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  • Health Articles

    Recover—When Can I Run (and Race) Again?

    Way to go!  You have finished (hopefully!) a half or full marathon and may wonder what to do next.  Here are a few pointers:

    Some rest from heavy training is needed after any race—the longer the race the longer the rest.  While there are no specific guidelines that have been scientifically validated, some suggest one day of “rest” for each mile run—13 days if you ran the half marathon and 26 the full.  Again—this is rest from heavy training.  A reasonable approach is 3-5 days of complete rest, followed by 20-30 minutes of light cardio work (running, cycling or swimming) 2-3 times during the first week of recovery.  This is called active rest.  Push-ups, sit-ups, and light weight training are OK too.  Rolling and massage therapy are also good ideas.

    If you are feeling good at this point (7-10 days out from the race), Susan S. Paul, MS from Runner’s World suggests doing a “reverse taper” by repeating your taper weeks in reverse order, gradually increasing the distance of your runs to close out the first post-race month.  Keep the intensity level at 60-80% of max heart rate during these runs.

    It is not unusual to have some muscle or bone pain after a race.  Delayed onset muscle soreness (DOMS) may actually make you feel more sore several days after the race.  This is due to microscopic muscle tissue damage—the better condition you are in going into the event the less likely this is to occur.  This should improve over the next few days, and go away.  If pain localizes to one area, or doesn’t go away after 7-10 days, consider seeing a sports medicine physician.  If you have severe pain, or the pain is getting worse, consider seeing the physician sooner.

    One way to assess how your recovery is going is by monitoring your resting heart rate (RHR).  This is best measured by taking your HR early in the morning just after waking up in the weeks leading up to the race.  If while you are performing you recovery runs your RHR is returning to pre-race levels, your recovery is on target.  If it continues to be elevated, your intensity is likely too great.  This is also a good way to monitor your pre-race training as well—if you notice you RHR going up as you train, you are not allowing your body enough time to recover between hard workouts.

    What about racing?  After a marathon 3 months is appropriate (before running another long race—probably a 10 miler or longer).  Muscle regeneration continues to occur for many weeks after an event like this.  Racing too quickly can damage muscles that are still healing, causing pain, limiting performance, and setting you up for other injuries.  Racing a shorter race (5K/10K) is OK as part of your recovery.

    There are many places to find us if needed.  We have locations with sports med doctors all over town—check us out at www.metrohealth.net for more information, or call 252-7778 to schedule an appointment.  And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-7:30 PM.  These are brief one on one sessions open to active individuals of all ages and sports.  Contact Gazelle for more information.  

    Be active!


    I Spy…

    If any of you have children or grandchildren, or even if you don’t, you are probably familiar with the game I Spy where one person picks something out, and says “I spy with my little eye” and the other person or persons has to guess what has been picked.  There are often clues that go along with the guessing—it is a good game to pass the time and have some fun.  This past weekend I had the opportunity to go out to California to a medical conference.  Along with learning new ways to keep patients and athletes safe, I had the opportunity to get out and see some sights.  Most times that I travel I get out for a few runs—and this trip was no exception.  Training for the Metro Health Grand Rapids Marathon (running the half marathon on race day before seeing many of you at the finish line) I needed to get out for a long run.  And while I was out I spied…

    A dad and daughter sharing a pretzel,

    A couple taking wedding photos on the beach,

    And 80’s rock (OK I “spied” with my ears for that one).

    So who cares?  I mean these are all nice things and all, but what do they have to do with running?

    You know how sometimes when you run you have an endorphin day?  Seems like everything is going well.  Temperature is good, you are injury free, good company maybe—it seems like you could just keep on running.  And then there are some days that nothing seems to go right.  Your pace is slower than it should be, you got a later start than you hoped, and well, the chafing (sorry) seems worse than usual.  Something keeps you moving along though—what might that be?

    For me it’s the daddy and daughter pretzel’s, wedding photos, and 80’s rock—all things that give me good feelings—an endorphin boost on the days that running endorphins are not enough.  You see when my daughter was younger she and I would share a pretzel and giggle.  When I see other dads (or moms) and daughters sharing pretzels it takes me to a good place.  Although I cringe when I look at my wedding photos (my wife looks as beautiful as ever—me not as much) I still get good vibes from remembering my facial muscles failing me when I had to smile “one more time.”  And 80’s rock—it doesn’t get any better than that for running tunes.  A couple months ago my son told me he and some of his friends “discovered” this genre of music and boy did that make me feel good!  Presto—think about these things in the middle of a tough run and instant endorphins!

    You may have different endorphin creators, but we all have them—memories that give us a boost today.  I am sure not everything in your past has been good.  In fact, for some of you there may be a whole lot you don’t want to remember.  But there are some good ones in there somewhere—right now is as good a time as any to dig them out!  They will not only help you when your running endorphins are low, but may also help you when your life endorphins are low as well!

    As a side note you may have noticed that my examples all included my family.  These were not made up—I am truly blessed to get inspiration from my wife and kids.  I don’t thank them enough for all of the support they give me (and many others) everyday—so here you go.  From the bottom of my heart thanks for all you do to keep me going on every run and every day!  And thanks to all of you reading this for allowing me to thank them and for reading—I get a little boost every time someone mentions they read the articles.  I am humbled to be part of your running lives!

    So, let’s get on with it.  You all should be in the midst of your taper and getting ready for your half or full marathon next week.  If you are not running due to injury or any other reason, there may be something around the corner for you.  Keep the faith and look for something that inspires you!

    Be active!


    Running Ambassadors

    Most of the articles I write deal with injuries, safety while exercising, or training issues.  Many of you are either avid or regular runners even if this is your first half or full marathon.  One of the things I struggle with as a physician is how to get some of my other patients to be active as well—maybe not as racers, but walkers, runners, or bikers.  Why, you may ask, am I writing this in a newsletter that is read by people who are signed up to run a race, or have run one in the past?  Because you are the role models, the torchbearers, the ambassadors of this grand idea of being active.

    Recently I had the opportunity to see both ends of the exercise spectrum—ironman distance triathletes at the Michigan Titanium Triathlon this summer, and new 6th grade cross country runners this fall.  The triathletes spent up to 23 hours swimming, biking and running (and sometimes walking).  Some significant training and planning is required prior to undertaking an event like this.  These athletes had been active for quite some time.  In contrast the new 6th grade runners ran for about 20 minutes or so.  For some this was the longest continuous running they had ever done (at least running for the sake of running—they seemed to forget about all of the running around they did playing in elementary school).  The hope is that they will slowly build up the amount of time/distance they are able to run and enter a few races.  Will they someday become triathletes?  Possibly not, but they will hopefully stay active and healthy.

    My challenge to you (as if training wasn’t enough) is to embrace your role model status, and find someone to help become active.  If we are all working together on this, the chance of success goes up.  Difficult you say?  It is, but so is training for a long race, and you’re doing that.  Pass this article on to someone, sign them up for the Metro Health Grand Rapids Marathon. . .Newsletter (did you think I was going to stop at the word Marathon—baby steps!), and be a cheerleader.  This is important stuff, and you are just the group for the job!

    Hopefully you can think of someone who will benefit from this information.  Injury Wise continues at the Grand Rapids Gazelle Sports location every Wednesday from 6-7:30 PM.  Sign up at the store.  If you have any questions about injuries (running or otherwise) or would like to talk about running in general, come on out and we will be happy to take a look at you.  Injury Wise is open to active individuals of all ages and sports (and even to those who don’t play a sport).  Students are welcome as well.  For more information or to schedule an office visit, contact Metro Health-University of Michigan Health Sports Medicine at 252-7778.

    Be Active!


    Running Rules

    Many of you have goals attached to your race:  finish, prepare for a marathon (or an ultra), or maybe help a newer runner with their goal.  In order to help avoid some of the “obstacles” you may encounter, here are a few things to consider leading up to your races.  “The Runner’s Rule Book” by Mark Remy offers a few “rules” that may help you in the next few weeks (and life in general).  Maybe the rules themselves (or the subsequent discussions) will help.  Maybe they will make you chuckle.  In any event here are a few things to ponder.  (The book is a great read by the way).

