Archive for September, 2010

Brutal is not best

September 26, 2010

After a decade in which African runners have almost totally dominated distance running, there has been growing interest in the possibility that athletes from elsewhere in the world might once again compete on an equal footing with the Africans.  Last year, Meb Keflezighi won the ING New York marathon, but that is probably of little relevance to this question.  Meb spent his school days in America and is a genuine home-grown American athlete, but he had been born in Eritrea, and there has been much discussion about the degree to which his African roots contributed to his success.  Perhaps even more important to the discussion of whether non-Africans might seriously challenge African domination of distance running is the fact that Meb is now 35 and approaching the age at which it will be a struggle to sustain the pace of his younger days.  Wonderful though his achievement in New York was, if there is going to be a substantial re-balancing of the geographical distribution of power in distance running it is more likely to be achieved by a slightly younger generation.  So hopes have been invested in two younger American distance runners: Ryan Hall and Dathan Ritzenhein.

Both have indeed shown great promise.  While it would be foolish to place too much emphasis on small blips, nonetheless, it is noteworthy that last weekend there were interesting hiccoughs in the career trajectories of both of these young hopefuls, and these hiccoughs are worth examining because they might perhaps be pointers to more serious underlying flaws.

In recent weeks I have on several occasions discussed Dathan Ritzenhein and the question of how he is dealing with his metatarsals.  In my recent post I speculated that his attempt to change his running style might have contributed to his disappointing slow-down in the final 5Km of the Great Northern Run a week ago.  Today, it is time to wonder why Ryan Hall had a disappointing run in the Rock and Roll half marathon in Philadelphia that same weekend.

Hall is currently preparing for the Chicago marathon in October.   The Philly R&R was intended to merely mark a stage in his preparation for Chicago but nonetheless he approached it with hope that it would confirm that his preparations were going well and that he was building from the solid base demonstrated by his 4th place in Boston this year.  In his blog on Sept 13th he wrote ‘The great thing about running Philly is that I have a positive experience from last year to build from’.  Last year he had won.  His time of 61:52 on that occasion was somewhat slower than his personal best (the current US record) of 59:43 set in the Aramco half marathon in Houston in 2007, but nonetheless a victory indicates that you are the best in the field on the day.  So his hopes for the 2010 Rock &Roll were well justified.

However, these hopes were dashed.  After a sound start in which he followed his usual tradition of setting his own pace rather than worrying about maintaining a place in the leading group, at 10Km he was on course for a time similar to his time last year, but then faded badly in the second half to finish in 14th place in a time of 63:55.  What happened?

In that blog posted only six days before this year’s event, he also described his recent training:

‘On Sunday I ran my last significant long run before Philly. It was one of my favourite long runs of all time. …. On the trip to Mammoth there is a section of road from the 395 to the entrance of Yosemite National Park on the 120 that is called Tioga Pass. It is a brutal climb with majestic views. ….Tioga pass climbs from 7,000 to 10,000 feet over 12 miles, but that stat doesn’t do the run justice. The majority of the climb happens over a six-mile stretch, which makes for the steepest paved road grade I have ever run–and at an increasing altitude, to boot. Part way into the run I could see the elevation sign off in the distance and was sure it was going to say 9,000 feet, as I was already hurting and was sure I had already climbed a significant part of the pass. It was a little disheartening when I got closer to the sign and saw that it marked 8,000 feet. I still had 2,000 feet of climbing over the next four miles.’

Hall had intended the Rock  & Roll to be merely as a staging point in his preparation for the Chicago Marathon in a month’s time, and it would have been inappropriate to take time out of his preparation for a long taper for a race which merely marked an intermediate stage, but was it sensible to do such an exhausting long run in that particular week?  The phrase ‘brutal with majestic views’ I think reflects a mind-set that contrasts with phrases expressing the need to respect the body that are typical of elite Kenyan and Ethiopian runners.  For example, in his interview with Akio Harada before the Fukuka marathon in 2008, Olympic champion Sammy Wanjiru made clear that he races with grit.   He stated ‘but I’m not the type of guy who runs behind someone else.’   In contrast, his approach to training exhibited a respect for the body: ‘Sundays are off, and if it rains I also take the day off from training. If you train too hard in the summer it’s bad for your body.’

