Utah Running Doctor

Overcoming The Fear To Run After A Fracture

2010-12-07T06:30:00.000-07:00

On August 7, 2010 I broke my foot playing soccer. This was a fifth metatarsal fracture to the Left foot. I undertook some strict self care and got back to the point where I was released to run. Even with this release and visualizing the healing on x-ray personally, I had some fear of returning to running. Whether justified or not, I know better and still had that trepidation.

Why Would I Be Scared?
- Fear of Reinjury: Although injury is always a risk, after a truly healed fracture, the chance of reinjury is usually less, not more. Threrefore it is important to discuss this with your physician and get cleared to return to running. I cleared myself to run, conservatively, and should have no fear of reinjury.

- Does My Foot Still Hurt? After any injury, there is some residual stiffness and process of getting back to normal. At times I have thought that my foot may still hurt, but in reality it had no pain with pressure or pushing on it. Was this a valid fear? If it is truly healed it shouldn't be an issue.

- I Am Heavier Than I Ever Have Been: As a runner, I have kept my weight under control by running. When unable to run, and not changing my eating habits, I have gained weight and that (of course) makes it harder to run. Although this is a valid concern, if you are careful with return to running this problem can fix itself.

Overcoming My Fear
1. Remove Possible Excuses: The easiest way to justify not running (when afraid or otherwise) is to not be prepared to run. As cold weather is in full swing here in Utah, I ensured I had sufficient winter running wear to allow me to run when the time came. This included a good quality pair of running shoes and possibly a traction device if ice could be a problem.

2. Set A Date A Time To Start: In truthfullness, do any of us have time to run? Life will use any time we have for other purposes. Some purposes are valuable, and others are just time fillers. We always have time, however, to do what we want to do. Therefore, set a date and time to start running and don't let anything stop you. You schedule other things in your life and keep them. By making this strict appointment, you do the hardest part of running again, starting.

3. Don't Over Do It: It is irrelevant what distance and speed you were running before, you are starting over. Start slow and run relaxed. You should start with a shorter distance and slower speed and work back into what you were doing. My rule of thumb (for me) is to run until I am not hating it anymore and then turn around a run home. If you always hate running, that may not be a good rule, but for me it was just about one mile out so I started with two miles. I usually love to run once I am running again.

4. Run Baby Run: The only true way to overcome this fear is to run. After the first run, you will have much less fear and can work on the routine to get back to normal.

Remember the reasons you are running and get back to the routine that you were in before you stopped. If we can help you get back to running, let us know.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Prepare To Run, As Karl Metzer Must Have For His 2000 Mile Run

2010-09-30T15:30:00.002-06:00

Whether you are running 2 miles or almost 2000, the preparation is similar and important aspects should be considered. Karl Metzer, an Ultra-marathoner extraordinaire, is currently crossing the country from Sacramento, California to St Joseph, Missouri along the Pony Express Trail on its 150th anniversary. As he crosses through Utah, I thought it appropriate to focus on preparations that would be necessary for such a run (and any run to a lesser extent).

My recommendations would include:
       - Fluid => Important to keep the fluidity of the blood and reduce lactic acid build-up in the muscles.
       - Food => With high nutrient values at rest intervals and even throughout the run.
       - Shoegear => As a runner, shoes should be replaced every 400 miles. He will be using many pairs of shoes.
       - Running Gear => Whether the shirt, shorts, jacket or hydration/nutrition belt, the proper gear can reduce injury and protect against unforeseen running risks.
       - Support System => We all need support in our running, and his support system must be robust.

Run smart and run safe through these careful preparations for your run.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

When Should I Run Again After A Fracture?

2010-08-23T06:54:00.000-06:00

As a runner with a 5th metatarsal fracture, I understand the desire to return to running. This type of fracture doesn't just hurt physically, but interferes mentally because you may need to cancel your race and can't get the runner's "high" that comes with a nice run. In fact, runners often get in a hurry to get back and can cause additional injury from not waiting until the appropriate time to return to running.

With this thought in mind, and while currently only 2 weeks into the healing process, I thought it would be useful to discuss how I will be transitioning back to running.

- Pain is improved can I run? Depending on the extent of the fracture, pain can significantly improve and sometimes resolve at 2-3 weeks, with most fractures being painfree at 4 week. Although painfree is a good sign it is not a guarantee that healing is complete and running can be initiated. I am 2 weeks into a fracture and have a painfree foot (finally). My x-rays, however, show a fracture that is still healing. If I were to run too quickly, I could create a situation requiring a return to cast or boot and possibly even surgery.

