people gearing up for the Dallas White Rock Marathon in December.

It is amazing how the marathon bug has bitten so many people! Even Amani Toomer, former New York Giants' wide receiver, is running the New York City Marathon this year for charity. I remember when I planned to run my first marathon in 1999, most people thought I was a little crazy, and the Cowtown Marathon only had less than a thousand people every year. Now, it seems almost everyone is attempting a marathon or two; and the local marathons are busting at the seams with entrants. The Houston Marathon even went to a lottery because it has sold out so quickly the last few years! Wow! So many runners and so many "training theories" for people to hurt themselves with!

Here are a few tips to keep you on the roads and out of my office:

Tip #1: Do not increase your mileage by more than 10% per week. The body grows stronger if it is stressed in small increments, but starts to break down if it is stressed too much. Studies show that increasing your mileage by no more than 10% per week will help you grow stronger without breaking you down. Avoid increasing duration and pace at the same time.

Tip #2: Always follow a hard workout with an easy one. The body’s like a cell phone. If you continue to use it without recharging, it will eventually wear down. By incorporating easy workouts or cross training into your program, you’ll allow your body a chance to rest and repair itself.

Tip#3: Add strength training to your workouts. Strength training is usually absent from most training programs, but cross training with weights is the only component that has been proven to reduce running injuries. Proper strength training can help you overcome muscle imbalances that lead to injury, as well as strengthen connective tissues that help support your joints.

Tip#4: Do regular self-checks. Tune into what your body is telling you. How do your muscles and joints feel? How does your breathing and heart rate feel? Are you straining to keep up your pace? Anything that doesn’t feel the same may be an early sign of overuse. Keep a training log of not only your mileage, but how you feel during and after each workout. Fatigue over a period of a few days is a huge red flag that your body is trying to tell you something.

Tip#5: Respond to pain immediately. If you experience pain during or after a workout, follow the rule of R-I-C-E (rest-ice-compression-elevation). Use an ice massage or cold pack for 10-15 minutes every 4-6 hours to relieve inflammation and swelling. Elevation is also quite helpful in the first 48 hours. Apply a compressive wrap and hang out on the couch for a few hours and rest. After 48-72 hours, if the inflammation has subsided, apply heat to help promote healing.

Tip#6: Do not take pain-relief medication to finish a workout! Non-prescription anti-inflammatory medications can reduce inflammation and pain, but they do not speed healing. Taking anti-inflammatories prior to a workout may decrease your discomfort and allow you to finish a workout, but they also allow you to overstress already damaged tissue. This can prolong the healing process. Pain is a sign you should not ignore!

Tip#7: Choose relative rest over inactivity. Active rest, or easy exercise, is better than inactivity because it stimulates blood flow and promotes healing. If slow running is painless, but picking up the pace is painful, then stick to slow running until you feel better. Or do other activities, like swimming, cycling, or aqua running until you can run pain-free.

Tip#8: Don’t wait too long to seek professional help. If your pain does not respond to a week of R-I-C-E and cutting mileage by at least 50%, see a sportsmedicine specialist. Not only can a professional help you diagnose and treat the condition, but they may also help you determine and biomechanical abnormalities that can lead to recurring injuries.

Tip#9: Try to maintain a positive attitude. You immune system fights injuries with a complex army of nutrients and special cells. But, you immune system doesn’t work alone. Your mind also has a voice in what goes on. Attitudes and feelings are organized in your brain to communicate with your immune system with chemical messengers. A positive attitude can go a along way to help speed healing.

Tip#10: Ease back into your regular training program. Remember, too much, too soon, too fast is what hurt you in the first place. It’s tempting to jump right back in where you left off, but your injured tissue may not be fully recovered. It’s during the first few weeks back that most runners get re-injured. Use the 10% rule to ease back into mileage….

Above all, have fun! Marathon running is a challenge that is mental as well as physical. The miles between 20 and 26.2 take determination, stubborness and probably a tiny bit of inner insanity! Whether you finish in 2 hours or 6+, you are still a marathoner forever after you cross the finish line!

Run Happy! And Injury Free!

The State of the Economy Can Be Accurately Predicted by Women’s Shoe Buying Habits!

2010-08-30T17:44:00.000-07:00

A skeptic you say? Here is a true story borrowed from an article in the Chicago Tribune by Barbara Brotman. Turns out there is good evidence that the Dow Jones Industrial Average can be predicted very well by the Nordstrom’s Shoe Index (my favorite shoe store as well!)

"The biggest swing in spending has been in retailers, such as Saks and Nordstrom, that target high-income consumers, a pickup that coincided with the rally in the stock market." — economist Michelle Meyer.

The science of economic analysis has taken a leap forward with the discovery of a new, highly accurate economic indicator: The Nordstrom Shoe Index.

Economists were intrigued to find that statistics on consumers' attitudes toward the economy coincided with the actions of a single consumer in Chicago. Taking a closer look, they found that they could track consumer confidence and its resulting influence on the nation's economy simply by following this consumer's interactions with the shoe department at Nordstrom.

The phenomenon came to light during a recent surge in consumer confidence. Barbara relates that she happened to be at Nordstrom buying eye shadow. Something, possibly a premonition of consumer confidence, drew her to the nearby shoe department. She began browsing high-heeled sandals, though she did not need a pair of high-heeled sandals, as her husband would later point out. But then she saw them: brown leather sandals with that thick-strapped look that stops just short of dominatrix, strips of leather accents in a fetching shade of salmon and a breathtakingly high heel.

She bought them.

The Nordstrom Shoe Index spiked.

The same day, the Dow Jones Industrial Average went up 21 points.

The purchase also mirrored the Conference Board's Consumer Confidence Index, which in April reached its highest point since September 2008.

Analysts noting the Nordstrom Shoe Index phenomenon were particularly cheered at the price the Nordstrom Shoe Indexer paid — $224.95. They reasoned that consumer confidence had to be surging pretty high for anyone to spend that much on a pair of sandals.

Moreover, the increase in the Nordstrom Shoe Index was accompanied by a high Lying to Spouse score. When her husband asked how much the sandals cost, the consumer claimed they were only $180. Though this still resulted in an increase in the Spousal Irritation Industrials, analysts noted that 20 percent represented an impressive level of lying, significantly above the routine 5 percent spousal lie discount.

However, stock market bears warned of a correction. And sure enough, within days, the Nordstrom Shoe Indexer began to have buyer's regret.

Trying on the shoes at home to defend the "$180" purchase to her spouse, she realized that the heel was so high as to cause intense pain, and not just because of the bunion problem. The heels threw her entire body onto the balls of her feet. She could barely walk in them.

For two days, she vacillated. (Really? Why do we do this to ourselves over cute shoes?)

In the same time span, the Dow Jones Industrial Average dropped 236 points

She brought the shoes into the office one day and tottered along a carpeted hallway, trying to decide whether she could take the pain. An economics debate broke out when several female colleagues stopped to say that her shoes were darling. Upon learning of the pain problem, some counseled her to be practical and return them. Others argued she should man up and wear them no matter how much they hurt because they were so white hot. (Pick some new friends!)

The Dow Jones, aka the Jimmy Choo, rose 49 points, apparently on hope of persuasion.
The direction of the nation's economy hovered in limbo as the Nordstrom Shoe Index progenitor agonized. Stock brokers chain-chewed antacids. Hedge fund managers gnawed on their fingernails. Institutional investors fanned themselves.

Finally, the indexer decided that she couldn't justify spending $224.95 on shoes she could wear only while sitting at her desk.

On Friday, she made the call: Back they would go.

The Nordstrom Shoe Index plummeted.

The Dow Jones dropped 173 points the same day. The Standard and Poor's 500 Index fell 20 points.

Some analysts use complex mathematical formulas to predict the behavior of the economy. Some stock-picking experiments have tried dart boards.

The Nordstrom Shoe Index, however, has earned its place in the economic indicator pantheon. A nation searching for signs of financial direction should consider this:

Barbara laments that she still want a pair of really cute, but lower-heeled, sandals.

Ladies…we all knew our shoe shopping habits were important, but now we know the economy depends on it!

Shop On!

Is Your Metabolism Happy?

2010-08-17T15:39:00.000-07:00

Why is it that so many people complain that they eat very little, but are still overweight? I have many triathlete friends that eat way better than I do, yet can’t seem to tame the belly bulge. Then there are people like me that eat everything in sight, and never seem to gain weight. We complain that during times of extreme training that we are hungry constantly and work hard not to drop too much weight! No one feels sorry for us! What’s up with that?

Your metabolism is the key. Most people are somewhere between the two extremes. Their intake, metabolism and output are on a roller coaster ride. If only you can tame the metabolism beast, healthy weight and better performance will follow.

How can we make our metabolism happy? The answer is a healthy, consistent diet and regular exercise routine. The key word is consistent! Food becomes energy at the rate our metabolism dictates. Exercise utilizes this energy at a more efficient rate if our metabolism is fast and happy.

This is not only the key to getting stronger, faster and more efficient but also the million dollar answer for weight loss! Losing weight means taking in less than you put out. You have to take into account your personal BMR (basal metabolic rate) which is one part genetics, one part age and many parts lifestyle habits! Seems simple enough; but if you are on a constant fad or crash diet, your body’s BMR is very low. Hence, you burn much less at rest than a hyper runner like me who eats constantly! I love my BMR! I burn more calories when sleeping than the average person!