While it is sensible to run a competitive half marathon as a tune-up in the final 6 weeks of the preparation for a marathon, it seems to me that preceding a half marathon race with a ‘brutal’ long run ascending from 7000 to 10,000 feet is not a sensible and respectful way to treat the body. It is the hubris that invites nemesis.   I hope that Hall manages to recover in time for a good run in Chicago.  Perhaps it might be even more important for him to re-evaluate his approach to building up rather than wearing down his body.  Both Haile G and Paul Tergat emerged stronger after disappointing performances during their careers, so it would be far to dramatic to make too much of the recent disappointing half-marathons of either Hall or Ritzenhein, but I think every race performance requires a little bit of scrutiny to see if there are lessons to be learned.

[1] http://ryanhall.competitor.com/2010/09/13/race-week/#more-113

[2] Akio Harada (2008)  ‘Samuel Wanjiru shares the secret of training to win.’, published in the program for the 2008 Fukuoka marathon; translated from Japanese by Brett Larner with editorial assistance from Mika Tokairin, and posted on http://japanrunningnews.blogspot.com/2008/12/samuel-wanjiru-shares-secret-of.html

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Heel striking v. forefoot

September 24, 2010

A few weeks ago I had speculated on how Dathan Ritzenhein might fare in the New York marathon on 7th November.  As I described, he has been cruelly afflicted with metatarsal problems throughout his running career, and in the past year or so has taken three steps to banish these problems.  First he moved from Boulder, Colorado with it hard trail surfaces, to join the Nike team in the verdant environment of Portland, Oregon, where the trails are softer.   Secondly, Nike’s head of biomechanics, George Valiant, designed some shoe inserts which relieve the pressure on the downward protruding head of the third metatarsal of his right foot.  Thirdly, and more controversially, under the guidance of Alberto Salazar, he has adjusted his style from heel striking to a landing with the impact point nearer to the forefoot.  I think that such an adjustment must be approached cautiously by any runner, but especially by an individual with metatarsal problems.

On Saturday he returned to racing following his most recent metatarsal injury, running in the Great Northern Run.  He finished 4th in 62:35., which was disappointing in comparison with his time of 60:00 in Birmingham a year ago when he won the bronze medal at the World Half Marathon championships. In his recent blog post [1] he put a brave face on his performance in the GNR by pointing out that it was not bad for a first race after injury.  He had done only about 10 weeks of serious marathon training, though he had previously posted on his blog on Sept 9th that he felt not far off his fitness a year previously in Birmingham.  At Gateshead on 19th Sept he set out in the lead group, covering the first mile in 4:38 (on target for around 60 minutes for the HM), but dropped off the pace when Kiplimo Kimutai surged shortly after the 5Km mark, which leaders had reached in a fairly brisk 14:09.  Only the eventual winner, Haile Gebreselassie was able to stay with Kimutai after the surge and perhaps it would be expecting too much to expect Dathan to hold that pace at this stage in his training.  However, in the later stages of the race he slowed even more due to tight calf muscles.  In his blog post he reported ‘my calfs were barely working in the last 5K of the race’.  He blamed this on his light weight Streak XC shoes, which is perhaps plausible though I would also wonder whether his changed running style might  contributed. While it is currently popular to advocate a forefoot landing, even for  long distance runners,  there is little doubt that a forefoot landing places extra strain on Achilles and calf.

The good news is that Dathan suffered nothing worse that tight calf muscles.  At least his metatarsals are surviving.  I still hope he does well in New York, but after Haile G’s comfortable win in the GNR it is clear that Haile is in dominant form and he must start as the favourite in New York.  I hope his run in New York will dispel the disparaging whispers that he has shied away from the head-to-head competition in recent years, to focus only on world records on flat courses.  I think that these whispers are unfair on the greatest distance runner the world has ever seen.  So I am hoping for a great race in New York, with Haile prevailing, but others including Martin Lel, Meb Keflezighi and Dathan running really well.