- What is the most accurate indication of healing? Bone healing, as with fractures, is usually confirmed on x-ray. If the x-ray shows sufficient callus formation across a fracture, the area is healed. This means the bone is stable and reinjury risks are decreased. I wll therefore be confirming healing on x-ray and only start running after the bone is visibly healed on x-ray. I want to get back to running painfree, and will not rush it for that reason. I plan for years of running, not just one more race, etc.

- How do I get back to running? The best way to get back to running is to do it slowly. You have been limited activity for 6-8 weeks and should take twice to 3 times that (at least) to get back to where you were. Start slow, preferrably on a surface that will protect you from reinjury. As I transition back (hopefully in 4 weeks), I will be running upto 1 mile only for the first 3-5 days, and then start progressing slowly back to my normal running routine. Again, I will take close to 12 weeks to get back to the point where I am ready to train for a marathon. This will preclude me from running my marathons this year, but will allow me to run many marathons to come.

Just like you use care in training to not under or over train for any particular event or race, you should use care to not progress to soon or too quickly back to running after a fracture. Your body will thank you!

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

When Life Interferes With Running

2010-08-11T16:13:00.000-06:00

We love to run. In fact, I run to relax and enjoy every run I am able to participate in. But what do you do when running is not possible because of interferences of life? I am currently facing this issue with a fractured foot that will not heal with continued running. Here is what I am doing to "survive" while not able to run.

- Focus On Health: This includes taking in sufficient fluids (at least 6-8 cups a day of water), eating healthy foods and avoiding unnecessary interferences in my health. This will allow me to feel better even without the runners high and allow me to heal more easily.

- Focus On Healing: I can truthfully say that my fracture makes me angry, but I have stopped focussing on that. I now think about what I need to do to heal. This includes wearing my cast boot like a cast (24 hours a day, except for showering). As I focus on these aspects, it is easier to follow the doctor's instructions (even if they came from me for me).

- Be Prepared To Start Back Slowly: After my injury, I will need to start back running more slowly than usual. This is important so that I don't get irritated as I start back.

Healing correctly is imperative to returning to running without limitations. For this reason I need to stay focused and not allow it to interfere with my regular activities or get me down. Although this fracture is inconvenient, it will not have any longterm effect on me.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Barefoot Running, What's The Truth?

2010-03-13T14:31:00.000-07:00

Barefoot running is not new, in fact it has been around since the beginning of mankind. Often man had to run to find food, or keep from being food. This reasoning is often the justification for barefoot running. They will often even quote "studies" that prove running shoes are bad, or barefoot running is good.

But what is the truth about barefoot running? Here is a good discussion that was brought to my attention: http://www.prolaborthotics.com/Blog/tabid/90/EntryID/132/Default.aspx

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Should I Change My Running To Increase Speed?

2009-11-09T17:27:00.000-07:00

Here on the internet, I have seen articles on barefoot running, including a recommendation to run 100 miles barefoot, and I have seen recommendations to run on the forefoot or midfoot. I recently have adjusted my running to increase speed and wanted to discuss some of these claims. Before it all, I recommend that you continue what is normal for you!

Forefoot or midfoot running has been said to increase speed of long-distance runners. This is based on a single study that found that 23.7% of runners used a midfoot pattern and that in this study these runners were faster. It is based on the fact that sprinters run on their toes (forefoot running). More recent studies, however, including one by Dr Hamill, a professor of kinesiology at the University of Massachusetts at Amherst, have shown some benefits to each type of running. Rearfoot running, for example, has been shown to be more energy efficient. No significant speed differences were shown, when all other factors were as efficient as possible. My recommendation, therefore, is that you not try to adjust your running pattern to forefoot or midfoot from rearfoot or even to rearfoot from forefoot/midfoot.

Barefoot running is a subject that should be considered carefully. If you walk and run barefoot already, then again I would not recommend you change. If you are thinking about it because of some book or website, please consider the following recommendations from the APMA:

Barefoot running has become an increasing trend, and a possible alternative or training adjunct to running with shoes. While anecdotal evidence and testimonials proliferate on the Internet and in the media about the possible health benefits of barefoot running, research has not yet adequately shed light on the immediate and long term effects of this practice.

Barefoot running has been touted as improving strength and balance, while promoting a more natural running style. However, risks of barefoot running include a lack of protection, which may lead to injuries such as puncture wounds, and increased stress on the lower extremities. Currently, inconclusive scientific research has been conducted regarding the benefits and/or risks of barefoot running.

The American Podiatric Medical Association, along with the American Academy of Podiatric Sports Medicine, encourages the public to consult a podiatrist with a strong background in sports medicine to make an informed decision on all aspects of their running and training programs.

