24 February 2013

An attempt to run a marathon using SCIENCE: part VII ("Niggles")

Runners don't like to take it easy. After last Sunday's long run was replaced with an epic afternoon of photography - due to some niggling pain in my right foot and a tight left calf/back of knee - I managed to contain myself for one more day, playing it safe on Monday with a swim. Then it was back to running on Tuesday with a 12k. The rest of the week involved a punishing interval session combining 1500m and 200m repetitions (in below-zero temperatures), weird foot stretches, early morning hill runs, physio, an "easy" 5k and finally a 25k long run that resulted in a surprise half-marathon PB.

Fastest 21.2k ever - during a 25k run!
I know, I know, I've only got myself to blame for the niggles. But over the years, running has come to form such an important part of my routine that it's hard to stop for more than a couple of days. Any longer than that and I find myself fidgeting while trying to write and pestering Mr Hayley half to death... poor Mr Hayley. He does suffer so.

Since it's sort of difficult to apply SCIENCE to deal with niggles in general, we have to use common sense to tell when a "niggle" is actually something more serious, when to give ourselves a break and when to consult a professional. This is a point that was made very well in a copy of Runner's World I happened to leaf through in the waiting room at my physio appointment. Niggles can easily turn into injuries and injuries can turn into months of being unable to run. (Ultimately the worst fate a runner can suffer, pretty much besides death.) Ignore niggles at your peril.

My particular niggle turned out to be serious enough to require me to book in for a full assessment next week, but not serious enough for the physio to suggest I stop running. But in the meantime, I have been doing what I've been told... which is this:

Ice. Yow!
Unfortunately, though, sports medicine - like any type of medicine, I suppose - is not always as straightforward as simply diagnosing the problem and treating it, as I'll explain. The snippet of SCIENCE I have to offer this week relates to that foot and a bit of it I didn't even know existed. (Despite being a biologist by training, I have almost no clue about anatomy.)

It turns out there is a chance I may have something called plantar fasciitis - put that into Google and you will get some scary pictures of foot braces. This condition affects the tissue in the base of the foot; the connective tissue (plantar fascia) that joins the toe bones to the heel and forms the foot arch. Among runners, plantar fasciitis is relatively common - 8% of all running injuries! However, it does also affect people who have recently gained a lot of weight, presumably because the foot arch suddenly has to support that extra weight.

Plantar fascia, apparently...
According to a long, incredibly fastidious and very well referenced blog post by John Davis at the RUNHAPI injury clinic in Leesburg, Virginia, there is no evidence that plantar fasciitis is related to inflammation - as the suffix "-itis" would usually suggest. Instead, rather more worryingly, it seems to be caused by degeneration of the tissue itself. Unfortunately, this means that treatments like ice, which should work for inflammation, may not work for plantar fasciitis. Or, at least, they may only be beneficial in the initial stages of injury, before degeneration sets in. So that bottle of ice I've been rolling my foot on? Well, let's see if I have plantar fasciitis or not first. I'm really hoping NOT.

The exact causes and risk factors for plantar fasciitis are hard to pin down. Possible risk factors, including being flat-footed (check, I have flipper feet) and having a job where you have to spend a lot of time on your feet (nope, I barely move all day). As for treatments, it seems there is little to inform treatment in runners specifically, but some evidence for calf stretching being of benefit more generally. You can also do a more specific stretch for the plantar fascia itself, which involves pulling your toes back. So, as I wrote a couple of weeks ago, stretching before and after running is probably of little benefit, but specific injuries may call for stretching at other times. Other options include wearing a really uncomfortable-looking splint at night (oh great), taping to support the arch, shortening and quickening your stride pattern to reduce impact (hmm, difficult), and, um, electric shocks (oh, come on, really?).

As with a few of the topics I've looked at in this series of posts, there's a lack of high quality evidence in this area. It will be interesting to hear what the physio has to say in his full assessment, simply to see whether he really knows his stuff... If you're interested in reading more about plantar fasciitis, and especially if you think you might be suffering from it, I would really recommend Davis's post as it cites proper research in proper journals. I've given a very basic summary here, but his is really the most comprehensive non-academic article on this topic I've seen.

So boo to niggles - and niggles that may turn out to be injuries. Thankfully, I'm not in huge amounts of pain and there seem to be *some* sensible treatment options. And like an alcoholic at an AA meeting, I've taken the first step by admitting I have a problem. Fingers crossed.

17 February 2013

An attempt to run a marathon using SCIENCE: part VI (Apparatus)

Today I had one of those ideas where you think you'll do something cool and it will just take an hour, and then it ends up taking the whole day. Yeah. At about midday today, I decided it would be cool to photograph all the individual items that make up my training kit to illustrate this week's blog post. "This will be a doddle. I'll just photograph everything against the same background and then stick it all together in some sort of collage."

Well, photography is actually not my strong point, although I do enjoy it. Also, I don't have a smartphone or Instagram or any of that new fangled stuff, so I had to do it using a real camera and Photoshop. At about 3pm, I realised it was going to take a lot longer than an hour, but by then I had passed the point of no return. So I did it and it took me all day and now there's no blog post to illustrate. But hey, this is my kit.

I don't know what this proves. That you can spend a lot of money on running? That I am really, *really* avoiding writing the last chapter of my book?