So what does all this mean? A person who eats very little but can’t lose weight probably has a slow BMR and is often sluggish in their energy output; while in contrast a person with a fast EMR can eat more calories, utilize them more efficiently and have a higher energy out put!

The formula "energy plus metabolism equals output" means that all three react synergistically. High output is always desired, so in order to affect output, more energy either has to come in, or metabolism has to speed up, or both. Metabolism tends to be the limiter in most cases, since we can choose how much to eat. The volume of output can also be manipulated through programming our metabolism to be happier.

How do we affect our metabolism to achieve our goals? The most logical means to improve metabolism is to do more work. Increase your exercise in either duration or intensity. This will encourage your body to pick up the pace!

Many times your metabolism is low genetically and environmentally for many years and is stubborn to move. It is clinically depressed! The way to jolt it into action is not through starvation, which is often a knee-jerk response to the problem. Steady and consistent eating habits will be supported by good and steady energy inputs and high-energy outputs.

It makes sense that we need to increase our output and eat sensibly and consistently in order to change long-term trends. It is important to remember, this is a gradual process, so a commitment to the course of action is necessary.

Small consistent meals five or six times a day with a gradual increasing exercise program over a period of months leading to years will help kick your metabolism back into its happy place! Patience and discipline are the two primary rules of metabolism repair mechanism.

Almost all of us can improve what we're doing at some part of this equation. Grade yourself honestly. Is your metabolism happy and trusting? Is there enough energy? Is there enough exercise? Too much? Is your metabolism depressed and mad at you having been starved and stuffed with bad food and bad habits? Is there enough energy coming in and where is it going? Where can you improve?

Make your metabolism happy for better race results and an added bonus of a better waist line!

The Barefoot Running Debate Continues

2010-08-08T07:40:00.000-07:00

Here we go again....More questions about the benefits of barefoot running. A new biomechanics study concluded that pronation was more controlled in unshod subjects than those that wore shoes. No conclusions were made on whether this translated to less injuries and no long term study of the subjects was performed. Bottom line, in a small group study, the barefoot runners were seen to pronate less than those that were wearing shoes. What does this mean? Not much. More studies of larger groups and over a longer period of time need to be performed, but barefoot running may be a tool to strengthen your feet. Let me emphasize the words "May" and "Tool". Which means a part of your training program, not a license to go chuck your shoes and just head out the door. Let's look a little closer at the recent study:

Some of the reasons which were indicated by the researchers for this healthful barefoot advantage to runners include:

1. The tendency of the foot to flex more while running barefoot.
2. The fact that the foot moves around inside a running shoe less than was originally believed.
3. The distribution and frequency of the ground’s impact forces on the foot has a better and less stressful pattern on bare feet.

All good, valid points. Personally I'm sticking to my Newtons to strengthen my feet and I have an orthotic in them to control my late stage pronation in my forefoot. Without that, I get hurt! But that's just me.

So you want to try barefoot running? A good test to see if you are a good candidate is to balance on one foot on your forefoot, keeping your heel in the neutral (perpendicular to the ground) position and hold that for one minute. If you can do this, you can start a gradual progression to barefoot running. I would go buy a pair of Five Finger Vibrams to protect the sole of your feet, then start with no more than 5 minutes on a track or softer trail surface. See how you feel. Then progress no more than 10 percent no more than 3 days a week. It will take you at least 6 months to work your way up to a reasonable time and pace. (And I still think its crazy, but again....just my personal opinion)

If you want to go totally barefoot without a pair of Vibrams, then you should take careful precautions before running completely barefoot. You must ensure that the track or path you’re running on is a non-abrasive surface, and is completely free of sharp or dangerous objects. Barefoot running is best done on a track with a smooth but tractable surface which you have personally inspected and removed any objects which could cut or damage your foot during running, and learning to run barefoot is a skill and must learned-slowly. SLOWLY!!!

I still think the jury is out on barefoot running. It is the latest fad which may or may not stick, but for those that want to try it.....take my advice and go really really slowly down that path. Most of the injuries we see from barefoot running are from progressing way to quickly!

Race Recovery Secrets Revealed!

2010-06-01T07:10:00.000-07:00

How long does it take to recover from a marathon? How long does it take to recover from an Ironman triathlon? How much racing is bad for my body? These are all good questions posed in my office on a regular basis. The problem is that the answer is always, "It depends". Everyone recovers at a different rate. Age, experience and current fitness level are large variables in the equation. I know a marathon runner in town who ran 100 marathons in a less than 10 years; and of course, we have all heard of Dane Rauschenberg who ran 52 marathons in one year for charity and then wrote a book about it! The flip side is that I know runners who can only do one marathon a year without getting hurt and most triathletes only train for one Ironman a year.

So what is the magic formula? How much is too much? I think the first thing to think about is what is your goal? If you are just talking about finishing the marathons and not really having a time crunch, then feel free to do up to six a year but realize that having more than two quality runs in a year is very difficult. The Ironman distance should not be attempted more than 2 or 3 times a year regardless of time goals! Now, for those of us who are addicted to the watch, "racing" a marathon is something that should not be done more than twice a year. "Racing" an Ironman triathlon should only be attempted one a year.

Why is this true? Well, simple math. It takes a minimum of 4 months to train effectively for a marathon and 6 months for an Ironman. Then you need at least one day for every mile you ran and three to five days for every hour your triathlon took. That means a month of recovery before you start to train again after a marathon and at least 6 weeks after a 12 hour Ironman. Last time I checked, there were only 12 months in a year; hence, the common recommendation of racing no more than 2 quality marathons or one quality Ironman triathlon a year.

Why do some people recover faster? Age. My feeling is that youth is wasted on the young. I remember being able to run a marathon and get up and go to work the next day. Now I have to take at least one day off and often take two! Experience does help. Your body has been there before, so it knows it will live. Veterans often have a post-race routine down that helps them recover. (Often this includes the anesthesia known as beer!) If your fitness level is high and your nutritional status is good, you will recover faster.

What can you do to hasten recovery? Walk a cool down after the race. Do not sit down immediately even though your legs are begging you to! Take a 15 to 20 minute walk and stretch gently. An ice bath is best, but very few people I know are that tough. A cool bath followed by stretching before you go to bed is helpful. A large amount of carbohydrates and water also helps. Hence the beer phenomenon! A massage a few days after the race will help you recover. More than anything, do not start training again until you are fully recovered. Many injuries occur due to too much, too soon, too fast and too fatigued syndrome!

So how much is too much? Again, the answer is always, "It depends." Listen to your body. Really listen and stop being stubborn or stupid! If you start training and you are exhausted, you are doing too much. If you are spending too much time in my office and less on your bike, you are doing too much. The answer is really simple stupid. Listen to your body and it will tell you how much is too much.

Bottom line: Let your body fully recover from your races and quality times will be recorded. Race only one to two marathons or one Ironman triathlon a year. As for other distances, keep in mind that you need one day for every mile of a running race and at least 3 days for every hour you raced in triathlon. Anything shorter, you better take off your watch and go for the finish instead of the time and prepare yourself to spend some quality time with your local sports medicine physician!

Run Happy! And Recover Well!

Off to Texas Man Triathlon This Weekend!

2010-05-13T13:14:00.000-07:00

Texas Man triathlon series is this weekend in Denton, Texas. The girls at FAANT (Foot & Ankle Associates of North Texas) have decided to try to suck in one of our coworkers and do the Half-Ironman distance relay. Janet and I are still tired from the New Orleans 70.3 so we thought a relay would be fun and it would get Lori to drink the Kool-aid of triathlon! I get to swim (why does everyone hate the swim?), Janet is going to smash the bike (I heard there were a few little hills, ha ha) and our newest triathlete, Lori, is going to motor the run! A good time I’m sure will be had by all. I’m happy because the swim should be wet suit legal! I float better that way. The forecast is bleak and includes possible thunderstorms, so pray for good weather at 7am on Sunday! We will update you after the race!

Here’s a shout out to everyone else racing this weekend. Be safe and have fun!
Run Happy!!

Which is Better? Ice, Beer or Heat for Injury Rehabilitation?

2010-05-12T11:24:00.000-07:00

Ice, Heat or Beer? That is the Question?

Seriously, I crawl over the finish line and the first thing I want is a beer (or twenty)! I think that beer is a great adjunctive therapy for injury rehabilitation. Think about the benefits of beer:
1. It relaxes you.
2. It is a great pain reliever.
3. It makes the end of a race much more enjoyable.
4. It can precipitate post-race amnesia making you want to do another one.
5. It tastes much better than Gatorade.
6. I think I even read a study that showed beer helps flush out all that lactic acid!
7. It promotes social activity after a race when you feel like you just got run over by a truck
8. It’s a great carbohydrate replacement recovery drink.
9. It makes the ride home so much more comfortable……….and the next morning if you don’t have to go to work 

All right, all funny aside, how about the ice versus heat question?

Ice versus heat? This is a common question a lot of athletes, coming into my Grapevine, Texas office, ask. Most understand that ice immediately after injury is very important. The questions usually revolve around when to use heat. There are some basic guidelines that every athlete can use to reduce confusion.