Again, my recommendations (and the pattern I am following) is to continue to run in the way that is natural for you. Run smart and keep running for a longtime to come. I will be speeding up my running, but through natural processes of speed work and careful training regimen.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Running In The Snow...Yes It Can Be Done Safely

2009-10-30T15:43:00.000-06:00

Although it is only October, we have already seen a couple snow storms. In fact, my yard still has a little snow. This brings to mind the trouble many of us have running on the roads when ice and snow become common. I would like to give a couple traction options for running in the snow:

•STABILicers SPORT - An adjustable slip-on cleat that can be placed under a walking or running shoe to add traction. This is a good option for walking, but not as good an option over a running shoe. It may interfere with the ability to run as would be done without the cleats. It does a great job, however of limiting slipping.

•Kahtoola MICROspikes - Strategically placed steel spikes that easily slips over shoes. This product works well in minimizing slip on packed snow or ice and allows running or walking in winter conditions.

For a video of this product in use: see http://www.kahtoola.com/microspikes_video.html

•Yaktrax Pro - A device that also slips on the shoes, but works much better in producing traction without the sensation of having something on the foot. In fact, these are quite light and work well even when running at full speed. This is the item I will be utilizing when running in the snow this year.

So best of luck continuing to run even in the cold winter months here in Utah. Run Smart and Be Safe!

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Fifth Metatarsal Fracture & The Runner

2009-10-06T13:07:00.000-06:00

As a runner, I understand how hard it is to not participate in your sport. But sometimes it is necessary to change your routine to allow healing. I will discuss one such situation, a 5th metatarsal fracture. This diagnosis was recently seen in a gymnast in my office and I thought of all the runners that suffer a similar injury.

The fifth metatarsal has a bony process (the styloid process) back towards the heel area. In this area a tendon, the peroneus brevis, attaches and manipulates the foot with walking and running. When a foot or ankle is twisted or an ankle is sprained, this tendon can cause abnormal pull on the styloid process and cause breaking of the bone. This can be a simple stress fracture with incomplete seperation of the bone, a complete fracture with both cortexes (edges of bone) broken, or an avulsion where the piece of bone is pulled from the area and has significant seperation from the remainder of the bone. Any of these can be a problem, but the greater the seperation the more difficult the treatment for an athlete.

If you have pain to the side of the foot that hurts with twisting of the foot or ankle, I recommend evaluation by a foot or ankle specialist. If you sprained your ankle severely and now have pain on the side of the foot, again get the foot evaluated. Although the treatment may preclude you from running for a period of time, the longer you wait the less treatment options that are available.

Possible treatments may include bracing (even a simple ankle brace) if very mild, a boot or cast if more complex (this will stop your running) or surgical correction if it is severe or fails to heal. This area is notorious for not healing and may require surgery in some cases. Severe ankle sprains should be treated early and surgery for this condition may be unnecessary.

Although I hope no runner sees this condition in their running, early treatment will keep you running and allow you to perform at your top level. As I continue to run, I think of these type of injuries as I step over holes on the side of the road, or get mild twists from stepping off the side of the asphalt into dirt. Let's stay injury free and keep running...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.utahfootdoc.com/

The Truth About Leg Length Differences In Running...

2009-09-25T16:15:00.002-06:00

As I stated in a seperate blog, the development process causes each half of the body to develop independently, including foot size and leg length. As a runner, it is imperative that you understand these differences and adjust your equipment and training to accomodate the differences.

1. Based on which foot is larger, you should fit your shoes to minimize injuries from loss of toenails, to ingrown toenails, to blisters and even stress fractures.

2. Leg length difference can be a bigger issue:
-If the leg length difference is only minor, you will often not notice any difference and can continue to run without difficulty. No training adjustments will be required.
- For a significant difference, the following training modifications should be considered:

A heel lift or orthotic (with heel lift integrated) should be considered to allow modification of length to make the legs function closer to the same. This minor modification of equipment will preclude major changes in training.

If you typically run on a treadmill, the heel lift/orthotic are imperative, because there is no training adjustment that can be done to fix the additional stress on the bones, ligaments and tendons or aggressive pronation of the shorter leg that will occur irrespective of the shoe utilized.

If you typically run on a road, modify your running such that the longer leg is on the downside of the road. For example if your left leg is longer, running against traffic is good. The opposite is the case for a longer right leg. This is because most roads are canted to allow runoff during rain storms to the sides of the road.

So before you get more expensive shoes, run long distances or get injured from poor functioning of your feet from a simple leg length difference, make the necessary adjustments to improve your running gait pattern. Your body will thank you.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

What I Learned From Three Marathons

2009-09-23T07:38:00.003-06:00

After completing 3 marathons this season (slower than I would like, but completed), I have taken several lessons from the marathons. As I prepare to have a more aggressive marathon season in 2010, I have started to reevaluate the lessons I have learned.