Meanwhile on a much more humble stage I have been pleased with the result of my regression from my usual forefoot striking to heel striking, to deal with the recent acute exacerbation of  my own longstanding metatarsal problems. Since temporarily adopting a high cadence, heel-striking style, I have gradually increased my training volume with runs in the lower aerobic zone (HR around 120 b/min; pace around 5:45 /Km). I have had no metatarsal pain while running and only mild discomfort later in the day.  However, while the metatarsalgia has receded into the background, the knee problems that have hampered me all year are still lurking.  I am aware of the potentially greater jarring forces on the knee when heel striking and have been ensuring that I land with a ‘soft’ flexed knee so that the quad absorbs much of the impact.  I think this has been successful, because my knees have also continued to improve in the past two weeks and I no longer suffer knee pain while actually running.  However I still get some pain in the anterior compartment of the knee on standing from a sitting position, and I am also getting occasional spasms in popliteus (the small muscle running transversely behind the knee, which is responsible for unlocking the fully extended knee). The spasm of popliteus had started when there was a marked effusion in my left knee during the episode acute arthritis that afflicted me in February.  The fact that the popliteus spasms are continuing indicates that there is still something not quite right about the mechanics of my knee, so I am being very cautious in building up the training volume.  I will refrain from increasing the pace for a few weeks longer.  Overall, I think that my heel strike experiment is proving to be a success.

I remain convinced that the choice between heel and forefoot striking, at least when running slowly, should be decided by an appraisal of one’s own situation rather than being dictated by popular dogma.  For a person with metatarsal problems, heel strike might well be safer, provided one lands with moderate flexion of the knee.  Nonetheless, I anticipate returning to my habitual forefoot landing once I start increasing the pace a bit, because impact forces are greater at higher speed, and the forefoot landing helps distribute the task of absorbing the impact between structures of foot, lower leg and thigh.  However I will take care to ensure that I condition my calf muscles to cope with the extra stress.

[1] http://dathanritzenhein.competitor.com/2010/09/19/great-north-run-ouch/

Integrating the runner’s mind and body: the role of HRV

September 12, 2010

In his response to the post in which I presented my daily Heart Rate Variability (HRV) recording for August, Rick provided a link to the blog by Carl Valle in which he raises the provocative question that HRV is the ‘new lactate’ [1].   On the whole Carl’s posting was typical of a coach who brashly denies the value of scientific data yet takes for granted that he/she knows how to advise his/her clients.  This implies that there is some mystical source of wisdom that transcends science.  I believe a good coach observes, draws conclusions, makes predictions and offers advice, though sometimes he or she cannot put the underlying series of logical deductions into words.   The thinking style of such a coach is indeed almost pure science but it is a science that sometimes defies words.  This might be called intuition but it is not magic.   There is indeed a rich stream of activity in the human mind/brain that defies words yet is crucial for excellent performance in almost any sphere of activity, physical or mental.  My own interest in HRV and the question of how it might be best understood and used, is closely related to my speculations about how best to achieve the coordination between mind and body necessary for optimal performance, taking account of the fact that most of the communication between mind and body is non-verbal.

One piece in the kaleidoscope of memories and ideas that fuel my speculation is the most memorable race of my life.  It was a very low-key event; a 10,000m in a meeting in my home town, Adelaide, one summer evening almost 45 years ago ago.   I had not made any advance plan to run.  I had finished work rather late but on the spur of the moment decided that I would see if I could get to the track on time for the start, because in those days there were few opportunities to run 10,000m on the track. It was my first, and so far, only 10,000m race.  I arrived in time to line up for the start, but without any opportunity for a proper warm up.   However from the moment the starter’s gun fired, I was into my stride.  I did not consciously plan my pace as I had never run a 10,000 race before, though I frequently ran distances around 8-10K for recreation, so I suppose my body had a good non-conscious estimate of the magnitude of the task.  As the race unfolded, I ran with an amazing feeling of grace and power.  I was calmly aware that I was headed for victory, but winning was of little importance.    Perhaps endorphins contributed to my transcendental state but any circulating endorphins were not a reaction to pain; I was simply running well and enjoying it.  I have kept no record of the finishing time, nor indeed of my PB for any other event run in my youth, but that matters little.  The memory I treasure is the feeling of grace and power.  I doubt that my family or friends would use words like graceful to describe me, but in fact from time to time since then, I have had flashes of that same sense of grace and power – though sadly, not often in recent times.