Immediately ice the “fall down, go boom injuries.” Ice works well for reducing redness, swelling and internal bleeding in acute injuries. It also is a great pain reliever. Acute injuries and post surgical pain and swelling usually respond well to 10 to 15 minutes of ice every few hours. This should be done for up to several weeks after an injury or surgery. Ice can be in the form of an ice pack (ice wrapped in a protective towel) or ice massage (massaging with a frozen water bottle or block of ice).

Ice can also be helpful in reducing swelling in a chronic injury like runner’s knee or plantar fasciitis. Icing immediately after activity can prevent further inflammation of an already annoyed area and help in recovery.

So where does heat come in? Heat can be used in several different ways. Contrast baths with ice/heat/ice can be helpful in chronic injuries. Especially those joints or tendons that still have just a little inflammation or edema. Heat should never be used alone in these cases. Moist heat is best for chronic stiffness and old injuries with scar tissue. It can also help in the rehabilitation process. For example, when plantar fasciitis becomes plantar fasciosis after four to six months (which is a chronic degeneration of the plantar fascia), deep heat therapy with ultrasound or moist heat packs can help increase range of motion of the area and increase the effectiveness of physical therapy. Heat actually temporarily increases inflammation in an area, but this is often helpful in kick starting the healing process. Heat can also be used to calm muscle spasms and relax a tight muscle.

Heat causes an increase in circulation to an area, so it should never be used in acute injuries or chronic injuries with a lot of swelling. It can actually make an injury worse if there is still a little internal bleeding going on. A great way to heat a joint or tendon is to use a reusable heating pack or an electric heating pad for about 20 minutes before stretching, massage or other therapy. Heating an old injury before exercise can also be helpful in warming up the area to ready it for increased activity.

The simple rule of thumb is that ice is used for acute, swollen injuries and heat is used for stiff, chronic injuries. This subject is debated continuously, but I hope this discussion clears up the mystery of ice versus heat!

It's National Running Month, So get Off the Couch!

2010-05-02T16:38:00.000-07:00

Hey, it's May. You know what that means? It's national running month!

Wow, what a great month to get started with your new running program! We all know that there is a new running boom and running is one of the fastest growing sports in the United States next to my second favorite, Triathlon! The bottom line is that running gives you the best fitness that you possibly can get from a simple exercise that costs almost nothing! So think about it. Let's walk down to the local running store and get yourself a new pair of running shoes! Let's get back on track today just because national running month! It's a great excuse to get started.

A wise woman always says that the hardest part of a marathon is the first three steps out of bed in the morning, so let's get out there and get running.

If you are using your on and off foot pain as a good excuse to stay on the couch, click here and order my free book on foot and ankle woes. Yes, I said FREE!

Gotta Tri New Orleans 70.3!

2010-04-20T08:42:00.000-07:00

It’s the day after my second Half Ironman. Funny thing, I’m stiff and sore, but the worst pain I have is in my sunburn and my wetsuit rub on my neck! What did we learn from the Oschner New Orleans 70.3 this weekend? Sunscreen and Body Glide are essential to a good long course triathlon experience. You would think after finishing Austin 70.3 last October with sunburn that looked like ahi tuna on both shoulders that I would learn. Must be the blonde in me, ha ha. Stubborn or stupid Hmmm….

What a great day it was in New Orleans. Lake Pontchartrain was choppy and took out quite a few swimmers. I had some rough early moments, but then became one with the waves and relaxed. Unfortunately, I probably swam 3000 meters instead of 2000 because I was all over the place. The waves were pulling you into the shore. I even had one chick in a kayak yell at me “Go left or you will hit the levy”. I was sure levy ping pong with my body would hurt, so I zigzagged my way back on course. I got out of the water about 5 minutes longer than it should’ve been, but no major damage done.

On to the bike! Transition was smooth. Thank God for wet suit strippers! Onto Roxanne (that’s my bike’s name) and away I went. My bike got tons of comments from the other riders. No exaggeration, I think about 500 people in the race commented what a cool bike I had (she’s hot pink camo). I wish they gave out style points, because she is definitely a statement on the ride! The best part was that after I Retuled my bike last month, I rode almost 2.5 mph faster than before! Sweet! The course was flat and fast! The only hills were the overpasses! I spanked the bike and entered transition. I was happy to see only about half of my age group competitors were already on the run so I was having a fine day!

Then the sun peeked its head out from behind the clouds and made all of us pay. It was 83 degrees and about 90% humidity. A hot, steamy day in New Orleans. Normally for me, this would not have been a problem, but the weather in Texas has been so cold that we had no training in the heat to get our bodies acclimatized. Lots of water, Gatorade, salt tablets and ice. I found a great new use for the Jog bra….it holds ice very well between aid stations and definitely helps keep your core temperature down! The run was not pretty, but I dug deep into my mararthon experience and realized the faster I ran the sooner I would be done. Not pretty, but got it done. I crossed the finish line in front of Jackson Square in 6:28 and happily had a beer to celebrate. That was the best tasting beer I think I have ever had! After a potty break and a silver blanket, it was back to the course to find Janet. The boys let me know that she was hurting coming off the bike and probably was walking it in. Happily, we spotted her running slowly but moving forward. She crossed the line and took her beer as well! A good time was had by all!! Janet’s coach Della Irby won her age group, so we had a second beer to celebrate!!

So again, what did we learn? Lube or Body Glide the heck out of your neck before putting on your wet suit if the water is at all choppy. You spend the whole time looking like a turtle popping your head up to try to see where you are going. Sunscreen after you take off your wetsuit in transition. The extra 20 seconds are worth it not to be whining about your sunburn the next day! And remember that God has a sense of humor…..Hydration and nutrition is the key to getting through to the finish. Will I do another one? Of course. Thinking about Miami 70.3 in October. Hmm….A salt water swim would be a cool new experience and I love Cuban food!!

RunDoc at DFW Sports Medicine Symposium

2010-03-28T10:32:00.000-07:00

This morning I spoke at the DFW Sports Medicine Symposium in Arlington, TX. What a great crowd! Over 300 physical therapists, athletic trainers and sports medicine physicians from all over Texas gathered to discuss advances in the medicine of sports.

I spoke on running injuries and more specifically the need for a complete biomechanical exam to not only diagnoses, but to guide your treatment plans. This way the runner can return to running in much better shape than they walked into your office. I feel it is a missing link in a lot of offices due to the time involved. Dynamic gait analysis can actually help the clinician diagnose the root cause of an injury instead of just treating the symptoms. This will decrease the chance of a repetitive injury.

I also talked about the current barefoot running phenomenon and the fact that the average runner will most likely not benefit from barefoot running due to poor biomechanics and muscle imbalances. There is much more of a chance that they will actually hurt themselves. Those runners with fairly good biomechanics and patience can benefit from some barefoot running in a controlled environment. Lots and lots of questions still exist and more biomechanics research needs to be done in this arena.

The need for functional foot orthotics was also discussed. No! Every runner does not need orthotics, but almost 80% need some kind of biomechanical help. Most can be accommodated with shoes, stretching and strengthening programs. You would be amazed how much impact a core strengthening program can have on your running biomechanics. Recurrent, nagging injuries often require orthotic control to alleviate recalcitrant pain.

The last thing I discussed was the need for a gradual return to sport so there will be no more of the too much, too soon, too fast phenomenon that plagues so many runners!

A great question and answer session followed. I gave away a few copies of my book, If Your Running Feet Could Talk. I think we all learned something this morning. A good time was had by all and all the athletes in the Dallas-Fort Worth area and all over the State of Texas will benefit!

Running Too Much, Too Soon = Shin Splints

2010-03-27T12:44:00.000-07:00

The last few weeks, lots of patients have been coming into my office in Grapevine, TX saying, “My shins are killing me after running". This is a common complaint of new runners or runners increasing their mileage or intensity. It has been estimated that "shin splints" account for approximately 15% of all running injuries and may account for up to 60% of leg pain in runners. Many terms have been used to describe exercise-induced leg pain, including shin splints, medial stress syndrome, tibial stress syndrome, recurrent exercise-induced ischemia, and chronic exertional compartment syndrome. "Shin splints" has been commonly used as an all-encompassing term for many disorders causing lower-leg pain so that’s how I’ll refer to it during this discussion.

So what is a “shin splint”? Shin splints are pain in the lower leg usually caused by a variety of overuse or chronic stress related fatigue syndromes. The root cause of most shin splints is chronic biomechanical imbalances of the lower leg and feet. What does that mean? Bad feet, muscle imbalance, bad shoes, or improper training. In Caitlin’s case, she was running too much, too soon, too fast like many new runners and needed better stretching and arch supports.

What can a “shin splint” represent? The underlying pathology of a shin splint can be a fatigue injury of almost ever tissue seen in the lower leg. This can include:
1.stress fractures
2.periostitis (irritation of the covering of the bone also known as medial stress syndrome)
3.Muscle fatigue or fascial herniation (compartment syndrome)
4.Tendonitis
5.Peroneal nerve entrapment
6.popliteal artery entrapment or intermittent claudication (decrease blood flow)
7.spinal radiculopathy (spinal nerve compression causing referred pain).
Wow! That’s a lot of things that can cause shin splints!