1. Run Because You Enjoy It --> I have always loved to run. The training was more enjoyable without the stress of "I must run today." When I went on a evening or morning run and enjoyed it, it was a better run. For that matter, the race that I enjoyed was the easiest to run, even with it being faster than the race I didn't enjoy as much. Don't forget your purpose for running, and seek for ways to enjoy it.

2. Fluid & Fuel Is The Key --> Depending on the expected weather and the expected terrain, your fuelling and hydration regimen should be adjusted. After two marathons, I determined that I ran better in the third carrying my own hydration as an addition to the water/gatarade stations. This also allowed me to carry additional electrolytes or fuel for the course. If you overheat, become depleted of energy or become dehydrated, the race becomes much more difficult. I have determined to carry an additional water station on my belt, so that I can fuel and hydrate as desired outside the scheduled water stations. I train this way, so I should run this way.

3. Train Faster --> I am quite competative in much that I do. I don't like to run slower than I know that I can. For this reason, I have taken a step back this season and will retrain at the pace I want to run my marathons in 2010. Distance was never the problem this year, as 80% of finishing a marathon is mental, but it was slower than it should be because my distance runs didn't have a strong enough base to allow completion at a faster speed. I now have several months to recreate the base and train faster. So, in 2010, I will see you at the finish line faster and more prepared for the marathon.

4. Recovery Period --> In my research, all the professional runners take less time recovering between marathons. My goal is to complete the 7 Utah Marathons in one year. This is a marathon each month (April - October) and requires a quicker turn-around. For this reason, training should be sufficient at the start of the season to have a strong base that can be augmented with 3-4 weeks of training between each race. Only minor speed improvements or adjustments can be made in the small amount of time available between the races. I guess that is my job over the next several months to create a powerful base that will allow me to work toward the 7 marathons in one year without injury and at a speed I am comfortable with.

I have learned a lot during this running season. I can truly say I have enjoyed the process and plan to enjoy it much more over the next running period and next season.

Run happy, Run safe and Run healthy!

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Second Marathon, Three Months After First

2009-06-02T10:00:00.001-06:00

After running the Salt Lake Marathon in April, I am now training for the Utah Valley Marathon in June. My goal is to run multiple marathons this year and to document any changes in running technique, nutrition and even recovery techniques to help other runners compete at a higher level. I therefore want to document the changes I have made while training for my second marathon (in hopes of speeding up the second marathon):

1. Running more hills. Although I was ready for the first marathon, I felt I didn't have enough hill training. I even recently ran a 16 mile run "up the mountain" in our area. It is a course that allowed me at least 9 miles of uphill running at a pretty significant incline. The goal was to produce more hill strength and decrease my deceleration up the hills.

2. Changing my nutrition level. I often get distracted during the day and don't eat as well as I should. Good nutrition on a regular basis helps muscles recover quicker and provides more energy for even those short runs.

3. Changing the course. I have found I enjoy the runs more when I see something new. Any goals I have had to run a course have been accomplished during this process. (ie Run to my sister-in-laws home in Saratoga Springs (a 15 mile run one way), or Run Suncrest (a 7 mile hill up the mountain)). I have had some great runs and enjoyed the changes.

4. Run because I want to. Some days it may be necessary to take the day off from running. My feeling is that you don't ever run because you "need to", but instead because you enjoy it and want to. I still love to run while training for this second marathon.

These are what I am currently doing to improve my runs. I hope this helps others who are considering running a second marathon (or third) during a single season.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

The Midnight Run

2009-06-01T13:12:00.002-06:00

After running my first marathon, and now that I am preparing for the second, people commonly ask me when I have time to run. My answer is always, "I don't have time!" I run now and have always because I want to, not because I have unlimited time to train for marathons. As the father of 9 and a fulltime podiatrist, I often need to modify my training for my schedule. Running may be early morning, or even late at night. Let me give an example...

Last week I was busy all day Saturday with soccer games and working in the yard. I didn't get out early to run, so I left home at about 9:00pm for the necessary 20 mile run. It was a special run, because I am training more aggressively this marathon to speed up my time and was to include lots of hills. Hill running is typically slower, and will lead to more running time. Needless to say, I was running well into the night.

Advantages: 1) Since the sun was down and the air was cooler, I required less fluids to run this distance. 2) Less cars were also encountered, allowing me to run more fully on the road and stay of the shoulders that are usally more canted. 3) No distractions or places I needed to be.