And P.S. I am not cross-training in rounders. It's a foam bat that I'm using as a roller to work the base of my foot.

10 February 2013

An attempt to run a marathon using SCIENCE: part V (Stretching)

Tut tut. Two weeks without an update. It's becoming apparent that if there's one time of the week that I'm least inclined to blog, it's on a Sunday evening after the most demanding run of the week. But I'm persevering, even after today's 30k - in appalling conditions - into which I mixed some nasty hills, just for "fun".

So this week I've been researching stretching. Personally, I've never been much of a stretcher. But since starting training with my local athletics club, I've adopted some of the dynamic stretching exercises we use at the track for my own running routine. More about those later though. Let's start with more basic static stretches. These are the kind that you can do standing or sitting on the spot. If you watched the Australian Open final the other week, you will have seen the frighteningly flexible Novak Djokovic running through a series of static stretches during one of the breaks between games. Whether these were meant to aid his tennis performance or just to intimidate his opponent, I've no idea. We're focusing on running.

The theory behind pre-run stretching was always that it would reduce muscle soreness and the risk of injury. As most serious runners will probably know, however, experts are now advising against static stretching before running. This is backed up by some fairly extensive studies on static stretching vs no stretching. In 2002, the British Medical Journal published a review of studies on stretching before and after exercise that suggested the benefts of pre- and post-exercise stretching for muscle soreness and injury prevention were at best tiny.
"...on average, about 100 people stretch for 12 weeks to prevent one injury and (if the hazard reduction was constant) the average subject would need to stretch for 23 years to prevent one injury."
And 23 years is a really long time to have to hold a stretch... sorry.

At the time, the review authors concluded that there was not enough evidence to say whether stretching could improve performance. But more recently, in 2009, US reviewers found an "acute bout" of stretching before exercise could actually impair muscle strength. With regard to injuries, they said there was no evidence for reducing overuse injuries but some, limited evidence for reducing muscle strain. Yet another review, published by The Cochrane Collaboration in 2011, found stretching - before or after exercise - did not reduce later muscle soreness.

None of these reviews were specific to running. But a year later, an orthopedic surgeon (and lifelong runner) called Dan Pereles was involved in a stretching study that recruited 2729 runners via the USA Track and Field website. I found this particular study interesting because it tells us something about why this type of research is difficult to carry out, and why the practice of stretching persists, despite its lack of any real benefit.

Like many studies before it, Pereles' study split the runners into two groups: a stretch group and non-stretch group. Runners fell injured at exactly the same rate over a three month period - 16% or just under 1 in 6 of the volunteers - whichever group they were in. So again, no discernible benefit of stretching for injury prevention. But what's interesting is that many of the runners who initially volunteered to be involved backed out as soon as they found out they would not be able to stretch for three months. And therein lies the problem: runners are creatures of habit. They can become so attached to their routines that they are afraid of changing them, even when there is little indication that these routines are doing them any good. The fact that it took two years to get enough runners to balance out the stretch and non-stretch groups is telling.

Having said that, many of those runners who backed out probably saved themselves an injury, because as it turned out, those who were avid stretchers and ended up having to join the non-stretching group were more likely to injure themselves (almost 1 in 4). Why? It seems no one is exactly sure, but it may have had something to do with an abrupt change in a routine that the body has already adapted to. The lesson: if you're going to change your routine, do it slowly and carefully. I guess we could also conclude from this study that stretching is nothing but a harmless waste of time. So if you're married to your routine, perhaps there's no real harm in sticking to it.

All of this doesn't necessarily mean that stretching is pointless. Some static stretches are targeted at specific muscle groups and connective tissues and may help in prevention of or rehabilitation from injury - at times other than before a run. There also seems to be some confusion about whether static stretching might be of benefit when it's part of a more general warm up. And in some forms of exercise, like ballet, stretching may be more beneficial for helping athletes (or dancers) achieve the range of movement they need. I haven't looked into other sports, so it's worth seeking out more detailed research, if it exists.

What of my dynamic stretching then? This is basically movement-based stretching or drills a bit like you might see footballlers doing as part of their warm up. I like to refer to it as the Ministry of Silly Walks. It's the kind of stretching that's really quite embarrassing to do on the side of the road at 7am, especially when you live opposite a bus stop. Plenty of coaches are subscribers to the dynamic stretching approach - including Robert Chapman, who coaches elite distance runners from Team Indiana Elite. He says:
"...by engaging in these activities, we can neurologically activate specific muscle groups prior to running, which helps us minimize injuries and perform better in the subsequent workout."
Sounds a bit hand wavy and to be honest, I haven't been able to track down many references for dynamic stretching, despite plenty of pages on the internet recommending it based on miscellaneous "research". However, that 2009 review I mentioned refers to various potential benefits, including raising core temperature ahead of exercise and increasing your range of motion without damaging your performance during the exercise. This recent study found that male sprinters performed better after 1-2 sets of dynamic stretches, but less well after 3 (suggesting too much dynamic stretching could be tiring). On the other hand, dynamic stretches seemed to have little effect on long distance running performance.

So I guess that brings me back to the central question of whether dynamic stretching is really going to help me in my marathon running efforts. I wonder whether its use might actually be limited to the shorter track sessions. But hey, I'm a creature of habit - why change now? After all, it doesn't seem to be doing me any harm...