    Run The Mile You’re In (Rule 2.27).  “… keep your head in the here and now” as Mark puts it.  Training runs and races (any distance) can be long, and if you focus on the whole thing it may seem a little overwhelming.  But if you break them down into smaller pieces (this mile, the next block, or even the next step—I have used this last one more than once), the larger task is attainable.

    Pretend You’re British (Rule 2.29).  Say what?  Are we supposed to run with an accent?  No.  What Mark is getting at is decorum—how you should respond in tight quarters at the start of a race (or in the middle for that matter).  When (and it will) the jostling occurs, be “unfailingly polite and unassuming.”  Don’t get too worried about being bumped, clipped, or blocked—let the runner pass, back off a little, and get back to your running.  (Having said that, try not to be the bumper, clipper, or blocker).

    Line Up Where You Belong (Rule 2.18).  Last year I overheard two runners talking about the signs with times on them (7:00, 7:30…) at the start of the race.  One noted that they were way too far forward in the race corral for their pace.  The other said not to worry, that even though they were walking, there was no need to move back to the proper location, and that the runners would just have to go around them.  While not everyone is worried about their finishing time, this is in fact a race, and isn’t it the right thing to do to line up near your expected race pace?

    When you are feeling an energy drain, talk to the fans (This one is my own).  On more than one occasion when I started to feel sluggish, I have yelled out something to the spectators (“Let’s go!”, “Thanks for coming out!”, or “Why did you get up so early?” are some of my favorites) and felt an immediate surge of energy.  It makes my wife a little uncomfortable, but I feel great.  Try it—you’ll be glad you did!  (Thanking a volunteer along the way has the same effect).

    If things don’t go as planned on race day, or you are looking to take your running to the next level, call us at 252-7778 or find us at metrohealth.net.  We are the choice of many elite athletes, and utilize our knowledge and resources in getting ALL athletes back on track!  It does not matter how fast or slow you go, or what your goals are, Metro Health-University of Michigan Health Sports Medicine wants to be your go-to organization to help you achieve your goals.  Let us know how we can help!

    Be active!


    Be Smart To Stay Safe

    There has been a shift in the types of athletes I’ve been seeing in the office lately—more broken or twisted body parts from football, volleyball and soccer players, and fewer runners with sore legs and feet.  This is the “quiet time” in the weeks leading up to big races—this time of year around here it is Chicago, Detroit or (my fave) the Metro Health Grand Rapids Marathon.  Runners have trained for weeks and months, and are ignoring the things they would normally go to the doctor for.  The last thing they want to hear right now is “You are injured—you cannot run!”  Here are a few things to keep in mind leading up to your race.

    First, be smart—don’t ignore things that may derail you on race day.  There is an expo the day before the marathon, and I spend most of my day there, going over last minute training issues and giving out advice.  I can guarantee one thing will happen:  a runner (often brought over by a significant other or friend) will limp up asking what can be done to get them through the 13.1 or 26.2 miles the next day.  We usually come up with some type of plan which usually ends with “there are doctors and nurses at every aid station, don’t be afraid to stop and have it checked again.”  (I don’t like to tell people not to run either, so you will rarely hear those words come out of my mouth.  Sometimes it’s the only way.)  Some runners finish, others do not, and I always want to tell them that if they had come to see us just a few weeks earlier, we would have had more time to nail down a diagnosis and formulate a plan, even just two or three weeks before the race.

    Second, if you cannot (or will not) go to a doctor in the few weeks leading up to a race, here are a two things that may help settle things down: ice and relative rest.  If something is sore (a shin, foot, ankle or knee) put ice on it, 10-15 minutes 2-4 times a day.  Ice is your friend.  It is hard to over-do ice (I did have a patient who left it on too long and developed a mild case of frostbite), and it does a great job of calming down inflammation.  Too much inflammation/irritation may cause an alteration in gait, worsening the problem that already exists, or leading to a new one.  Relative rest is the concept of altering your activity (by adding swimming or biking) on some or all of your running days to let a problem heal up.  You are still doing something to get/stay in shape, but resting the injured area.  You may not know exactly what the injury is, but these two things can help get you through.

    Finally, if you are able and willing to go and see someone, make an educated choice.  Even as you read this, there is still time to get a diagnosis and make a plan, but you need to find someone who has the expertise to guide you through this process.  At the risk of sounding self-serving, a primary care sports medicine doc is a great choice (and at Metro Health—University of Health Sports Medicine we happen to have a few).  But don’t just take my word for it.  In a Runner’s World (July 2011) article regarding finding the right care, the author noted “Physicians with added training in sports medicine are often the best place to start . . . and can give you a comprehensive evaluation that includes diagnostic tests, from blood counts to bone scans to MRIs.”  After doing this for 19 years, I see the value of getting proper care from sports medicine trained physicians.  You go to a specialist for other problems—why not your sports injuries?

    Good luck in the next few weeks as you begin your taper (love that word) to get ready for your run.  The InjuryWise clinic brought to you by Metro Health—University of Health Sports Medicine continues at the Grand Rapids Gazelle Sports location every Wednesday at 6 PM.  If you have any questions about injuries or running in general, come on out and we will be happy to take a look at you.  Also, our Saturday AM hours (9-11) continue at Metro Health Southwest Plaza on 44th Street —go to www.metrohealth.net or call 252-7778 for more information.

    Be active!

    Course Correction

    Have you ever looked back at where you came from and wondered “how did I get so far off course?”  It may be a literal (like in a run or hike) or figurative (as in life).  Many times when you retrace your steps you realize that while your most recent path is pretty good, one right angle turn at the beginning sent you in the entirely wrong direction.  You have been in fact zigging and zagging at the right times, you are just doing it 90 degrees off course.  Many times you feel like you have failed miserably because you are far from where you thought we would be.  If running (or biking as happened to me a few years ago) you must adjust course and find the true path.  The same holds true in life with a slight but important twist.  Unlike really running or biking, in life you can take a portal of sorts and get back where you need to be.  Instead of retracing all of your steps, just keep doing the things that are working for you and adjust where and how you are doing them.  Don’t scrap the whole thing—there is likely a lot of good that has been done.  Focus on that and make a small adjustment to get going in the right direction!

    I would like to thank you for reading these articles.  Many of you let me know in the office, at various expo’s and on race day that they can be somewhat helpful—thanks!  In my day job (which I am not quitting anytime soon) I help people get and stay active.  I have excellent partners that do the same thing.  To find out how to see us call 252-7778 or click on www.metrohealth.net.  We would love to help you out!

    Be active!

    Exercising in the Heat

    Just when you thought it might cool down and stay that way—the heat will be on again!  Here are a few things to keep in mind in the warmer weather:

    1. Slow down. Running generates heat.  The higher the temperature, the harder it is for the body to cool down.  One estimate suggests that every five-degree rise in temperature above 60°F can slow pace 20-30 seconds per mile, and in marathoners the pace can slow about three percent for every 10 degree rise above 50°F.
    2. Cool down. Run for 1-2 miles (or up to 15 minutes), hose off or jump in a pool for a few minutes—then do it again.  Or intersperse walking and running—the higher the temperature, the more walking.
    3. Run in the AM or PM. If possible run at the cooler times of day—early morning (preferable) or in the evening.
    4. Dress right. Light colored, tech fabrics keep you cooler by not absorbing as much heat and helping wick away sweat. A visor will shade your face while letting more heat escape (guys—watch the dome!).

    Also, don’t forget sunscreen.  Even on cloudy days UVA and UVB rays will get through.  Use SPF 30 or higher and reapply every two hours.

    The sports medicine physicians at Metro Health Sports Medicine are experts on these issues and many more.  We have offices in Allendale, Caledonia, Cascade, Cedar Springs, Rockford and Wyoming, and you can find out more at www.metrohealth.net , or by calling 252-7778.  As team physicians for the Griffins, Drive, Grand Valley State University, Aquinas College and Calvin College (among others) as well as events such as the Millennium Meadows Marathon and the Metro Health Grand Rapids Marathon, we have the experience and expertise to work with athletes of all ages.  We will also be present at many event expos and training runs, as well as our weekly Injury Wise clinic at Gazelle Sports in Grand Rapids every Wednesday night from 6-7:30 PM.  These are brief first-come encounters for active individuals of all ages and sports—contact Gazelle for more information.