Disadvantages: 1) Time. Need I say more. I don't recommend running in the middle of the night unless no other options are available. 2) Less visibility. 3) Safety may also be an issue depending on where the run is done.

My biggest recommendation at this time is not to run late at night, but to make time to exercise. If you are training for a race or just running (or even exercising) for health reasons, it will never be convenient. Schedule time to exercise or run and make time to accomplish this task. It will definitely be worth it!

I loved my midnight run and ran because I love it. I have vowed to find the time to exercise so I can be ready for the marthon coming in 2 weeks.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Proper Running Technique For Hills

2009-05-12T08:32:00.003-06:00

I was talking on Sunday with a runner who is training for the Wasatch Back Relay and has been running without difficulty for months. Recently she has been runnning hills and is trying a new hill running technique taught at the local Rec Center and has started having leg pain (shin splints). The cause of this new pain is improper running of hills, as this instructor told the runner to turn their upper body sideways and push up the hill (after they start getting tired) with almost a side step running technique. Whether you lead with your right shoulder or left shoulder, the technique is biomechanically unsound and caused her current overuse injury. I will therefore give my recommendations for hill running:

1. Hill running should always be a part of training, as the running of hills improves your mental attitude (you believe you can) and increases conditioning. Many studies have shown improved performance in races from running hills as part of your training.

2. Run up hills utilizing the same energy as on flat ground. Instead of "attacking" hills, I recommend running at the same energy expenditure, meaning slightly slower with shorter steps. This will allow you to reach the top of a hill without being short of breath and permit you to return to your pre-hill speed (often passing many runners that overexerted on the hill).

3. Use proper running technique. As you run, arms should swing at your side toward the front and back. Never allow arms to swing across the body as this reduces efficiency of running and interferes with proper swing of the legs. Legs should move straight forward (not to the side, not crossing).

4. Arm swing should be shorter and lower. By less aggressive arm swing, you are keeping the legs closer to the ground allowing better propulsion up the hill.

5. Set mental goals as you move up the hill. A majority of hill running is mental (as is most running) and setting short goals helps keep you moving up the hill. Don't allow the hill height to win by thinking your not moving very fast. I don't like to stop and walk when running, therefore I break hills into little sections and countdown the sections as I complete a long or difficult hill.

Uphill running can be a great addition to any running, and can provide you with an edge when racing. Run smart and keep running...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

How I Recover After A Marathon

2009-04-20T16:46:00.003-06:00

Everyone is searching for the quickest route to recover from a long run or a strenuous race. The recommendations are found throughout the magazines and across the internet. I have my own special regimen that speeds my recovery, and once again has helped me progress to almost complete resolution of muscle pain and weakness after just 48 hours. Let me list the process I underwent after my marathon:

1. Cool Down
It is recommended in all research I can find that a runner should not stop to stretch or lie down after a strenuous exercise. The cool down can be a simple walk or jog after the race. I walk for at least 10-15 minutes without sitting or stretching to ensure the muscles have time to cool down with a light stretch from regular motion. Sitting or lying down will allow cramping. Stretching may overstimulate the stretch mechanism in an exhausted muscle and produce cramping or even injury. Stretching can be done after the cool down and is a good idea if done at the right time. If the cool down is done effectively, it will alleviate some of the after marathon recovery.

2. Refuel
Any amount of exercise utilizes the glycogen in muscles as an energy source, with blood glucose and free fatty acids. As the exercise level progresses to longer exercise or more strenuous exercise, these sources become depleted more quickly and "anaerobic" (without oxygen) mechanisms are utilized to produce lactate. The lactic acid in muscle fibers or even the muscle breakdown to obtain necessary energy can lead to muscle pain and stiffness. The speed of muscle recovery is determined by the amounts of lactic acid or protein (muscle) breakdown is required to repair the muscles (especially after an exercise is completed).

The University of Illinois did a study on rats in 1999 that showed quicker muscle recovery from this depletion with refuelling with foods containing Leucine (an amino acid) immediately after exercise. They showed muscle stiffness and soreness would subside more quickly. More recent studies have found 30 minutes to be the key time for muscle recovery. The foods eaten in the first 30 minutes after exercise help rebuild the muscles, while foods eaten later have less benefits for muscle repair.

Leucine is found in protein products such as meats and dairy products, as well as in protein bars and some sports drinks. It is not recommended, however, that pure amino acid supplements be taken, because the beneficial amount is not known. In the study, they made the following findings: "It [Leucine] stimulates muscle protein synthesis, provides fuel for the muscle and helps to maintain blood glucose. What really surprised us was that its activity is not seen when leucine or protein is consumed before or during exercise. Instead it has a dramatic impact on protein synthesis during the recovery period after exercise."