While every shin splint injury has its own specific biomechanical causes, most are rooted in tight calf muscles and relative weakness in the front leg muscles. What's going on is that your tight calves are pulling up on your heel, which in turn pulls the front of your foot down. This puts strain on the muscles in the front of your leg, which unfortunately are not strong enough to resist the pulling. This causes a big pain in the leg! This is very, very common in runners, since running tends to exercise the calf muscles more than those in the front. But fear not, a little rest and a lot of stretching and strengthening will fix you up and possibly make you a better runner, too.

How do we treat them? Early on in the syndrome, shin splints are treated with ice, relative rest (slow down and get off the hills and uneven surfaces), anti-inflammatory like ibuprofen, stretching, and arch supports. Take a good look at your shoes. These often need to be replaced or upgraded to a better pair for your foot type. (More discussion on that topic in a future article). Yo may even need a custom foot orhtotic.

After we address your shoes and overpronation or underpronation (your foot rolling in or out excessively when you run), then we move on to the muscle imbalances in your lower leg. Your calf muscles are too strong and tight, while your front leg muscles (anterior compartment) are too weak. This is easy to remedy but won’t happen overnight. Stretching your calf muscles with a simple wall stretch for your Achilles tendon many times a day( how many?) will help. Strengthening the front of your leg can be done by actually putting a small weight (or an athletic sock full of sand) on your foot and lifting it towards your shin. Hold that for a count of ten then relax. Repeat twenty five times. You will be amazed how tired those muscles are!

If your pain persists after two weeks of these simple solutions or is at any time pinpoint or severe in nature, call you podiatrist or sports medicine physician. Stress fractures can creep up on the overzealous new runner and can take 8 to 10 weeks of no running to heal!

Shin splints are common in today's active population. It is important to keep in mind that shin splints, like most running injuries, are basically an overuse injury. Listen to your body and back off when you begin to feel pain.

These are just a few tips to get you on the road to recovery! Run Happy!

To Wave or Not to Wave? That is the Question

2010-03-23T08:01:00.000-07:00

Sounds like a funny question, but what is the right answer? Is there a universal unwritten rule? Should you always wave so that other runners will see you as friendly? Or should you only wave at people you know so that a stranger won't think you are a potential stalker?

In Texas, it is typical to wave and even say hello to every runner you pass on your runs. Heck, I wave at runners, walkers, people's dogs, and even a few passing motorists who yell out the window. I figure they are either saying "Hi!", because they know me or they are admiring my sweaty derrière. Either way, a wave is indicated. I also talk nonstop while I run, so people either love to run with me or find me incredibly annoying. I was even told to shut up by another runner while running a marathon. Guess they were having a bad day. I know my incessant chatter can be distracting, but what about the wave?

To complicate the musing in my head, I also wonder about cyclists? Do you wave to everyone on a bike? After plunging head first into the triathlon world a few years ago and riding hundreds of miles, I still don't know the answer to the waving question when it comes to cyclists. The first few months I was learning how to cycle without falling down; a wave would've caused me to crash. I didn't even think about it! Now, I often wave or at least nod at the passing cyclists. You never know who is a friend or not with the helmets on.

Geography may also have something to do with it. I have come to realize, after running quite a bit while traveling, that the automatic wave is not the norm in other cities. I even started to think it was just a Texas thing, but remembered my childhood running in Rhode Island where everyone waved. Then again, everyone knew everyone else in my small town. Maybe it's a suburbia thing. In fact, while running in Chicago, people looked at me quite strange when I waved. No one actually returned my hello and I have to admit I was not feeling very welcome by the time I finished. My experience was similar in Pittsburgh. Not a lot of waving going on. I expected the same in New York, but was surprised when I received quite a few waves and even a passing grunt while running. Who knew New York runners may be friendlier than Chicago and Pittsburgh?

So, I embarked on a mission to answer the waving question. To wave or not to wave? After a very unscientific poll of over a hundred runners across the country, it turns out there are no hard and fast rules. There are however some loose guidelines:
1. It is always better to wave than not to wave unless you are running in a city. Wavers may be confused with muggers.
2. Wavers tend to be out for a recreational run, not a hard tempo run or speed workout.
3. There are more wavers in the South than in the North.
4. Woman wave more than men. In fact, one man felt a wave may be interpreted as a pick up line.
5. Non-wavers are often wearing an IPod and never even realize they are possibly considered rude and unfriendly.
6. Most cyclists have actually never even thought about waving, but feel a simple nod is recognition enough.

So, I guess there is no universal rule about waving, but I am going to continue to wave to ever and all runners to try to foster a community feeling while I run, but as for cycling; I think I will stick to the nod.

St. Patricks Day Tri Kicks Off the North Texas Triathlon Season

2010-03-17T18:00:00.000-07:00

Keller, Texas was the home of the St Patrick’s Day Tri that kicked off the season for many an age-group triathlete. This year, the season actually started a little early on the Sunday before the great Irish-fest.

It is always a historically cold morning and was double whammy by being the morning of the great turn the clocks ahead tradition of the end of daylight savings time. Tired and cold, what a great morning! At 7:40am, just as the sun was coming up in the DFW area, the first swimmer hit the water. Almost 700 swimmers followed.

After a short 300 meter pool swim in the lovely Keller natatorium, it was off to T1. I cannot describe the feeling when wet feet hit freezing pavement. Picture it is 40 degrees and the cement between the natatorium exit and the parking lot where the bikes were hanging was hard and very cold. By the time I got to my bike, I could not feel my feet. I did don a long sleeve shirt over my dripping tri suit in transition or I thought I might be a popsicle by the time I hit the first mile. Thanks God for that thought!

Onto the bike I went. A brisk wind was my friend for the inaugural race on my new hot pink camo Quintanaroo Dolce bike. Yes, I said hot pink camo! Why not? I’m in touch with my inner princess ha ha. Love the new bike! It is a sports car when compared to my old Specialized road bike, but boy is it squirrely! I’m sure I will get more comfortable with its handling, but this morning I was a little unsteady. I’m sure a few people thought I had been up drinking green beer before the race. The ride was rolling hills and went uneventfully. I passed a few people and got passed by a few more. One guy turned to his friend as I passed them going up a hill and yelled, “Dude, we just got chicked!” Too funny, guess the pink bike bugged him ha ha. It was a smooth ride into T2.

Donned my hot pink Newtons (yes, they are obnoxiously pink as well) and it was off to the run. This is where I realized my legs were dead. The first mile I looked more like a jogging grandmother, but then my quads relaxed and I started to run. The adventure of triathlon is that you never know where or when the wheels are going to fall off (sometime literally). I finished in respectable style. Not my worst, but not my best effort.

The race was a good start to the new season. A little green beer and lots of laughter was had by all! A large group of first time triathlete’s were beaming and showing off their medals. Dallas Athlete’s put on a good show as usual and the triathletes of North Texas are at it again! Watch for cyclists and runners on the roads. In a month or so you will have to look for us in Lake Grapevine (still too cold for now). As for me, Run Doc is off to New Orleans to race the 70.3 in April. Get off the couch, it’s time to race!

Moderate vs Vigorous Activities

2010-03-09T07:15:00.000-08:00

Study shows that vigorous exercise is better for your health than just moderate! Exercise junkies rejoice!

Moderate vs Vigorous Activities

Lance Armstrong Targets Ironman

2010-01-16T06:05:00.000-08:00

Armstrong an Ironman?

After returning to top-level cycling, Lance Armstrong has set a new challenge by saying he intends to compete in the Hawaii Ironman.

The 38-year-old Austin resident was targeting the 2011 or 2012 event in Kona, Hawaii, depending upon whether this year or next will be his final Tour de France.

"I will be in Kona 15 months after the final Tour," Armstrong said Friday. " I'm not saying that with any expectation; it will require months and months of getting back into swimming and running. But I want to just do it, just for fun."

A swimmer as a child and promising national-level triathlete in his late teens, Armstrong has also run in marathons. The Ironman event consists of a 2.4-mile swim, 112-mile bike leg and 26-mile marathon.

"I don't know I could be top three, top five or top 10, but anyway, I want to come and finish," Armstrong said.

Ambitious goal, but he will probably do it. It takes the average runner almost 3 years to train and compete their way to an Ironman. Most people never get to Hawaii unless they get in through the lottery; but knowing Lance Armstrong I'm sure they will find a spot for him just for the publicity. What he doesn't fully realize is the carnage that is seen among the best athlete's in the world at Kona. Even the tough barely survive.

My hat's off to you Lance. Ambitious goal and a "no quit" mentality are neede to survive Kona!

Tony Parker Playing With Plantar Fasciitis

2010-01-15T07:52:00.000-08:00

Last season we talked about Tony Parker of the San Antonio Spurs blowing out his ankle. Seems like his foot and ankle woes are back. He reported this week that he has been suffering from plantar fasciitis for several weeks. The arch of his left foot is killing him and he blames his declining productivity on his foot pain. I know when my arch is just a little irritaed from worn out running shoes or when I need a new pair of orthotics, I have a hard time pushing off when I run. I imagine Tony is having a hard time not only running up and down the court, but having the same spring in his jump shot. He reports that he is using a special stretching sock to help stretch the fascia while he is sleeping. He is also doing quite a bit of physical therapy. Maybe we should send him some orthotics? Then again, maybe it is good karma for the Dallas Mavericks that his feet hurt!

If your arches are killing your personal jump shot, click here for more information on the treatments for plantar fasciitis. Get back in the game!