    Be active!

    What Is Ferritin (and Why Should You Care)?

    If you have spent any time running or with runners you may have heard the term ferritin being used and wondered what it means.  Even in the medical community there is ongoing discussion and debate as to what significance this blood level has with respect to endurance athletes.  Simply put ferritin is the protein bound iron stored in your body (liver, spleen and bone marrow in particular).  The not so simple part is identifying what a low ferritin level means, and if it is important what level does it need to be.  Let me say this right off the bat:  ferritin is important in endurance athletes; knowing your number may be as important as any training plan you are following; and ferritin should be checked at least yearly.

    First a few definitions:

    Hemoglobin—the oxygen carrying component of blood.

    Serum Iron—the active iron in the blood stream.

    Ferritin—the storage form of iron.

    Each of these is important for the endurance athlete, but ferritin seems to be the key.

    Iron is important as a key part of hemoglobin, the oxygen carrying component in blood.  Endurance athletes need to get oxygen to working muscles while training and racing.  It stands to reason that when hemoglobin levels are low there will be an issue with oxygen transport.  When iron levels are low, hemoglobin levels may be low as well, but sometimes are not.  What is not so clear is whether or not normal hemoglobin levels with low iron levels is a problem, and if so is it the active iron only that is important, or the ferritin as well.  One thing we do agree on—hemoglobin levels do NOT directly assess iron levels.  If you are told your iron levels are normal but only the hemoglobin was tested you are not getting the complete story.

    For many years this has been a discussion in the medical community.  Most physician who work with endurance athletes feel that hemoglobin, iron and ferritin levels are all important, and anecdotally when athletes were found to have normal hemoglobin and iron levels, but low ferritin levels iron supplementation helped.  One other confounding factor is that ferritin levels are considered “normal” down to levels of 10 or 12 even though this is too low for the endurance athlete (more on levels later).  It makes sense, though, that different levels are “normal” for different people—even if a good chunk of the general population is somewhat active (and this is open to debate as well), what is normal for that group may not be normal for those who push their bodies on a regular basis.

    Recent studies have begun to show that those with normal hemoglobin levels but low ferritin levels feel better, perform better, and have better treadmill test results after taking iron and getting the ferritin level up.  This is not surprising to any of us who treat endurance athletes regularly.  Symptoms of this will include fatigue, having trouble keeping up during workouts, plateau in performances, injuries, and even GI discomfort/issues.  If you develop any of these, getting blood work done (CBC, chemistry panel, serum iron, ferritin and possibly thyroid tests) would be a good idea.  There are other problems that can lead to the above symptoms, but the labs are an easy way to get the work-up underway.  One problem with waiting until there are symptoms, however, is that by the time the blood is tested the ferritin level may be very low and it takes a little time to get the levels up.  That is why we recommend if at all possible that endurance athletes get it checked at least once a year, and more frequently if a problem is identified.  The caveat is without symptoms, screening ferritin levels may or may not be covered by insurance.  In my experience, most if not all endurance athletes do experience fatigue at some point in training so checking a level is not just screening at that point.

    So what is a prudent plan for checking and treating this issue?  Here are some guidelines I use with my athletes.  These may need to be adjusted slightly as high school, college, and recreational “seasons” are not all the same:

     

    1. Assess serum ferritin levels (as well as CBC and serum iron) in the “pre-season” if at all possible. For the recreational athlete this may be as they embark on a new training cycle, and for the high school or college cross country runner at the beginning of the summer ramp up period.  I may recheck these athletes early in the season as well (September/early October), particularly if they are having any issues.  It should be noted that this issue appears to affect females more than males, but it does affect males as well, so checking all athletes makes sense.  Hemoglobin alone is NOT iron testing.
    2. If the ferritin is low (less than 30) even if hemoglobin and serum iron are normal, I would recommend supplementing with two over the counter iron pills per day (there is typically 65 mg of active iron in each tablet), with Vit C (which helps absorption) and folate (a deficiency in this can also inhibit absorption). Do NOT take at the same time as calcium as this will inhibit absorption.  Certainly increasing iron containing foods can help as well, but vegetable sources of iron are not nearly as well absorbed as meat sources, and with the varied types of diets athletes have these days, tablets seem to work the best.  There is no evidence that liquid forms are absorbed better that tablets, but in someone who has trouble swallowing tablets, or if the level is not rising this is an option.
    3. Recheck levels in 6 weeks. For most athletes the target is a level of 50 or more.  Once the athlete is in the mid 30’s they often feel a lot better, and if they top out in the 40’s most will do fine.  Higher level athletes should use 60 as the goal.  I check every 6 weeks until a level of 45 or more is achieved, and then usually 1-3 times a year thereafter—for high schoolers and collegians at the beginning of each season.
    4. DO NOT just start iron as 1 in 250 may have something called hemochromatosis that can cause a toxic build-up of iron in the liver. While not common, monitoring levels will help stay away from this problem, and help guide ongoing treatment.
    5. When the desired level is achieved I usually have the athletes cut down to one tablet a day. While the endurance training is going on there is a good chance the levels will drop again if the supplementation is stopped completely.
    6. Talk to your doctor about this. If they agree with testing and understand that for an endurance athlete “normal” is 35 or more, not just barely inside the normal range of 10 or 12 for the normal population—make sure you get the actual number from your doc, not just “everything looks fine.” If your physician is not as up on ferritin as needed, find a sports med doc or come and see us.  While I have presented a very basic science lesson here, sometimes interpreting all of the values can be a little confusing, especially as the treatment is starting—this is where seeing a sports medicine specialist can help.  I have seen too many seasons or races affected by low ferritin levels—this is something that is easy to test for and easy to treat.

    If you have any questions about ferritin, or other issues, you can find us all over West Michigan.  Go to MetroHealth.net and search “sports medicine” for more information.  We treat all types of sports injuries, and while we have experience treating professional athletes like the Griffins and Drive, we us our expertise to help athletes and active individuals of all ages get going again.  You don’t need to be on a team to be an athlete!  You can also find us weekly at our Injury Wise Clinic at Gazelle Sports in Grand Rapids every Wednesday night from 6-7:30 PM—again all active individuals are welcome on a first-come first-serve basis.  On September 8 we start our Saturday AM office hours (walk-in or appointment) from 9-11 AM.  This will run every Saturday AM from September 8 through the end of October and is open to all.  Friday night football injuries, or any other high school, college or recreational injuries can be seen, and we are able to assess concussions as well.  Call 252-7778 for more information—more details to follow.

    Be Active!

    How Running Short Can Help You Run Long

    For most of you running is a year-round endeavor.  There are local races every month of the year, and “destination” runs all over the world.  You may be in the middle of training for one of these events, or in between training cycles wondering how to stay motivated.  Maybe you are a beginner figuring out how to prepare for a 5K.  Here are a few thoughts on how running shorter races can be a fun way to train for some of your upcoming events.

    With fall marathons and half marathons coming up, you may be in a little rut with training.  Even if things are going great, running a 5K a few weeks before your target race may be just the thing you need.  This “race” can serve several purposes:

    1. If you are training for a 5K and have not run this far yet, a 5K 2-4 weeks before your target race can serve as a dress rehearsal—what to eat, what to wear… You can also run at a slower pace and even walk part of it if needed—there is no pressure.  If you have run this distance before, you can use this as a gauge of your fitness/pace.
    2. If you are running a 10K, a 5K can serve as a tempo run in your training program while giving you the chance to do race day prep before the target race. Laying out clothes and shoes, making sure you have the timing device needed, and getting out of bed in the morning all need to be practiced, too!
    3. If a longer race is your goal—this works for 10 milers, half marathons, and full marathons as well—a 5K is a great way to focus on speed work, something important for long races. According to Alex Hutchinson in Go Short (Runner’s World April 2012), training for short races will speed up your cadence and increase the power of your push-off, increasing efficiency and making you faster at longer distances.  There are a few workouts in the article as well that you can incorporate into your training program over the next few weeks or for your next long race.