So how do I refuel after a race? After any run, and especially after this marathon, I drank a large glass of milk withing 30 minutes of completing the exercise. Fluids are also imperative as are some other carbohydrates to help further maintain blood glucose and reduce lightheadedness from low blood glucose. When I don't want to eat within 30 minutes after an exercise, I eat anyway, especially the large cup of milk and/or a yogurt to get the Leucine benefits.

3. Fluids, Fluids, Fluids...
Part of refueling is getting the necessary fluids to replenish the body. I have a tendancy to start sweating when I think about exercise. I therefore must replace a large amount of fluid after any form of exercise. This replacement is both for refueling and for providing the reservoir for flushing out waste products from the body and especially the muscles. It requires more fluid to carry all these waste products out of the muscles into the kidneys for excretion. Try to drink 6-8 ounces of water every 2-3 hours during the initial recovery period.

4. Hot or Cold?
Everything I have read recommends ice baths or ice massage after a strenuous exercise, and often they recommend avoiding the heat after exercise. I will say now that I aggressively treat my muscle soreness after an exercise (even after the marathon) with soaking in a warm bath or hot tub. Let me explain the scientific basis for my actions. (Note that for me this works really well and decreases my muscle soreness significantly within the first 24 hours and reduces it nearly completely by 48 hours.)

The body reacts to hot and cold by dilation or contracture of blood vessels. Cold (ice) will reduce(vessel contracture) the blood flow into the area or cause the body to pull the blood from the area. Heat will increase (vessel dilation) the blood flow to the area and allow increased blood flow through the area. Since muscle pain is often due to lactic acid in the muscles or other waste products of "anaerobic" muscle metabolism (contracture), heat will allow blood flow through the muscles that can remove these waste products. Heat is only recommended by me during the first 12-24 hours. Ice can be utilized at anytime, but is rarely necessary if I undergo my usual exercise recovery regimen.

I have found through the use of these 4 simple techniques that I can continue to run, recover quickly and not suffer for days - weeks after a strenuous exercise. I plan to continue to train and run marathons and will evaluate the benefits of this regimen after any strenuous exercise. The proof will be in my recovery. Currently I am basically painfree the Monday after a Saturday 26.2 miles...I hope this helps.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Final Preparations For A Marathon

2009-04-03T08:29:00.004-06:00

I am two weeks away from the Salt Lake Marathon, and I am once again reviewing my preparation. What am I doing to ensure that I am running the race correctly, to protect my health, avoid injury and compete at a good level? Here is the thought process I undergo as a physician specializing in foot and ankle health.

Physical Preparation
Physical preparation starts months to years before the marathon and must include regular running with increasing endurance. You can't physically prepare for a marathon if you are not consistently running and able to increase your distance to near marathon distances (20-22 miles are recommended). During the week, longer runs can be split between two runs in the same day (10 miles can be run as two runs of 5 miles in the same day), but at least one long run must be done each week. The advantage of splitting some longer runs into two is decreased chance of injury from stress fractures or other running related injuries.

As you move closer to the race, the training should continue, but be modified to allow full muscle strength and full body preparation for the run. A marathon, due to adrenaline and competition, will usually be faster and harder on the body than other runs. This is what brings the runners high from such a long run.

Therefore, at this time, I am ensuring regular runs with some modification of mileage to protect my body during these last 2 weeks. I am also doing what I can to eat right (regular, healthy, energy rich foods), sleep good at night and trying to avoid sickness that could interfere with the functioning of my lungs. I am doing what I can to be physically prepared.

Mental Preparation
I am still strongly of the opinion that the most important preparation for a marathon is mental. As part of the physical preparation, you get to the point where you believe you can complete a marathon. During any given run, there will be times that are hard and times that are less hard. If you believe you can do it, you will.

Often when I am running I will hit what many call "the wall" and just tell my body that it is not an option to stop running. I run because I can and mental preparation keeps legs moving when the muscles ache, the lungs are tired and the body is ready to stop. This mental attitude is the key to running distances, running hills and even starting a run when the desire may not be there.

I feel that I am mentally prepared, but it is a constant process. My goal is to "run and not be weary, walk and not faint." Mental attitude definitely helps.

Correct Equipment
With all the physical and mental preparation, injury can occur in a 26.2 mile run easily if poor equipment (or even worn out equipment) is utilized. Things to consider are the shoe, and what clothes will be worn for the run.

With shoes, mileage over 300 - 400 miles will wearout a shoe. A new shoe, however, should also not be worn without a breakin period. I plan to use a good shoe that has participated in about half of my training. This shoe, however, will be replace before my next marathon.