Amputee who ran White Rock Marathon hopes to help others through her running | News for Dallas, Texas | Dallas Morning News | Latest News

2009-12-14T11:24:00.001-08:00

Be Inspired to run!

Amputee who ran White Rock Marathon hopes to help others through her running News for Dallas, Texas Dallas Morning News Latest News

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Runners: Tips for Winter Survival, by Hal Higdon

2009-12-02T03:26:00.000-08:00

I was going to write a dissertation on running in the winter season, but I came across this post by the always helpful Hal Higdon and felt he covered the topic well. Click here to read Hal Higdon's advice on surviving the winter "off season".

I Survived Longhorn 70.3!

2009-10-27T09:15:00.000-07:00

Yes, RunDoc survived her first Half Ironman!

Wow! We were blessed with a great day for racing on Sunday. Slightly overcast and chilly at the start. The elite wave went off just after the sun came up over the water. What an amazing sight. They are so very fast!! I got in the water on the 5th flight (old ladies ha ha) and spanked the swim! It took about 5 minutes for me to get comfortable, but given the water was 70 degrees I was happy to have my wet suit on. Steady rhythm and out of the water in 44 minutes.

Transition was hilarious. The wet suit strippers unfortunately stripped off the bottoms of the girl next to me (so much for public nudity being prohibited) so she was mortified and I couldn’t stop laughing. I had trouble finding my bike in the sea of bikes but then got changed and off I went. I had to keep a steady heart rate during the bike so I would have something left for the run. I also had to make sure I took in enough nutrition and drank enough so I wouldn’t be dead before I started to run. Rolling hills are your friend, but some killer turns were nasty. I only passed 4 people that were actually moving forward. The other 12 or so were either crashed (sorry Diesel) or were somewhere between throwing up or passing out. Being the stellar cyclist I am (NOT), I think at least 2000 people passed me on the bike.

Oh well, I still got through faster than my goal and after a smooth transition started to run. Well, you may call it running but it was more like a slow crawl at first. Then a walk. My stomach was in knots. After a quick trip to the port-a-potty and a little vomitus, I was feeling much better. Guess I actually ate too much on the bike. I was 4 miles in and started to actually run. The run was three loops so I got to see my awesome cheering section of sherpas three times. They reminded me on the last loop that I would make it under 7 hours if I just kept a steady pace (which at this point was 10 minute miles). Boy did it get hot on the run. Thank God for the cold towels, wet sponges and water stations about every mile. It was amazing to me how many people were walking and crawling at the end. Some were even staggering. I finished with a strong charge and made it in at 6:57:59. Yea! An hour faster than I predicted, and under 7, so Janet’s prediction came true. All weekend she was chanting 6, 6, I know you can do it in 6.

A cold Shiner was my reward after the finish line and a good time was had by all. Worst part of the whole weekend was the drive home (and the sunburn)…Thank God Janet was on sherpa duty and loves to drive! What did I learn? Patience and perseverance mixed with a little stubbornness will get you through, but a few more long bricks probably would’ve helped me take an hour off my time. Off season a new bike is definitely in order and oh yeah….wear sunscreen!

A great first Half-Ironman experience! Funny thing, I hurt a lot less the next day than I did after my last marathon. Guess I will have to try another one next season…who knows maybe even a full in 2011! Run Happy my peeps!

Why is My Second Toe Curling?

2009-10-19T15:22:00.000-07:00

A great question was received this weekend from a hiker in Louisiana: I am not a runner but have been hiking with a backpack for over 19 years with a non painful bunion most of the time unless we travel too many miles in a day. My question is most recently I have begun to have pain in my second toe . It appears to be developing into a hammer toe. Are there non surgical things to do? Also who would be better to see a podiatrist or and orthopedic surgeon? Are there devices I could wear at night that might help? Thank you for your time.

Great question! Why is my second toe curling? What can I do about it? Who should I seek advice from?

In most circumstances, your second toe is curling because it is trying to stabilize your forefoot in gait. A bunion deformity (a.k.a. Hallux valgus) causes the weight to shift to the second MPJ (or knuckle). Over time, the flexor tendon causes the toe to curl and eventually a hammertoe can occur. This will then become a rigid deformity of the toe and cause pain in the joint.

Non-surgical treatment attempts to take the stress off the joint using a Budin splint, hammertoe crest pad, or an orthotic with a metatarsal pad. Once the toe is rigid, surgery is neede to correct the deformity and reduce your pain.

The best advice I can give if you are experiencing hammertoe pain is to seek the advice of a board-certified podiatric foot and ankle surgeon. You can find a local one at http://www.footphysicians.com/

Hope this helps! Run Happy! And without toe pain!!

Why is There an Epidemic of Heel Pain?

2009-10-15T17:51:00.000-07:00

Why does it seem like there is an epidemic of heel pain in the United States? Everyone I talk to has had plantar fasciitis or at least has heard of it. Many can even spell it correctly. (Isn't that scary!) Most people suffer for months and even years before they seek medical attention. Even those treated with traditional methods seem to take just about forever to get better. And there are more voodoo treatments available than Carter has liver pills. Why is that? Seems to me that there is a lot of money in heel pain!

So let's take a closer look.

What is plantar fasciitis? Simply stated, it is inflammation of the ligament that holds up your arch, also known as your plantar fascia.

What causes heel pain or plantar fasciitis? Most experts agree that plantar fasciitis is caused by too much stretching of the plantar fascia, usually because of excessive pronation or flattening of the arch of your foot while you walk. Some people just have excessive stretch because they have flat feet. Others have really high arches and their fascia is under a lot of stress in normal walking. Some are just too heavy. It can be triggered by an injury like simply falling off a curb, excessive stress by a new exercise program, poorly supporting shoes, and many other increases in stress like a new job or carrying heavy objects. There is even one theory that states that plantar fasciitis is caused by weakening of the muscles of our feet from wearing shoes all of our lives. Hmm...Will have to look at that a little closer in the biomechanics lab.

Why does it afflict so many people? Let's think...oh yeah...most of the United States is overweight. Most people choose absolutely awful shoes to wear due to their sense of fashion. Slaves to fashion usually have painful feet! And the flip flop phenomenon has accelerated the epidemic! Those that aren't fat and in poor shoes are usually crazy obsessive exercise-aholics.

Now that we know why it seems that everyone suffers from heel pain at some point in their lives, how can we treat it without breaking the bank? Let's start simple. Better, more supportive shoes are the key to success. Arch supports if the shoes aren't enough. You need to stop the stress that caused the arch to strain in the first place. Then treat the inflammation with over-the-counter anti-inflammatories, if you can tolerate them, and lots and lots of ice. Slow down. (That's tough for more people) And gently stretch the arch of your foot and your Achilles tendon.

When should you seek medical attention? If you have arch and heel pain for more than three or four weeks, and you have done the simple things to alleviate the pain; it's time to see your podiatrist. Not time to go to the shoe store and spend a bizillion dollars on off-the-shelf inserts and funky "proven to work" shoes. Not time to go to the pharmacy for hundreds of dollars worth of gadgets and creams. Time to see your podiatrist, who is the expert in heel pain.

How will your podiatrist treat your heel pain? Every case of plantar fasciitis is different, but some standards of care do exist for treatment protocols for heel pain.

First order of business: You need to rule out anything else by taking an x-ray to make sure it's not a stress fracture or tumor in your heel bone. A physical exam is also needed to assess why you have heel pain.

Then your podiatrist will usually assess your shoes and possible prescribe arch supports or orthotics if your need them. An injection or two of an anti-inflammatory into the heel is often used to break the pain cycle. Physical therapy is also often helpful. A night splint or brace is sometimes used. And if all else fails, you may be put in a cast to rest the area.

Contrary to popular belief, you do not have to suffer from plantar fasciitis forever. Most patients (>85%) will get better with aggressive conservative treatment. It is tedious and frustrating, but the diligence and consistency in the treatment protocol yields excellent results.

Here is the bottom line: if you seek the attention of your podiatrist early, you will get better faster and your treatment will not break the bank. Procrastinators will end up spending a lot more money and the chance of needing surgery to alleviate your pain goes way up!

Is Your Achilles Tendonitis Really Bursitis?

2009-09-30T11:52:00.000-07:00

Did you know that there are more than 250,000 Achilles tendon injuries in the United States each year? Of these injuries, almost 25% require some kind of medical intervention to heal. A fully ruptured tendon requires surgery. Most other injuries can be treated conservatively and will resolve without surgery.

The most poorly understood Achilles tendon injury is actually not an injury of the tendon, but an inflammation of the bursa sac that separates the tendon insertion on the heel bone from the back of your ankle. The fluid in the bursa actually allows the tendon to move smoothly over the bone. When the bursa sac becomes irritated from frequent or abnormal movement, it becomes inflamed and bursitis can set in.

Achilles bursitis, also known as retrocalcaneal bursitis, is a common overuse injury in runners, hockey players, football player and many other athletes. Improper shoe gear and too much, too soon, too fast syndrome are usually the cause of this pain in the heel. It can also be seen in non-athletes who wear poor shoe gear or low cut shoes. Often it is seen in people with rigid, high arched feet.

Bursitis is a painful swelling that occurs in the back of the heel just deep to the Achilles tendon insertion on the heel bone. This inflammation makes it painful to squat, lunge or run uphill. Many shoes press on this area and make the pain worse. Even running on uneven or soft surfaces can increase the inflammation.