    If you do find yourself injured (or wondering whether you are or what you should do next), we have locations with sports med docs all over town—check us out metrohealth.net for more information.  We are also seeing patients at the Metro Health Sports Medicine Center inside the Spartan Stores YMCA at the Metro Health Village.  Call 252-SPRT (7778) for more information or to schedule an appointment.  And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-7:30 PM.  These are brief one on one sessions open to active individuals of all ages.  Contact Gazelle for more information.  

    Be active!

    Is 80/20 Right for You (And What Is That Anyway)?

    Ed Kornoelje, DO

    Runners run. This can be both good and bad. One thing we have learned is that while running more can make one a better runner, running more also increases risk of injury. We also know that adding some strength and core training can help decrease the risk—this is some of that evolutionary thinking I was talking about. Another way to decrease injury rates is to run less. So how do we reconcile this—run more to run better, and run less to stay healthy. This is where multiple approaches come into play—some feel the need to (and can) run more, and others should run less. Age, schedule, injury history… these are some of the factors that help determine how much running can be done.

    Last time we explored how running three days a week (and cross training two) is an acceptable if not desirable way to train. While there is good evidence that this type of program offers benefits for those with tight schedules or prior injuries, for the running purists this was always a bit of heresy as they grew up running five (or six or seven) days a week. And they have a point. It does appear that running more does help one become a better runner. The principle of specificity we tout in many pursuits holds true for running as well—to get better at something the more you do that thing the better you become. If that is true how does one run more and stay healthy? That’s where 80/20 comes in.

    While the 80/20 principle of training is not new, one of the best explanations comes from 80/20 Running—Run Stronger and Race Faster By Training Slower by Matt Fitzgerald. When he looked at the training programs runners and elite athletes from other endurance sports utilized, in most instances (sometimes without realizing it), 80% of the training was done at low intensity and 20% at mid/high intensity. Ratios from each program differed slightly but ended up very close to 80/20 (get the book for a much more in depth discussion). Why is this important? By spending a majority of training at low intensity one can run more (up to six days a week) and be injured (hopefully) less compared with doing much of the training at mid or high intensity. (This also keeps us out of the “black hole” of training—runs that are too fast to be slow runs and too slow to be fast runs. These “black hole” runs are of limited training value but may increase injury risk). While the “run less” group suggests these extra miles at a slow pace are “junk” miles offering little benefit to the overall program, the 80/20 group (and many coaches and runners out there) see these as miles that help any number of things—running economy, form, mitochondria production in the muscle… The reality is we don’t know for sure why this type of training works, it just does.

    In reality there are several ways to get to a finish line in a highly trained fashion. If factors allow only three days a week to run there is a way to maximize training and perform very well. If time and interest in running allow for more training there is a safe and effective way to do that as well. I should mention that the 80/20 plan offers cross training options too. Even the best plans can result in injury and cross training is still a great way to stay active when this occurs, or when the running is getting to be a little too much. Get out there and run. Run a little or run a lot. Be smart and listen to you body—that is a truism for all programs!

    If you do find yourself injured (or wondering whether you are or what you should do next), we have locations with sports med docs and physical therapists all over town—check us out metrohealth.net for more information. We are also seeing patients at the Metro Health Sports Medicine Center inside the Spartan Stores YMCA at the Metro Health Village. Call 252-SPRT (7778) for more information or to schedule an appointment. And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-7:30 PM.   These are brief one on one sessions open to active individuals of all ages and sports. Contact Gazelle for more information.

    Be active!


    What Do You Think About Three?

    Ed Kornoelje, DO

    Last time I noted a few resources one might use when fashioning a training program. To highlight some of the ideas from one of them (Run Less, Run Faster) let’s start with this question: Can running only three days a week be an acceptable or even better way to train? This highlights an ongoing discussion—the balance between running enough to get in shape and perform well, while not running more miles than needed which may put too much stress on your body. In this article we will look at why and how three days per week of running may be the way to go for some, and what EVERYONE can do if injuries are starting to pop up or time is becoming an issue no matter what type of program is being used.

    Here are a few additional questions to get us started:

    1. Is running less (3-4 days a week) a good idea, and possibly better for most of us?
    2. If you are following a training program, is it OK to miss a few runs?
    3. If exercising 5-6 days a week is ideal, are swimming, biking and rowing good alternatives?

    Proponents of three day a week running believe this: you do not need to run a lot of miles or many days a week in order to prepare for a race, and run it well. In over 19 years of practicing sports medicine, one thing I have noticed is that most training programs are typically 5-6 days a week, with mileage ranging from 30 to 40 miles a week in beginner programs, to 60, 70 or even 80! miles a week in advanced programs. For most of us (and there is a good chance you are “most of us”), this may be too many days and too many miles to run. Injury rates go up as miles and days increase, and I often see runners who develop small aches and pains become more seriously injured trying to keep up with their programs. (And just to be clear I am NOT advocating coming into any event unprepared—that will lead to its own set of problems).

    For years I have suggested to many of my patients (and followed this advice myself) that running three days a week and cross training two days a week may be a good way to go when training for races of any distance. The three runs include speed work, a tempo run, and a long run each week (fast/medium/slow). Good cross training activities include swimming, biking, and rowing. Weight training, while also a great thing to so, does not count as cross training. This type of program allows a runner to be active five days a week—many of us feel better if we are active more than three days a week, and looking at it from a health perspective five days of activity is better than three—while cutting down on injuries that may come from running too much. I realize that many elite athletes do run six or seven days a week, but they have regular access to many things we do not—massages, nutritionists, and naps! to name a few. They also push their bodies right to the edge of injury in order to perform at an elite level. When we do this we often don’t know when we are going over the edge until it is too late. While I love to see runners, I would rather see you all out for a run, not in my office! And a confession here: while my goal is to follow the run three days/cross train two program, due to time constraints I often only get in the three runs, and have done many half and full marathons running “only” three days a week.

    Based on discussions with many runners, keeping abreast of the running literature, and talking to running coaches, I am sure that there are more than a few skeptics out there. “We were taught the only way to become a better runner, is to run more. If you want to play the piano better, play more.” Well, good evidence suggests just the opposite. Jeff Galloway and the FIRST program by Bill Pierce both have high mileage weeks for marathon distance races in the 30-35 miles per week range, and both programs have high finish rates, even high PR rates. These are just a couple of programs—there are others out there (check out the book Run Less, Run Faster and the Jan/Feb 2014 issue of Running Times magazine for a couple of good ones).

    Finally, when it comes to training programs please remember these are guides, not “set in stone and if I miss a run I might as well give up” documents. Of course with whatever type of program you choose to follow it is better if you can follow it as closely as possible. Just remember that if you are doing a five or six day a week program you have a little leeway if you cannot get all of your weekly runs in (and less leeway if you are following a three or four day a week program). Also, if you are ill or busy and miss a week of training your body will not lose a lot of fitness, just be smart about starting up again—use the next two weeks to catch up to your program.

    So, how should our questions be answered?

    1. Running less (3-4 days a week) may be a good idea, and possibly better for many of us.
    2. If you are following a training program, it is OK to miss a few runs.
    3. Exercising 5-6 days a week is good—in place of running, try swimming, biking or rowing.

    If you do find yourself injured (or wondering whether you are or what you should do next), we have locations with sports med docs and physical therapists all over town—check us out metrohealth.net for more information. We are also seeing patients at the Metro Health Sports Medicine Center inside the Spartan Stores YMCA at the Metro Health Village. Call 252-SPRT (7778) for more information or to schedule an appointment. And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-7:30 PM.   These are brief one on one sessions open to active individuals of all ages and sports. Contact Gazelle for more information.

    Be active!