Clothing choice is more variable. What will the weather be like? How will you limit rubbing that can cause soreness throughout a run? What will you do to limit sunburn or other discomfort during the run? Will you wear a hat? Whatever the clothing choices may be, it is important to train with these clothes, even utilizing them on long runs to ensure that you are able to enjoy the 26.2 miles without interruptions from the clothing you wore (or didn't wear).

I can truly say that I am excited for this marathon and I am doing everything in my power to be prepared for this run. Besides I have already registered for other marathons that I must be ready for also...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Shin Splints Can Be Avoided

2009-03-24T09:00:00.000-06:00

Commonly runners are sidelined or limited by the presentation of leg pain during and often after runs. The pain is usually located at the sides of the "shin" bone and can be debilitating, even limiting the ability to walk. Over the years, this has been a problem that I sometimes have encountered in my running. Since I love running (and don't like not running), I have researched over the years some ways to limit the presentation of shin splints while training for a race, or in my case a marathon. I will discuss some ways that we can "run smart" and limit the injuries that have been commonly classified as shin splints.

What is a shin splint?
A shin splint can be located on the medial (inside) or lateral (outside) of the lower leg below the knee. Medial shin splints are commonly inflammation of the muscle attachment to the shin bone (tibia) and hurts as from pressure to the muscle just inside the bone. Lateral shin splints are commonly inflammation to the tendon (posterior peroneal tendon) and adjacent tissues in the front of the outer lower leg. In either case, the pain can present during a run, immediately following the run or sometimes the next day.

What causes shin splints?
The exact cause of shin splints are not known, but usually it is related to rapid increase in running or jumping (or sometimes walking fast), changes in shoegear, or pronation (flattening of the foot). Some secondary causes may be balance problems (leaning to one side during a run), poor training technique (progressing too fast, poor running technique or surfaces), leg length problems or even injury.

What I have learned...
1) Using correct shoes.

Since commonly over pronation (excessive flattening of the foot) or over supination
(increased arch height - rolling out) can cause stress to the muscles or tendons in the area and create shin splints, a quality exercise or running shoe will help improve and prevent these symptoms. In choosing a shoe, price is not the most important, but cheap priced shoes are usually cheap shoes. Get a quality shoe, designed for the exercise you are doing (running shoe for running or walking, basketball shoe for basketball, etc.).

2) Training smart.

As you run or train, Run Smart! Let me explain…

If you are running on a track, understand that always running the same direction on the track will work muscles differently than switching directions. One of the possible causes for shin splints is working muscles at different rates, therefore switching directions regularly will work all muscle of the legs equally and reduce the chances for shin splints.

If you are running on a road, most roads in most locations throughout the country are canted (or tilted to improve water runoff). Therefore, running against traffic always will cause supination of the left foot and pronation of the right foot. With supination, you will work the lateral (outside) muscles of the leg more than the medial (inside) muscles of the leg. Pronation does the opposite. By switching sides periodically, you will again work all muscles equally and prevent the presentation of shin splint symptoms.

Lastly, in running smart, the speed of training should be carefully controlled. Start slow and progress slowly to the amount of running you desire. Give the leg muscles time to get strengthened before forcing them into harder regimen. The speed of progress will require understanding of how much running you have done and where you should start. Cross training (elliptical or bike) can also help even the muscle strength as you progress.

In all these aspects of running smart, it should be understood that shin splints are caused by overusing a muscle group and creating an injury. By adjusting the training to reduce this overuse, you will have a more enjoyable run.

3) Evaluation for possible "gait" abnormalities.

“Gait” abnormalities are best described as running or walking abnormalities. Do you have a leg length problem? Do you over pronate or over supinate? Do you have imbalance issues, back problems, knee problems, or other reasons to overwork a muscle group that may cause your shin spints?

Let me discuss some of these running issues:

Leg length abnormalities (left leg longer/shorter than right) can be a large problem when running. The APMA has found that running produces 4-5 times your body weight through your feet. If one leg is shorter, the body is designed to adjust…you will pronate the shorter foot to make it longer and supinate the longer foot to make it shorter. This will lead to overworking the muscles and cause leg pain and possibly shin splints. A simple adjustment to your shoes (or orthotics) will alleviate this problem and produce continued running without pain.

Imbalance issues, often caused by weakness of ligaments (like chronic ankle spraining) or ear problems. One of my patients is deaf in one ear and runs lopsided (towards the deaf side) and has issues with shin splints. With a simple orthotic, a custom item to replace a shoe insert in your running shoes that maintains your foot in neutral position and helps the foot function as it should, his shin splints have been eliminated.