First line therapy for Achilles bursitis is rest, ice, heel lifts or heel cups and gentle stretching. Many patients require physical therapy and functional foot orthotics for complete relief of symptoms. Severe cases my even require a period of non-weight bearing casting or bracing prior to physical therapy in order to decrease the inflammation of the bursa. Chronic cases may even require more invasive therapy with extra corporeal shock wave therapy or injection of platelet rich plasma to jump start the healing process. Surgery is rarely needed unless bursitis is ignored for a significant period of time.

Long standing Achilles bursitis can cause significant difficulty in ankle movement and often a spur will form within the insertion of the tendon. Left untreated, this can eventually cause a rupture of the Achilles tendon at the insertion and lead to life long disability. If you are experiencing painful swelling in the back of your ankle, seek the help of your podiatrist early, so you can get back to running quickly and avoid any long term effects of this chronic inflammatory syndrome.

Will I Be Able to Run After Bunion Surgery?

2009-08-23T15:21:00.000-07:00

Running After Bunion Surgery?

Great question! I hear this question at least several times a month from my active, athletic patients. Of course, my first response is always, “Are you able to run now?” This is not sarcasm, but a true fact finding mission. If you are unable to run before your surgery, due to the pain in your bunions, then if you can run afterwards - I am a hero! The same goes for the opposite. If you are running pain free before surgery, and really only want your bunions fixed due to the fact you think your feet are ugly, if you can’t run afterwards - you really don’t like me very much!

Let’s talk about this a little more in depth. A bunion is the result of undue stress on the big toe joint, which causes a protuberance of bone or tissue around that joint. Bunions can be very painful, inhibit normal walking, and make it difficult to fit into some shoes. Contrary to popular belief, bunions are aggravated, not caused, by tight shoes. They usually are due to inherited faulty foot mechanics which put abnormal pressure on the front of the foot. Pain is the primary reason patients seek medical attention for bunions. A majority of bunion surgeries are performed on women because they wear tight-fitting, high-heeled shoes that worsen the underlying foot problem and cause abnormal stress to the joint.

There’s good news for anyone considering bunion surgery. A survey in 2003 by the American College of Foot and Ankle Surgeons (ACFAS) had surgery performed by a foot and ankle surgeon to correct bunions within the past 6 to 24 months found more than 90 percent of patients who had the procedure say they experienced significant pain relief, increased their physical activity, and would recommend it to others.

Many runners who can benefit from the surgery avoid it and continue to endure pain because they have heard that surgery doesn’t work and is excessively painful. Their biggest fear is that they may not be able to ever run again! The truth, as evidenced by the survey results, is that advanced surgical techniques have allowed us to effectively correct bunion deformities with excellent outcomes in terms of pain relief and improved quality of life.

Ninety-six percent of the survey respondents identified pain relief as a desired outcome of the surgery, and 86 percent also said they hoped to improve their walking and increase their physical activity following surgery. On a scale of 1 to 10 with 10 representing “much pain,” the survey respondents averaged a score of 7 when assessing their pain before surgery, and the average score dropped to 2 when they assessed their pain six months after the operation. Ninety-two percent said they were able to increase their physical activities -- walking, golf, tennis, exercise -- and 90 percent said they would recommend bunion surgery to others.

That being said, in most cases, we can treat the pain caused by bunions conservatively. In fact, we feel strongly that surgery should be a last resort. We surprise many bunion patients with our ability to help them avoid surgery when they have been told previously they have no choice but surgery. A custom foot orthotic to off weight the bunion in your shoes is often very helpful. Many patients run for years pain free in orthotics before they decide to have surgery. If you have tried all conservative treatment, however, and bunion pain is causing pain or limiting your activity, surgery as you can see, can be a very effective option.

If the pain in your bunions has caused you to decrease or eliminate running from your life, contact our office for alternatives. Do not let the pain in your bunions change your life!

Run Happy!

Huckabee Encourages Health Reform at APMA National Meeting

2009-08-03T08:01:00.000-07:00

Huckabee encourages Heath Reform at the APMA National Meeting

Health care reform is on the tip of everyone’s tongue this week. The debates in Congress and the attempt to pass some kind of legislation that most Congress members have not even read, let alone understood, is the news leader. I was lucky enough this week to be present for Mike Huckabee’s keynote speech to the American Podiatric Medical Association in Toronto, Canada. The former governor from Arkansas inspired and encouraged the APMA to discuss more than health care reform but to think of revolutionary health reform in the United States as the answer to our health care woes.

What does he mean by health reform? He encouraged the physicians to stop thinking about fixing the health care system. The system isn’t broken. It is actually considered the best in the world. If you start discussing socialized medicine overseas, you will quickly realize that most wealthy foreigners would rather have surgery or cancer treatment in the US than in their own countries. We don’t need to fix the system; we just need to work on unhealthy American habits. The combination of obesity, lack of exercise and smoking, lead to most of our chronic health problems in the US. The system is overwhelmed by chronic disease! Why not come up with a system that encourages healthy living, therefore decreasing chronic disease and actually increasing productivity in the country?

Mike Huckabee knows a lot about unhealthy living and its consequences. Several years ago he was diagnosed with Type 2 diabetes and was told he was now in the last decade of his life. His physician outlined what death by diabetes looked like and encouraged him to take control of his future. He lost an incredible amount of weight, starting eating better, and even started running for exercise. Multiple marathons later, he is no longer a diabetic and is healthier than he has been in years. Mike Huckabee took control of his health and wants every American to experience this life-changing heath makeover.

Why do most Americans have unhealthy habits? Is it laziness? Is it hereditary? Is it social? Actually it is a combination of all of these things in most people. We need to encourage healthier lifestyles and teach our children the importance of healthy choices. Multiple studies have shown that regular exercise including around three hours of aerobic exercise and an hour of strength training each week leads to decreased depression, diabetes, heart disease and osteoporosis. This has been well documented, but most Americans are not listening.

How can we encourage healthier life styles and off load the currently overwhelmed health care system? How about an overhaul of the health insurance system with incentives for healthy choices? I do not believe in penalizing people for obesity or smoking, but how about incentive discounts for a healthy BMI, non-smoking and regular exercise? Just like when car insurance companies give discounts for safe driving records. We could even put an accumulative healthy point system with sliding scale premiums for regular checkup and prevention programs.

Think of what this type of system would look like. The current reforms of the health care system being discussed will lead to a two tier system where the wealthy will have the best care and the rest will be stuck with the socialist model which has been shown not to work in many, many other countries. If we focus more of health reform instead of care reform, we can decrease the load on the current system, decrease health care expenditures and actually have a healthier, happier, and more productive society. Political parties aside, call or write your representatives and let them know you are unhappy with this rushed consideration of the most important legislation in decades. Let us not quickly put in place a program doomed for disaster that will significantly decrease the standard of care in the American health care system. Let us uplift the health of the American people instead.

Book Signing at Borders Books in Colleyville

2009-07-06T15:17:00.000-07:00

Dr Crane's next book signing is at Borders in Colleyville, July 14th from 6-8pm.

Come by and say "Hi!"

Ow Ming! Is Yao Ming's Basketball Career Over From a Foot Fracture?

2009-07-01T04:16:00.000-07:00

Ow Ming!

Houston Rocket's Yao Ming's career may be over due to a non-healing foot fracture. He was sidelined during the playoffs on May 8th with a hairline fracture of his navicular. As of today, this has not healed properly. The nature of his non-union and his prognosis is being kept quiet by the team physicians, but it is evident that there is a problem. Most stress fractures heal completely in 6 to 8 weeks. This is not the 7 foot 6 inch center's first fracture. He has been out portions of the last three seasons with stress fractures in his leg and foot. Perhaps his lanky frame just can' handle the stress of the NBA? Why is it that some fractures don't heal?

Looking at his present injury, stress fractures of the navicular (the cornerstone of your arch) are often slow to heal due to three factors, blood supply to the bone itself, underestimating the extent of the initial fracture so delaying aggressive treatment and too much abnormal stress on the healing bone. Other medical issues can delay bone healing like lack of Vitamin D, poor calcium uptake and many other systemic problems like diabetes, hypothyroidism and peripheral vascular disease. Many of these fractures are actually missed due to lack of specific x-ray findings. Many fractures are actually misdiagnosed for months. Plain film x-rays are often read as normal so the fracture is missed until symptoms increase. Early symptoms can be diffuse and non-specific so the index of suspicion is also low. A bone scan, MRI or CT scan can identify the specific fracture. CT scan is often the most helpful in identifying the extent of the fracture and guiding treatment. For a non-displaced stress fracture, cast immobilization is the first line therapy. Studies have shown that non-weight bearing immobilization in a cast for at least 6 weeks is usually around 80-86% successful. For those that do not heal this way, surgical fixation of the fracture can be helpful and a bone graft may be needed for long standing non-unions. New technologies like electronic and ultrasonic bone stimulators and injectable platelet rich plasma can help even the most stubborn fractures.

Follow up care for a navicular fracture often includes physical therapy and custom foot orthotics. Abnormal biomechanics of the foot often are one of the causes of these fractures, so biomechanical control is crucial to distribute the abnormal stress so an athlete can return to sports and have a lower risk of recurrence.