    The “Not a Book Review” Book Review

    Ed Kornoelje, DO

    As noted in my last article there are several sources available for those looking for “pre-made” training programs. If you have read my previous articles you now have the information needed to put together a plan for your next race. But wait—didn’t someone do this already? Yes, someone has—in fact more than a few “someones” have done this, which is why there are many different training programs out there. What I am going to do is point out a few that have worked for me and patients of mine in hopes that you will find one that makes sense for you. With the knowledge you have gained over the last few weeks and some of these resources you may not need to write an entire training plan, but will be able to customize and adjust as needed.

    While there are several categories of sources (books, magazines and websites to name a few), this articles as well as the next few will focus on books. As noted in the title I don’t intend to “review the book” per se, but will highlight what the book is about and who it might help. In this article I will introduce the book, and in the next few go into a little more depth. These are only a few options—when you look into these you may find more that you like!

    The oldest book on the list is Run Less, Run Faster by Bill Pierce, Scott Murr and Ray Moss. Initially published in 2007 (and updated in 2012), this book explores how a “3-Runs-a-Week” training program is not only enough to help one run a fast race (such as qualifying for Boston—which my wife has done three times using this method), but may actually be better for you. There are plans from 5K to the marathon with specific training paces based on your current fitness and goals (1 slow, 1 medium, 1 fast—although the slow and medium runs are at the faster end of their ranges), with additional cross-training days. They use the term “3PLUS2” to describe the three runs and two cross training days—five total days of working out. They also discuss nutrition, stretching and strength training. One of their thoughts is that too many runners are injured running too many miles with no specific training purpose, which increases the chance of injury. I found it helpful when time was an issue—confession here I tried very hard to get the three runs in, but was not always able to get all of the cross-training in. We will look at this book in more depth next week. (In 2017 Pierce and Murr came out with another book titled Train Smart-Run Forever building on their previous work. While runners of all ages can use this info, it does lend itself to runners as we age—I am a lot more interested in this type of thing since turning the big 5-0).

    In 2014 80/20 Running—Run Stronger and Race Faster By Training Slower by Matt Fitzgerald came out. His research suggested that most highly successful runners over the years did approximately 80% of their weekly miles at a slow pace (zones 1 or 2) and 20% medium to high (zones 3-5). In general he suggests 5-6 runs per week, but allows for 3-4 runs per week with added cross training for those who are injury-prone or over 35 years old (yikes—that is not old at all). Keeping the pace slow 80% of the time is good for training (see my previous article titled “Slow Gets it Done”) and reduces injury risk. It also has training plans from 5K to the marathon, but spends less time on nutrition and weight training. I have use this type of program since my return from hip surgery (cartilage repair) in 2015.

    The final book Fast After 50 by Joe Friel came out in 2015. As you can tell from the title it is geared towards the over 50 crowd, and makes the point that while those who are 50 or older are likely in the second half of their lives there is no need to decrease the intensity of training (in-fact some may need to ramp it up a bit), but the way one goes about it and the total amount of training may need to be adjusted. Less specific than the first two books, this one gives you all of the tools to build a program that works for you. It discusses cross-training and nutrition, and really emphasizes strength training and recovery. I am currently using this method to train, pulling in some workouts from the first two books as this book does not have specific workouts, just workout types.

    I am going to mention one other resource that is both a book and a website—McMillan Running. Greg McMillan is a renowned coach who’s book titled You (Only Faster) I found very helpful in finding training paces and workouts. We’ll look at this info in the future as well.

    In listing the books above, I am leaving out A LOT of excellent resources by coaches, runners and physiologists such as Hal Higdon, Jeff Galloway and Jack Daniels to name a few. My hope is that in looking at some principles from these books in the next few weeks, you will do a little research of your own and find other resources that speak to you. The reason there are so many options is that there is no right way for everyone—you need to fine what works for you!

    If you (or your child) are injured we have locations with sports med doctors all over town—check us out at www.metrohealth.net for more information. We are also seeing patients at the Metro Health Sports Medicine Center inside the Spartan Stores YMCA at the Metro Health Village. Call 252-SPRT (7778) for more information or to schedule an appointment. And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-7:30 PM. These are brief one on one sessions open to active individuals of all ages and sports. Contact Gazelle for more information.

    Be active!


    Processes and Zones—Part 3

    Ed Kornoelje DO

    If you read Parts 1 and 2—thanks! If not look back at some recent newsletters or go to www.metrohealth.net and search “sports medicine” for the articles and other information. In Part 3 we’ll attempt to put it all together. Keep in mind these are basics—there are whole books written on training plans—but this should give you the “how” programs are put together the way they are, and the ability to adjust your program when needed.

    As noted previously how many days a week one should run is a topic with wide ranging opinions. In general, 3-5 days a week is optimal for most runners. High-level runners may run 6 days a week (7 is rarely a good idea), and it is hard to get optimal training running only 1-2 times a week, but 3-5 days allows the ability to get the key runs in while allowing rest days as well. If you want to be active more days a week—even 7—add activities like swimming, cycling, rowing and strength training. And you can vary the number of runs week to week—such as 3 days running one week and 4 the next.

    When putting a program together start with how many days per week in general you would like to/will be able to run. Then add in the number of days you can/will be active (cross training and strength training). Finally, assign zone numbers (1-5) to each of the runs, in general with at least one slow (1,2), one medium (3), and one fast (4,5) per week. For example, if you want to do some sort of activity 6 days a week and feel that running 3-4 days a week makes sense for you, during the three-run week, I would suggest a run from zone 1 or 2, another from 3, and one from 4 or 5. During the four-run week, keep things the same but add another 1 or 2 zone run (zone 1 will be very slow—rule of thumb is to keep your HR below 180 minus age—and zone 2 slightly faster, but not much!). Long runs typically fall into zones 1 or 2, and when running more than 3 times per week the extra runs are usually from zones 1 and 2 (recovery runs). Alternate zone 4 and 5 runs every other week (zone 4 runs would come from longer intervals—in Part 2 we noted up to 3 min intervals—they may actually be slightly longer at times, and zone 5 runs typically 90-120 seconds or less). Zone 4 runs are fast but not all out, zone 5 are pretty close to all out. Fill in the remaining days with 1-2 days of strength training (there will be an upcoming article on why and how), and cross training (cycling, swimming, rowing).

    While this may seem fairly confusing it really is not:

    1. Remember for most people 3-5 runs per week works well to reduce the likelihood of injury and allow for enough training to run any type of race.
    2. Remember SLOW (zones 1 and 2)/MEDIUM (zone 3)/FAST (zones 4 and 5) and run at least one from each group each week.
    3. When running more than 3 runs per week add additional slow (recovery) runs.
    4. Supplement with biking, swimming, elliptical and strength training as desired.

    If this makes sense to you but you are looking for plans already made, you are in luck. One thing we did not discuss in great detail is how long these runs should be (in general longer races will need longer training runs—up to a point). Over the next few newsletters I’ll suggest a few places to look that will help you develop and follow a plan that makes sense for you.

    Metro Health-University of Michigan Health Sports Medicine now has 10(!) Primary Care Sports Medicine Physicians all over West Michigan. We are by far the largest group in the area, and one of the largest in the country. Being trained in family practice as well as sports medicine means we can treat any and all medical issues, take care of injuries, and serve as your primary care physician. For a list of physicians, services, and locations check us out at metrohealth.net and search “sports medicine.” We are also continuing our weekly InjuryWise clinic at Gazelle Sports in Grand Rapids every Wednesday from 6-7:30 PM. Open to athletes of all sports and ages, it is an opportunity to get some info on injuries and training, and to see if an appointment with one of the sports med docs may be necessary.

    Be active!


    Race Season is Here!

    Ed Kornoelje, DO

    While you can run anytime anywhere, races really become plentiful around here this time of year. From the Gazelle Girl Half Marathon and River Bank Runs, through the Metro Health Grand Rapids Marathon in October, there are races of all distances every weekend. And we should know—we will be providing medical coverage at many of these events! With that in mind here are a few things to remember as your particular race draws near. (“Processes and Zones—Part 3” will be a part of next weeks newsletter—if you missed Parts 1 and 2 you can look back at recent newsletters or find them at www.metrohealth.net under “Sports Medicine.”)