Pronation or supination is also a form of imbalance of the feet and can cause overuse of some muscles and may also lead to shin splints. Orthotics are the answer here also.

By being evaluated for your running, your “gait” abnormalities can be evaluated and often adjusted to help you return to running without the pain.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Running On A Trip

2009-03-07T05:53:00.003-07:00

Most runners have a favorite route, or even a favorite run. Whatever the distance, most runners will also agree that running outside is easier than on a treadmill. This makes running on a trip more difficult, especially when training for a marathon. If traveling on a weekend, this may even raise greater difficulty to make long runs and consistent training. Many people have this difficulty, but are required to run on a trip. What are your options.

Recently, a friend and more experienced runner Dr Marybeth Crane of Grapevine, Texas helped me find an answer. In fact, I can say she provided an inspiration for me on my current trip to Pittsburgh, PA. In my training regimen, I was scheduled to run 16 miles today. Knowing that the travel would make this more difficult (based on Dr Crane's experience), I ran the long run on Wednesday prior to traveling. Running at home, on my regular routes is much easier and allows me to stay on track.

Today I did run a 6 mile pace run, which allowed me to continue to stay on my training regimen while traveling. Other options would include cross-training or even a shorter run in the morning and a second run in the evening. I was very happy with my 6 mile run, and glad that I ran the longer run back in Utah.

Thank you Dr Crane for helping me stay on track in my training...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Cross-Training With An Elliptical

2009-03-06T05:46:00.004-07:00

One of the big concerns with running at greater frequency and greater distances is injury, often called "repetitive stress injuries", such as muscle strains, sprains or stress fractures. Many of these injuries don't just limit continued activity, but completely stop the exercise for a period of recovery. With my current goals for the year of running, injury is not an option.

With this information in mind, I have continued to run (including a most recent 16 mile night) and am heavily training for an upcoming marathon. What are my other options for staying fit, working the muscles and reducing possible injuries? Swimming, although a good exercise utilizes different muscles and different motions than running. It is a good activity for cross-training, but will have minimal benefit for my running. Biking adds greater leg strength and greater aerobic benefits, but still is not a perfect match for running. A newer exercise modality, the elliptical, is a similar modality and has been shown to be valuable with cross-training for runners.

So, over the years I have been able to cross-train with the benefits of an elliptical trainer. I have also recognized a higher aerobic benefit in a shorter period of time. In my current exercise regimen, I am utilizing the elliptical as an additional activity for the day or an alternate when I have less time to exercise that day. Although use of an elliptical will not prepare me for a marathon, it is a good adjunct and should be considered especially by those that commonly get stress fractures or other stress injuries. I will keep you informed at how it works for me...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Winter Running

2009-02-23T15:31:00.000-07:00

In most training regimine, long runs are saved for the weekend. I am currently in a similar training process and do long runs on the weekends. Just over a week ago, I had a true winter running experience. As a soft white snow fell, all was silent and the road was only lightly covered with snow. The temperature was cold, but I was dressed warm and didn't even notice the temperature. I have done many long runs before, but this was truly a unique experience as any winter run will be. Let me talk a little about winter running...

As with any run, you need to be dressed appropriately and prepared. I had a wonderful running experience because I was dressed for the run. It is recommended that you dress warm for a winter run, usually in layers, so that you can adjust your body temperature throughout the run. Removing or replacing layers to ensure that the trunk temperature is maintained while minimizing overheating. Shoes should also be appropriate for the run and the terrain. There are newer products, including YakTrax Pro that can provide better traction on snow and ice. Although I have not yet needed any of these devices, it would make running in icy conditions much safer. (They are available at a local running store in our area Fleet Feet Sports.)

Avoiding dehydration is also important in the winter. In warm weather, it is common to recognize that through perspiration you are losing heat. Perspiration (due to layered clothing and level of exercise) will also occur in cold weather. Water loss, however, is exacerbated by loss from the lungs. Through the simple act of breathing, your body is losing this important body component. Maintaining correct fluid balance is achieved through drinking fluids before a run (called a fluid bolus - since the body utilizes this fluid easier than fluid you drink while running) and carry maintenance fluid with you either in a camopack or fuel belt.

The most important part of winter running is to enjoy it. Rarely will you see the peace that comes from falling snow, the quiet that comes from people staying inside or the smell of nice clean air (at least when it is snowing). Wind can make this less enjoyable, but will still provide a unique running experience. Don't limit your running experience by sticking to a treadmill or indoor track, because winter running is just one more high that can come from running (you and nature).

Dr Brandt R Gibson

Mountain West Foot & Ankle Institute

36 North 1100 East, Suite B

American Fork, UT 84003

801-756-0765