Yao Ming has had multiple stress fractures during his career increasing the likelihood of traumatic arthritis from avascular necrosis (not enough blood supply to heal so the bone crumbles) in his foot causing him to retire. The next few months will tell the tale for this multi-million dollar All Star. Can he heal his fracture and return to sport? The Rocket's fans are praying for divine intervention to cure their dominant center.

Train Smarter In the Summer Heat!

2009-06-22T03:58:00.000-07:00

I declared myself heat tolerant this weekend in my recent Twitter. I did a 3 hour bike ride in 99 plus heat at 5pm in the Texas heat and could still spit when I was done! That’s a success in my book! It definitely took 2 full weeks of suffering in the heat and a good hydration plan to finally feel like my body had made the transition to feeling relatively comfortable in the soaring Texas summer heat.

Dehydration, heat stroke and hyponatremia are your biggest worries while training in the summertime. Whether you are in Texas or Rhode Island, when the temperature soars over 90 degrees, heat illness can seriously hamper your endurance training. Most of us have an “A” race on the calendar in the fall and require a lot of base training in the summer. No way around those long runs and even longer bike rides in the heat. The average triathlete can sweat up to one liter of fluid an hour while training and sweat contains about 3 grams of salt per liter. How can we conquer the heat? Preparation and constant hydration! Diligence is the key! Always stay one step ahead of the hydration curve. Remember that heat illness really can kill you and hyponatremia has taken out more than one healthy marathon runner and triathlete!

Here are some simple tips that will help you train safely in the heat:
1. Hydrate all day long. Drink water throughout the entire day. Most people actually start their training runs already dehydrated. Especially when the temperature reaches triple digits, it is important to always have that water bottle near by.
2. Prepare for your longer training runs and rides. This means dropping water bottles along the route before you start or making the route circle around many times so you can stop and pick up more water at your starting point.
3. Drink a mixture of sports drink and water. Definitely mix it up. I always have a bottle of each on my bike.
4. Consider salt tablets if you are running or biking more than 2 hours. Unless you can carry salty pretzels on your run, salt tablets are a must if you are sweating heavily.
5. Never be afraid to get off your bike and run through a stranger’s sprinklers! You may look like an idiot, but cooling off and wetting your clothing can only help you stay cool! Putting ice down your shirt can also be helpful!
6. Listen to your body. Especially in the beginning of your heat training, listen to the symptoms of heat illness. If you are nauseous, cramping, can’t spit, have dry mouth, notice your hands and wrists are getting puffy and you are starting to feel goofy; STOP! Go home to run or ride another day.
7. Avoid anti-inflammatories if you can. Ibuprofen and Tylenol actually can affect your kidney function. This can increase you chances of suffering from hyponatremia.
8. Sunscreen, sunscreen, sunscreen. A bad sunburn will thwart your normal heat-regulation system. Heavy duty 70 plus water-proof sunblock is your friend!
9. Weigh yourself before and after your training. Replace your weight loss with more fluids.
10. Carry money. You never know when you may get lost and need to stop at a store for more sports drink or water.
11. Train with a friend. They may notice your symptoms of heat-illness way before you do. Denial is never a good companion.

Heat-illness is real! Be smart while training this summer! Follow these tips, heat acclimatize over a period of several weeks and be diligent about your hydration plan while training in the heat. Let’s get to those fall races stronger and without any heat-related training drama! See you on the run!

Denna Kastor Talks About Taking a Break After Breaking Her Foot at the Olympics

2009-05-29T14:38:00.000-07:00

There was a good Q & A in Running Times talking to Deena Kastor about her foot fracture at the Olympics. I think it's funny that she broke the same bone I did last year. Her discussion about the need for rest and recharging sounded like an echo. I think it is so important for us to realize we need rest after an "A" race or marathon. Also, as women, we need to understand the relationship between Vitamin D and the uptake of calcium. To read more about Deena's injury click here for the complete article. For more on metatarsal fracture in runners, click here.

Run Happy! Rest easy....and more than anything else...run forever my friends!

To purchase a copy of Dr Crane's new book "If Your Running Feet Could Talk" click here.

Running With Arthritis

2009-05-16T08:05:00.001-07:00

Running Forum Questions:

I recently received this email from a runner in Virginia asking a good question on running with arthritis:

“I have been running since I was 13yrs old and I am 42 now. Friday I was diagnosed with osteoarthritis after 6 weeks of no running but cross training on the elliptical. The doctor thought it was tendonitis but after not getting better he decided a MRI would be appropriate. The MRI confirmed it was osteoarthritis. I am starting physical therapy on Monday 3x a week.

My question: Is it possible for a runner who has osteoarthritis to be able to run again. I feel like my world has been rocked and shaken. Running is HEAVEN for me and nothing compares. It is my total stress reliever and if I do nothing else in a day if I've run my day is totally complete. I am the mother of 3 great kids and I guess I should be thankful I can do the cross training now because I get cranky when I don't get to do something. I just feel like this means my running career is over. My mileage before getting injured was about 25 a week.

Please let me know your thoughts. I have searched the internet for help on other runners who are going through what I am and have osteoarthritis of the foot with no luck so far. Thank you so much for taking my comment. I'm praying for a miracle. I know it's not life threatening but it's my mental state I'm concerned about.”

RunDoc Answers:

Let me start my answer with a story. I have a runner in his late 30’s as a patient who had the unfortunate luck to be blown up in the Desert Storm conflict while he was serving in the Marines. He has severe arthritis in both feet from his injuries. He has had at least 5 foot surgeries including a fusion of his subtalar joint in one foot. He ran the 2008 Marine Corps Marathon in less than 41/2 hours. If he can run a marathon on feet that are that bad, I am confident that you can get back to some kind of running.

The name of the game is accommodation. You will need a great pair of orthotics made by a podiatrist that knows what they are doing and specializes in biomechanics. They can fabricate a device that will transfer the stress from the arthritic area to a strong, healthier part of your foot. That coupled with physical therapy, core strengthening exercises and a good pair of running shoes will get you back on the road! For more information on living with arthritis click here!

Run Happy! And Pain Free!

How to Cope With Race Day Jitters!

2009-05-14T03:55:00.000-07:00

It’s just a few days from a big race and I’m already anxious. What am I afraid of? Running a bad time? Totally bonking? Looking stupid in front of my friends and patients? Drowning in the open water swim? Getting a flat tire? Perishing on the street? Where does all this performance anxiety come from? After 30 years of competitive running you would think I would have conquered race day jitters, but they are always there…kinds like an old friend…or a fungus….

So, how do I cope with race day jitters? Positive self-talk, preparation, visualization and organization!

A race is just another long training day in the company of a few hundred, or sometimes a few thousand, of your closest friends. Most anxiety comes from fear of the unknown and lots of negative self-talk. Reality – your friends and family really don’t care what your time is, whether you place or not, and the world will not end if you run a bad time! My patients are just amazed this old lady is still racing! Times are irrelevant! Setting high goals will just stress you out! Focus on running your best race that day! Relax! Have fun! Go into the race realizing you have nothing to lose and everything to gain. I treat every race as a learning experience. Even if you get kicked in the face in the swim and lose your goggles, get a flat tire or totally bonk on the run; you learn something you can use another day!

There are many things you can do to stay relaxed. Here are just a few I have learned along the way:

1. Be prepared! Have a pre-race checklist of everything you need. Set out all you clothes and gear the night before and go through the list. This includes checking your bike tires and inflating them. Finding a flat the morning of the race will send your heart rate through the roof. I set everything out on the living room floor then pack my bag. The bike goes on the car the night before after a thorough check. My nutrition is all set out and the coffee pot is prepped!

2. Never change anything the day of the race. This is not the time to try that new pair of Newtons! Stick with your routines. Treat this as just another long training day! Eat what you would normally eat before a long workout. Extra sleep always helps, so go to bed early!

3. Go to the race with a friend. Having your peeps with you can really help diffuse anxiety. Travel to the race together and help each other calm down. DO NOT let your friends make you crazy. Some people actually feed off others anxiety. If this is you, you may be better off with your Ipod as your friend while you set up your transition!

4. Visualize finishing. Visualize the entire race the night before. Go to the race website if you are not completely familiar with the course. Visualize a nice calm swim, a smooth transition, an awesome bike and a killer run! See yourself run a PR. My best races have been played over in my mind a thousand times before they ever happened. Remember what it felt like the last time you had a great race! Embrace that feeling!

5. Get to the race early. Get organized! Find the bathroom and then relax. Warm up and keep up the positive self-talk! Remind yourself that you have done the work and the race is just a celebration of how hard you have pushed yourself and your mental toughness! Claim your reward!

Race day jitters can completely derail your race before it has even started. Don’t let the negativity ruin all your hard work and preparation! Relax! Follow these tips and remember to banish the negative, and stay positive throughout the race! Try to have fun! Whether this is your first marathon or your 100th triathlon, remember to celebrate your training and have a great race!

Fat Parents Have Sick Kids!

2009-05-06T16:12:00.000-07:00

I heard a statistic today that startled me. If you are born after the year 2000; you have a one in three chance of having diabetes. One in three! That is truly scary!

A second frightening statistic is that this is also predicted to be the first generation of Americans that will not live longer than their parents.

Why? Both of these sobering statistics are a direct result of childhood obesity and a sedentary lifestyle. What are we doing to our children? We owe them a better future. Politics aside, we are already mortgaging our children's future with our current economic issues and national debt. We are also dooming them to suffer from many chronic illnesses by the lifestyle we are teaching them by being lazy, fat Americans.