    When you run you sweat. I know, I know—pretty obvious. We all sweat differently, however, and things like fitness, weather conditions and pace affect sweating as well. It is normal to lose weight over the course of a race (often 2-4% of starting weight). Weight gain (or minimal weight loss) raises the risk of hyponatremia—too much drinking of water causing sodium (salt) levels in blood to go down resulting in swelling of the brain. This is rare and preventable. How do you find the right hydration balance: 

    DON’T OVER-DRINK! Drink when thirsty. In longer walks/runs, a lot of sweat is lost. Sweat contains both water and electrolytes. Both need to be replaced to avoid medical complications. If this is done solely with water, an imbalance may occur—too much water, not enough sodium. To avoid this problem, we suggest the following:

    • Drink 12-16 ounces of fluid 1-2 hours prior to starting the race.
    • Drink another 6-8 ounces 1/2 hour prior to the race.
    • During the race, drink no more than 2-4 oz per mile (2 oz if you weigh about 100 pounds and 4 oz if you weigh about 200 pounds).
    • Adjust the rate of fluid intake to race pace: slower race pace = slower drinking rate (8 min pace—6-8 oz / 20 min, 9-10 min pace—4 oz /20 min, over 10 min/mile—3-4 oz / 20 min). Aid stations may be closer together than this—you do not have to drink at each one.
    • Consider using a sports drink (such as Gatorade/PowerAde) to replenish fluid—it has the electrolytes already mixed in.

    BE CAUTIOUS about taking anti-inflammatories/NSAIDS (like Motrin, Advil, ibuprofen, Aleve) 24 hours prior to a race. During exercise, the kidneys play a key role in regulating electrolytes to prevent dehydration. NSAIDS affect the kidneys ability to regulate these electrolytes & can cause other medical problems. Taking acetaminophen (Tylenol) is OK. Avoid anti-diarrheal and cold medicines as well, as they can have a dehydrating effect.

    Listen to your body. If you don’t feel right, your body may be trying to tell you that it’s time to stop and get checked out. Each event has different medical coverage. If you are having problems stop at one of the medical aid stations and talk with someone there—they want to help you finish the race safely. Most runners who spend time at a medical aid station finish the race—don’t be afraid to stop. We all want you to run again in the future!

    Speaking of the future, what is the best way to recover in anticipation of training again? Some rest from heavy training is needed after any race—the longer the race the longer the rest. While there are no specific guidelines that have been scientifically verified, some suggest one day of “rest” for each mile run—15 days if you run the 25K. I believe that a reasonable approach is 3-5 days of complete rest, followed by 20-30 minutes of light cardio work (running, cycling or swimming) 2-3 times during the first week of recovery. This is called active rest. Push-ups, sit-ups, and light weight training are OK too. Rolling and massage therapy are also good ideas.

    Metro Health-University of Michigan Health Sports Medicine now has 10(!) Primary Care Sports Medicine Physicians all over West Michigan. We are by far the largest group in the area, and one of the largest in the country. Being trained in family practice as well as sports medicine means we can treat any and all medical issues, take care of injuries, and serve as your primary care physician. For a list of physicians, services, and locations check us out at metrohealth.net and search “sports medicine.” We are also continuing our weekly InjuryWise clinic at Gazelle Sports in Grand Rapids every Wednesday from 6-7:30 PM. Open to athletes of all sports and ages, it is an opportunity to get some info on injuries and training, and to see if an appointment with one of the sports med docs may be necessary.

    Be active!


    Processes and Zones—Part 2

    Ed Kornoelje, DO

    In “Part 1” we identified how slow/medium/fast running can improve your running and racing. Several processes including VO2 max, lactate threshold, and running economy can all be improved by varying running paces during workouts. But how is this done?

    If you want to start a lively discussion just ask a group of runners how many days a week one should run (our assumption here is that there is some interest in training for a race—for general health even a couple of days per week of running or other exercise is better than none at all). If you have been paying attention you can see that in order to get slow, medium, and fast runs in each week there will need to be a minimum of three runs per week. In reality runs can be combined (such as a medium run in the middle of or at the end of a longer slower run), but this is a bit advanced—maybe something we’ll tackle in the future. In reality when training for a race you can find programs with runs 3-7 days a week. In my experience 4-5 runs per week is often an appropriate range with 3 the absolute minimum needed to train well, and 7 likely too many for most—almost everyone needs at least one day off per week.

    Having reviewed several types of running programs (both on paper and in personal race training) there are a few principles that will help us construct a basic training model. First, start by assigning numbers (sub-zones) to the three main zones: 1 and 2 for slow, 3 for medium, and 4 and 5 for fast. (There are several different naming constructs, but they all end up meaning the same thing, and numbering is the easiest to remember). Second, attach effort levels to each zone: “I feel like I am holding myself back a little” for slow, “I’m pushing myself a bit to the point I may be able to handle this pace for 30-45 minutes” for medium, and “I can handle this pace for maybe 15 minutes” to “I can only handle this for a minute” for fast. [As you can see in the fast zone there are two levels—fast can be fast (sub-zone 4) or super-fast (sub-zone 5). Slow can be divided into two levels as well. We will look as these differences in “Part 3”]. Third, find a minimum of three days per week to run slow/medium/fast.

    Starting with fast (zones 4 and 5), perform intervals lasting 30 seconds to 3 minutes with equal rest, totaling 5-15 minutes interval time. An example would be 10×30 second intervals with 30 seconds rest, or 5×3 minute intervals with 3 minutes rest. Warm up and cool down for 10 minutes before and after. Medium (zone 3) runs may be intervals or steady runs anywhere from 15-45 minutes in duration (if done in interval form, rest between intervals would be 25-30% of each interval duration) again with a 10 minute warmup and cool down. Slow (zones 1 and 2) runs can last anywhere from 30 minutes to 3 hours depending on race length.

    Now that we have three runs per week corresponding to the three major run types, in the next newsletter we will look at some minor tweaks to get a few more runs in each week if desired, and expand the zone concept as follows:

    1. Super-slow
    2. Slow
    3. Medium
    4. Fast
    5. Super-fast

    Metro Health-University of Michigan Health Sports Medicine now has 10(!) Primary Care Sports Medicine Physicians all over West Michigan. We are by far the largest group in the area, and one of the largest in the country. Being trained in family practice as well as sports medicine means we can treat any and all medical issues, take care of injuries, and serve as your primary care physician. For a list of physicians, services, and locations check us out at metrohealth.net and search “sports medicine.” We are also continuing our weekly InjuryWise clinic at Gazelle Sports in Grand Rapids every Wednesday from 6-7:30 PM. Open to athletes of all sports and ages, it is an opportunity to get some info on injuries and training, and to see if an appointment with one of the sports med docs may be necessary.

    Be active!


    Runner Strong

    Ed Kornoelje, DO

    When is driving rain, a steady headwind, and wind chills in the 30’s a fun place to be? When you are running or watching the Boston Marathon! Runners know that “fun” may seem like an odd term to some, but that being a part of an event of this stature, no matter what the conditions, is fun. And grueling. And tiring. And cold. And sometime impossible. But that doesn’t stop the fast and the slow from moving ahead towards the finish line—Runner Strong!

    With apologies to the Boston Marathon and Boston Strong (this was the 5th anniversary of the bombings and there were many inspiring stories), days and races like this cannot help but remind us how strong runners can be. Listening to the post-race news conferences two things were notable: many of the elite and non-elite athletes did not finished the race, and women’s winner Des Linden stated over the first few miles she felt it was not her day and she almost dropped out. That’s right—the winner! So what can we learn from these two things?

    First, there are times even Strong runners need to listen to their bodies and cut a race or workout short. No one likes to do this—we feel like we are letting ourselves or others down. But when weather conditions, or health concerns, or upcoming races require a DNF (Did Not Finish) that’s OK. It happens sometimes. While finishing is always the goal, getting to the start line is a noble pursuit as well, and sometimes the best you will be able to do. Make that DNF stand for “Did Nothing Foolish.”

    Second, other times you just need to keep going. If you are not in danger of harming yourself and you are not using the race solely as a tune-up for a future event, sometimes you just need to keep pushing ahead and get past the feeling that it’s just not your day. You may not win the race like Des did, but the feeling of accomplishment you will get from pushing through will be worth the pain you endure—just ask my wife (another Boston runner who just pushed through). And when you finish a race like this there is no limit to what else you can do in your life!

    So relish those tough races—they will make the others that much sweeter!

    If you (or your child) are injured we have locations with sports med doctors all over town—check us out at www.metrohealth.net for more information. We are also seeing patients at the Metro Health Sports Medicine Center inside the Spartan Stores YMCA at the Metro Health Village. Call 252-SPRT (7778) for more information or to schedule an appointment. And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-7:30 PM. These are brief one on one sessions open to active individuals of all ages and sports. Contact Gazelle for more information.

    Be active!


    Processes and Zones—Part 1

    Ed Kornoelje, DO

    In a previous article “Slow Gets It Done—Over and Over Again” there was a brief introduction to training zones. Most often there are four or five zones based on pace or perceived exertion. As we run faster we move up in zones—slow running in zone 1 and sprinting in zone 5. Before we get to zone specifics, just remember slow/medium/fast with three key processes tying it all together. And remember—even if you run all of your runs at about the same pace, just getting out and being active is the key. You will still receive significant health benefits from almost any type of physical activity no matter how fast or slow you go.

    So why do we care about zones then? For those wanting to take training to the next level, zones help to maximize race preparation by allowing the runner to become as efficient as possible in fuel utilization and running. How do we measure this? There are three main physiologic processes that help predict fitness: aerobic capacity (VO2 max), lactate threshold, and running economy. Let’s start by looking at each of these and why they matter for optimal training.

    Aerobic capacity is often denoted by VO2 max. The definition of this is a measure of how much oxygen you use when exercising at a sustained maximal workload. The more oxygen used, the more energy produced, the faster you can go. Lactate threshold is defined as the intensity of exercise at which lactate begins to accumulate in the blood at a faster rate than it can be removed. Huh? The key point here is that when lactate cannot be cleared by the blood, hydrogen ions are released causing the muscle environment to become acidic leading to the burning and labored breathing that we all have felt (or if you haven’t yet you may if you go with this zone thing). Finally, running economy has to do with how efficiently we use oxygen while exercising (as opposed to how much as seen in aerobic capacity). Turns out “the more economical the better” not only holds true with your finances, but with your running as well!

    Now that we know what we want to improve, how do we do it? That’s where fast and slow (polarization from the “Slow Gets It Done…” article) come in. Both VO2 max and running economy are improved best by fast running—such as track repeats measuring anywhere from 100 meters to a mile depending the race distance for which you are training. Raising your lactate threshold is accomplished by tempo runs—two to six miles at a medium-fast pace. Throw in slower runs for recovery and improving aerobic threshold (different than aerobic capacity—more on this later) and you have slow/medium/fast from above–ZONES!

    Whew—a lot of stuff here! Next time we will flesh out these zones to see how you can put this info to work for you.

    Metro Health-University of Michigan Health Sports Medicine now has 10(!) Primary Care Sports Medicine Physicians all over West Michigan. We are by far the largest group in the area, and one of the largest in the country. Being trained in family practice as well as sports medicine means we can treat any and all medical issues, take care of injuries, and serve as your primary care physician. For a list of physicians, services, and locations check us out at metrohealth.net and search “sports medicine.” We are also continuing our weekly InjuryWise clinic at Gazelle Sports in Grand Rapids every Wednesday from 6-7:30 PM. Open to athletes of all sports and ages, it is an opportunity to get some info on injuries and training, and to see if an appointment with one of the sports med docs may be necessary.

    Be active!


    Zones and Thresholds on Hold
    (Remember—Breaks are Important Too!)

    Ed Kornoelje, DO

    Last time I promised information on zones and thresholds. Articles are coming—likely two or three on these topics as there is a little complexity to them. But in the meantime, I am in the midst of a recovery week (see Perio…what? from the newsletter a couple of weeks ago or at metrohealth.net under “sports medicine” for more information on breaks and recovery), and I have had the good fortune of doing some hiking with my daughter. Less running this week, and a little more cross training—next week good hard workouts again. This hiking has also left me with a little less time for writing, so the articles are not done. Look for another one next week—I bet you can’t wait!

    If you do need us visit www.metrohealth.net or call 252-7778 or find us at Injury Wise at Gazelle Sports Grand Rapids 6-7:30 PM each Wednesday night.

    Be active!


    Walk Before You Run—And Maybe During as Well

    Ed Kornoelje, DO

    “Walk—don’t run!” Many of you will remember hearing those words when you were trying to move a bit too quickly around a swimming pool. But what does walking have to do with running? Oddly enough there are several situations during a race in which walking may suit you better than running.

    First things first—it is OK to walk during a race. One of the benefits of my line of work is that on occasion I get to run with some of the many running groups around Grand Rapids. Recently I was running with a group when we stopped at water stop. We stood for a few moments getting a drink when some remarked it was too bad races were different in that you could not stop and drink but had to keep running. Someone else chimed in that he was going to practice not stopping to walk so that he was as prepared as possible for the race. I suggested that instead of practicing “not walking,” consider walking during the race, maybe at aid stations. It’s easier to drink while walking, and your heart rate will drop a bit, making you feel fresher when you start running again. In fact, there are several race plans with walking built in (google “Galloway method” to find some). Half marathons and marathons in particular lend themselves to walking—some data suggests those who walk periodically finish with a better time than similarly matched runners who don’t walk, and they feel a lot less beat up at the end. Bottom line: not only is walking OK, it may help you finish with a better time (and feeling better) than if you run the entire race.

    Now that we have that out of the way, what are some other reasons you may consider walking during a race? The March issue of Runner’s World UK has a great article called “Now You’re Walking” touting the benefits of walking (as we discussed above) as well as noting five other situations that lend themselves to walking. The article will go into much more detail, but here is a brief discussion on these situations. (As an aside Runner’s World UK is a great resource, and slightly different than the domestic version. It focuses a little more on training and the science of running—available in Grand Rapids at Barnes & Noble or via subscription).

    1. Your training was below par. Walking the aid stations or at a predetermined interval helps keep finishing a possibility—running 9 minutes then walking for 1 minute often works well.
    2. You can’t hold back. If you tend to go out too fast (not the end of the world in a 5 or 10K, but big problems in a half marathon or longer), use an interval like the one above during the first half of the race to slow yourself down. If you are feeling OK run the second half or continue on with the interval if it seems to be working.
    3. You struggle with midrun eating. Sometimes eating blocks or gels and then drinking causes a lot of sloshing around in your stomach. Consider grabbing your fuel (from the table or belt), running to the end of the station, then slowing to a walk off to the side to ingest your fuel.
    4. Your course ascends. Hills can really take it out of you. During hill training, running hills is a good thing. However, remember how tired you are when you are done? The goal of the race is to finish. Walking hills can keep your heart rate below lactate threshold (more on that next time), keeping you (and your legs) fresher during the race.
    5. It’s sweltering. If you’re like me a little warm weather right about now would be a welcome thing. But we all know it’s coming, and during summer races your body temperature can really go up causing more blood to be used for cooling, and less going to the GI system, another potential cause of GI upset. Use the shady spots to “fuel and cool” by walking, fueling, and using cool water or a cool rag or sponge on your neck.

    To recap: whether or not you “run” the entire race distance has nothing to do with anything. You do NOT need to run the entire race distance in order for it to count. Walking may actually help you get there faster than running the entire distance. There are several specific situations that lend themselves to walking—I am a big proponent of walking and fueling at some to all of the aid stations. So, use walking to help you get across that finish line by any (legal!) means possible.

    Next time we’ll begin to look at zones and thresholds and what they mean for training and racing.