The typical American diet has substantially changed in the last generation. We no longer sit down to family dinners and tend to look for quick, often drive-through solutions. Our generation has more food choices than ever before; but tends to choose the fast, more often less healthy, alternatives. Why? Laziness! We are so busy trying to be super-productive that we don't take care of ourselves or our families. Our children are mirroring our behaviors when they make their food choices.

Exercise? Not most Americans. The minimum recommendation is to engage in moderate exercise at least five days a week or 20 minutes of vigorous exercise (aerobic activity) three days a week, plus to do strength training twice a week. A recent polling showed that only 17% of Americans managed to find the time to lift weights at least twice a week and engage in vigorous exercise three times a week or at least moderate exercise five times a week. Only 50% exercise at all three times a week! What kind of example is this for our children?

Many parents feel our children get their exercise from physical education classes in school, but less that 50% of school children have some kind of physical activity every day in elementary school. This number worsens as they progress in the school systems. Our children's activity level has plummeted dramatically in the last generation due to lack of physical education, lack of unsupervised play, computers, Internet, video games, etc. We can not depend on the school systems to teach our children to exercise and eat right. This must come from the example set by their parents. Right now, most Americans are setting a poor example!

Americans are not suffering from a lack of information. Most know what to do, yet choose not to. Since the early 1980's, the benefits of exercise has been preached on every street corner, yet we don't listen. Nevertheless, the cultural changes in the past decade have been so staggering in terms of decreasing physical activity in every sector of life and increasing the intake of garbage calories and fast food, that nothing short of a major paradigm shift is necessary!

Bottom line: a combination of obesity and lack of exercise contributes to more than 300,000 deaths each year in the United States as a result of heart disease, stroke, diabetes and other conditions. The statistics for the next generation are even more onerous. Only through changing our behavior patterns can we influence our children's future behaviors and reverse this trend.

Dr Crane's New Book Available Now!

2009-05-04T15:51:00.000-07:00

Dr Crane's new book : If Your Running Feet Could Talk now available on Amazon.com

Click on the title for more information.

Dr Crane has written a prescription for surviving and avoiding injuries on the run. This book provides practical advice and resources to the running community to keep you running healthy and strong. It is meant for the novice and intermediate runner who needs solid advice on getting started, training programs, aches and pains, and recovery. Persistence and determination is the key to surviving then ultimately avoiding most running injuries. This book couples years of blood, sweat and tears on the pavement with sound medical advice for all runners.

Please enjoy and send your comments for the next version to contactme@myrundoc.com

Run Happy!

Confessions of a First Time Triathlete

2009-04-27T17:53:00.000-07:00

This blog is a guest writer...Janet Dixon, my sidekick pedorthist proves how tough she really is. I am so proud of her....here is the story of her first triathlon!

Well folks, I finally did it. I finished my very first triathlon. I also had every possible thing go wrong today as well.....

So - I wake up at 450am. I thought hey, we are close by and since both Dennis and Claire were joining in as a cheer section for me, we can sleep in a bit longer. That was the first mistake.
Woke back up at 515am. Tummy is grumbling - so are you hungry or are you nervous? Suddenly a bowl of cheerios seemed to be the thing to do so I have at it. At this point I am pretty darn calm and ready to roll. I look for Claire and guess what - the 12 year old is still out like a lightbulb. So I chill as I hear Dennis yap at her to get up. She rises - takes a shower, we now are in human form.

Departure time scheduled for 545am. Hmmm - stomach is feeling funny. Here comes the nerves. I make one last stop to the restroom - much better. Time is now 555am.
Arrive to the race and we are guided to the overflow parking lot a block down. Darn it...should have got here earlier. My cell phone rings and it is Marybeth. I decide to mess with her and tell her I am still sleeping. She reacts, I laugh and tell her I am actually in the area.
So, rule number one - GET TO THE RACE EARLY!
Bike and accessories in tow, I head to transition. I am SO GRATEFUL, I elected to have markings done the day before at packet pickup. There was a huge line and it felt great to squeeze right past folks.
Rule number two - GET MARKINGS DONE EARLY IF OFFERED!

I head to transition and all of a sudden, I am nervous. Now remember my deal a few weeks back on getting into the unitard? Yeah...a two piece seemed to be such a better option at this point.
So I rack my bike and I am a happy girl! I find Marybeth who at this point is thinking where the hell is she and I surprise her in my zingy way. One problem, she tells me I am racked at the wrong bike rack....darn it!
Rule number three - MAKE SURE YOUR BIKE IS RACKED CORRECTLY!

Ok, so I feel pretty stupid and I am still in need of facilities - big time.
I look for Dennis and Claire and calm down. I tell myself, look nimrod, this is just to see what happens, to finish the race in one piece then look to see where I can improve for the future. Remember, I am and will complete a half ironman in less than six months
So facilities time - of course, as usual, there is a women's restroom line but not for the dudes. So unfair I thought. Finally, the visit to the facilities is complete. I feel fabulous!

The wait for the pool was interesting. Triathletes come in all shapes and sizes. I told myself to stop worring about what I looked like in my second skin. By the time September rolls around, I will have hopefully lost a few rolls of my own if you know what I mean.

The swim begins, I jump in. Water feels great! I start to swim....I am excited, I am doing this, I have propellers for feet, I am so glad to be doing this....I don't breathe! All of a sudden a foot nails me in the right side of my neck. Right where I had a neck injury. Right arm immediately goes numb. I almost call it and get out of the pool - no, I tell myself, you can manage this now breathe and move it!

Rule number four - PACE YOURSELF IN EACH LEG OF THE RACE.
After 150 yards Janet is tired....Janet can't breath right, Janet went out WAY TOO FAST! So, I flip over and backstroke the rest of the race. I don't care, I am not taking first place - I am here to finish. Ok I thought, I will pace more during swim training - I just learned to swim starting three months ago so I don't beat myself up for this.

Ah, transition! I found my bike - good sign. Wait - where is my computer at? Crap, it's in the bag. What felt like an eternity I finally found the Garman. I am feeling disorientated - I can't get the stupid Garman on my bike! So with computer in hand, I begin the ride.
Rule number five - HAVE AMPLE TIME IN TRANSITION TO ENSURE EVERYTHING IS LINED UP.

So off I go on the bike. Ah, things feel much better. As I cycle, the Garmin magically fits on the holder and I grab something to drink. YES! I watch my pace climb to 18, good - now hold it I thought. Hmm - did I fail to mention it was a very WINDY day? Oh wait, it gets better. Half way through my chain falls off! Can you believe this? Luckily, I got the oily thing back on - gross I thought. Yep - that affected my ride a bit however, the bike portion I can tell is going to always be my favorite part of a triathlon.

Transition #2
I was completely ready to jump off my bike at the right time and I did. I was impressed. When my feet hit the ground - oohhh what a weird feeling! Trying to run after cylcing is really weird. My brain was ready however my feet were not. I racked the bike - no idea if it was right or not, threw on my running visor, grabbed my running belt. SNAP - running belt and bib number detach from one another. So what, it's still hanging on by one loop - move your arse I tell myself.
Ok - so what rule are we on? Ah yes,

Rule number six - YOU MUST STAY CONSISTENT IN EACH AREA OF A TRI AND TRAIN APPROPIATELY. Yep, all those days in the pool, cycling...what about running? Hmm - my bad.
Running at this point was mute. I ran the first loop and suddenly I was tired. Oh gosh I thought to myself, I am going to walk during a measly 5k? What a hosebag I thought to myself. So, I walked a bit. Then I felt bad...then I got mad. Why didn't you prepare - what is wrong with you - if you come in last, you will let Marybeth down - where are your expectations - you are embarrasing yourself. All this past through my head then my stomach took over...I was hungry. Where is my gel? Yep - BACK AT TRANSITION! Sooo......Rule number seven - make sure you have adequete nutrition for each stage of the tri. So much for the cheerios and one goo before the swim - I want to eat. In fact, I want to chew off my right arm...I AM HUNGRY CAVEMAN GIRL....

Then I see members of the running club yelling out my name, starting running you goober I thought, you can't look that bad to your running group. So I pick it up until over the hill, I start to walk. Darn it...

Second loop felt like mile 19 of a marathon. I am amazed how hungry I am. Marybeth shows up. Springy and happy like she just woke up - note, she finished a half hour ago - she runs me in. She tells me we get a medal. We do? I didn't know that. Well, heck , I have to start running!
Now on top of starving, I mentioned previously I had a cervical injury. I lose my right index finger feeling. I don't want to stop however I fess up and tell her I have to walk. I feel like I am the biggest dope for walking. The throbbing stops, I try to run - comes back.

Finally, the last hill - I slow jog it in. I finish.
I thank Marybeth for her kindness and spirit. I look over to my right and see Dennis and in an instant, all of the insanity that happened during the race didn't matter. I find Claire - I am good. I did it...slowly, but I did it.

I will be a half ironman - you watch. It will probably scare a few people, it will surprise many. I am hooked. Next tri - no walking and I will forever have the above seven steps inbedded in my brain.

I learned today.
I am a triathlete.
I am caveman...girl!

Now go out and do something good for yourself today, I will be running a bit more...... ;)