    Metro Health-University of Michigan Health Sports Medicine now has 10(!) Primary Care Sports Medicine Physicians all over West Michigan. We are by far the largest group in the area, and one of the largest in the country. Being trained in family practice as well as sports medicine means we can treat any and all medical issues, take care of injuries, and serve as your primary care physician. For a list of physicians, services, and locations (and all of these articles) check us out at metrohealth.net and search “sports medicine.” We are also continuing our weekly InjuryWise clinic at Gazelle Sports in Grand Rapids every Wednesday from 6-7:30 PM. Open to athletes of all sports and ages it is an opportunity to get some info on injuries and training, and to see if an appointment with one of the sports med docs may be necessary.

    Be active!


    Inspiration

    Ed Kornoelje, DO

    What inspires you? Not just related to running (or walking), but for all things life? I’m watching the Oscars tonight—there are a lot of good movies around right now—and whether you are a movie person or not, these movies started with someone having a stroke of inspiration. Sometimes the outcomes are quite spectacular, other times not so much, and often which is which is in the eye of the beholder.

    Running (and being active) is spurred by inspiration as well. What gets you off the couch, or making a jump from 5K to 10K (or 26.2 to 50K)? Whatever change you are attempting to make (even if it is still “gotta get off this couch”) does not really matter—what matters is what gets you going. Internal competition, external competition, health improvement, and running for a cause are just a few.

    In upcoming editions of “Marathon News from Grand Rapids” we will look at items that inspire us to be active, training tips, health related information, and other concepts that advance the cause of active individuals everywhere. If you have read these articles here and elsewhere in the past—thanks! Hopefully you found them insightful and will again going forward. If you enjoy what you read let someone know. And if you don’t, let someone know anyway—they just might! The Metro Health Grand Rapids Marathon is still several months away, but it’s never too soon to be inspired!

    Be active!


  • Slow Gets It Done—Over and Over Again

    Ed Kornoelje, DO

    In running there are several (perhaps many) things we do over and over again. The act of running is probably the most obvious (left-right-left-right…), but we often do the same races over and over again, eat the same pre-race meal over and…you get the point. This repetition serves a purpose—we find out what works and stick with it. Running science can be the same way. We look for concepts that seem to hold true over time, and work on ways to refine the information so that we are using the info to its fullest. One of the truisms that keeps popping up is “in order to run fast, you need to train slow.”

    This may sound odd at first. A more complete way to put it may be as follows: most of your training should be rather slow or quite fast—stay away from the middle. In previous articles I have described staying away from the “black hole”—the comfortable middle running zone (I’ll describe zones below). In a recent article titled “It’s Okay to Run Slow… Really” from Trail Runner magazine, David Roche describes “two pillars of endurance training—polarization and periodization.” Polarization refers to the easy OR hard running that should be done, staying away from the “grey-area” moderate zone. And, when I look back at the running literature and tips I have received from seasoned runners over the years, this is a theme that pops up (you guessed it) over and over again! (We’ll look at the other pillar periodization in the next newsletter).

    To get started here is a little info about running zones. There are whole books on zones (I should know—I have a number of them), so this will be a VERY brief explanation. There are typically three to five zones. The lower zone or two are typically reserved for recovery runs and long runs, the upper zone or two for speed work, and the middle one for “tempo” efforts. It is important to train in ALL zones, but when the low zone runs are performed at the relatively comfortable tempo pace there can be issues.

    Although tempo pace is comfortable, spending too much time at this pace and faster causes injury rates go up, and we miss out on some training benefits that occur at slower paces. The goal pace would be about 1.5 to 2 minutes per mile slower than marathon pace. As noted in the article above, running at this pace (or even slower) allows several training benefits occur. First, slow running facilitates angiogenesis, the process of capillary growth. The more capillaries there are the better—these small vessels transport oxygen and nutrients to muscle and remove waste products. Second, easy running increases the number of slow-twitch muscles fibers, the type used in endurance events. Third, easy running days allows the hard days to be more effective while decreasing the likelihood of injuries. Moderate to fast running produces more of the stress hormone cortisol “which can contribute to injury and slow down aerobic adaptations.” Just as with weigh training the body needs a day or two to recover between hard workouts, and this recovery day needs to be slow.

    Hopefully this all makes sense. Slow runs need to be slow, and, as in life, variety in running is a good thing. Not all running need be slow, nor should it all be fast. Spending some time in the “comfort zone” is OK, but not too much (we’ll look more at how much time should be spent in a given zone in an upcoming newsletter).

    Next time we’ll explore the concept of periodization. In the meantime stay safe! Metro Health-University of Michigan Health Sports Medicine now has 10! Primary Care Sports Medicine Physicians all over West Michigan. We are by far the largest group in the area, and one of the largest in the country. Being trained in family practice as well as sports medicine means we can treat any and all medical issues, take care of injuries, and serve as your primary care physician. For a list of physicians, services, and locations check us out at metrohealth.net and search “sports medicine.” We are also continuing our weekly InjuryWise clinic at Gazelle Sports in Grand Rapids every Wednesday from 6-7:30 PM. Open to athletes of all sports and ages it is an opportunity to get some info on injuries and training, and to see if an appointment with one of the sports med docs may be necessary.

    Be active!


    Perio…what?

    Ed Kornoelje, DO

    Now that we are all running a little slower (at least part of the time), let’s turn to the other important concept we identified last week: Periodization. This topic can be a bit confusing, but there are several principles I will highlight to help you run and train better. (As a reminder polarization was the other concept—see last week’s newsletter or metrohealth.net for that article).

    How is periodization defined? Owen Anderson, PhD in Running Science states “Complicated definitions of periodization exist, but the term simply means the division of an overall training program into periods that accomplish specific goals. Since everything cannot be accomplished at once, training must be periodized into discreetly different units of time.” In its most basic form many training programs (including the River Bank Run or Metro Health Grand Rapids Marathon training schedules) utilize a form of periodization by increasing weekly mileage. By gradually increasing the load on the body, adaptation will occur to allow a person to run longer distances.

    Taking the concept a little further, Hans Selye (an endocrinologist who lived in the mid 20th century) “was the first scientist to describe how stressing our physiologic systems would result in adaptations that are specific to those stresses” (Running Times Jan/Feb 2014). This article (“Schedule a Breakthrough” by Jonathan Dugas) notes that Selye described a continuum of reaction to stress: no stress/no adaptation on one end, too much stress/failure of the system (injury) on the other, and in the middle enough stress to stimulate physiologic change. “Periodization applies these concepts of stress, adaptation and specificity in a systematic way—using different time periods. . .to accumulate a larger sum of adaptations than you could by working all areas of running fitness simultaneously.” (The article and book referenced above are excellent sources of information—take a look at these for a much deeper explanation of periodization and how it can be utilized).

    So what does this mean for you? First, find and follow a reputable training program. Whatever program you follow will likely have some periodization principles built in. Second, REST is a key component of periodization. Both between training cycles (which we did not discuss here—read the article!) and during, schedule breaks or periodic weeks of lower mileage to allow repair to the system. As Dugas notes “Too many runners never schedule downtime in their annual or monthly plan because they are too tied to weekly mileage totals.” Keep this in mind as you follow your plan—even if your plan schedules a lower mileage week every 3-4 weeks, at times you may need to schedule an easier week than noted in your particular training schedule (lower mileage and intensity) if you are feeling tired or run-down (over-trained). Finally, for those of you who run multiple events during the year, consider mapping out a yearly periodization program and watch your performance improve.

    So, remember to vary the pace of your training runs and keep some slow (polarization), and to make sure every 3-4 weeks your weekly mileage is down by about 25% (periodization) to improve your running and decrease your risk of injury. In the future we’ll look at how to put these together in a variety of ways to create a training plan that works for you. Next week: when is it OK (and even desirable) to WALK during a race (and yes—walking during a race is just fine).

    If you (or your child) are injured we have locations with sports med doctors all over town—check us out at www.metrohealth.net for more information. We are also seeing patients at the Metro Health Sports Medicine Center inside the Spartan Stores YMCA at the Metro Health Village. Call 252-SPRT (7778) for more information or to schedule an appointment. And don’t forget about Injury Wise at Gazelle Sports Grand Rapids every Wednesday night from 6-8 PM. These are brief one on one sessions open to active individuals of all ages and sports. Contact Gazelle for more information.

    Be active!

joseph.weller@metrogr.org