Another sparkling fragment in the kaleidoscope comes from a different time and place, Beijing 2008, and a different level of performance entirely: Usain Bolt’s victory in the 100m final, in the world record time of 9.69 seconds.  With 15 metres to go he was about 8 metres clear of the rest of the field; his arms spread in celebration; not a triumphant thrust of the arms, but an open gesture accompanied by turning his head to the crowd as if inviting everyone to celebrate with him.  It is tempting to think that he might have recorded an even faster time if only he had been concentrating on the race – but I doubt if that is true.  In fact his legs still drove powerfully forward to the finishing line.  It is more likely that he is such an amazing runner because he does not concentrate on his running in the conventional manner.  In the press conference afterwards he grinned: ‘“I was havin’ fun. That’s just me. Just stayin’ relaxed. I like dancin’.”

Mindfulness

Although perhaps the differences are more prominent than the similarities, what both of these illustrations have in common is a mental state, a ‘zone’, in which there is time and space to savour the moment; the body does not need to be driven by conscious determination.  It is state of unhurried awareness; but not detachment.  Perhaps this mental state is a variant of what is known in contemporary psychology as mindfulness: a calm awareness of ones breathing and heart beat, one’s muscle tone and posture, one’s thoughts and feelings, and of consciousness itself.

Although mindfulness-based therapy has recently become a popular form of therapy for the stresses of modern life [2,3], the concept of mindfulness is deeply rooted in all human cultures.  The Oxford English Dictionary unhelpfully defines it as “The state or quality of being mindful; attention; regard”, and notes that it was first recorded in the English language as ‘myndfulness’ in 1530.  The concept is even more strongly associated with the teaching Buddha who lived around 500 years before the beginning of the Christian era.  In the celebrated but perhaps apocryphal ‘flower sermon’, Buddha’s disciples were puzzled as he silently contemplated a lotus flower.  After it dawned on one of the disciples that the message was that enlightenment comes through contemplation, Buddha is reported to have claimed that this wisdom was transmitted by some mystical form of communication that transcends time and space and does not depend on letters or words.

But one does not need to invoke mystical power to account for non-verbal communication.  Modern neuroscience provides abundant evidence for non-verbal modes of processing and transmitting information.  Since the French neurologist Paul Broca established in the middle of the nineteenth century that the left frontal lobe of the brain plays a crucial a role in the generation of speech, a great deal of evidence has been assembled to demonstrate that logical, verbally mediated goal orientated mental processing is largely the work of the left hemisphere.  The right hemisphere has a gross structure similar to that of the left hemisphere but the subtle details of its internal and external connections facilitate non-verbal processes.   However, it would be simplistic to regard the brain as an organ with two competing halves, one verbal and one non-verbal.  The functions of the brain and body are integrated via a complex web of connections, neural and hormonal.  Neuroscience is beginning to unravel the principles underlying this communication web to an extent that was inaccessible to Buddha, but the details are complex and for practical purposes we are only a little further than Buddha in understanding how to tap into the power of non-verbal mind-body interactions.

Integration of mind and body

The understanding of the natural world provided by modern science frees us from many of the superstitions of our forebears, but there is a danger that we will lose that intuitive grasp of the wisdom that defies words.  There appears to be a contradiction between science that reduces the natural world to laws expressed in the language of mathematics and the intuitions that coach Carl Valle appears to extol in his blog. I do not accept that there is a real contradiction. Science is does not have to be purely reductive and it can certainly encompass non-verbal communication without resorting to mysticism. I believe that monitoring of HRV in combination with the practice of mindfulness, provides one way of using technology to foster constructive non-verbal mind body interaction

One of the communication systems within the complex web that mediates non-verbal mind-body interaction is the autonomic nervous system.  The parasympathetic division of the autonomic system mediates recovery from stress and can be engaged by meditation that encourages mindfulness. In light of the role that acute inflammation plays in the damage to muscles, tendons ligaments and joints that is an inevitable, indeed crucial part of the response to athletic training, it is of particular interest that mindfulness can modify the levels of the messenger molecules, such as interleukins and other cytokines that communicate to the brain information about tissue damage and help to regulate the inflammatory process.  The parasympathetic nervous system is intimately involved in the anti-inflammatory process, and HRV, both high frequency variability but also low frequency  variability, is associated with levels of cytokines circulating in the blood stream [4, 5].

Reliable measurement of HRV

As I have discussed on several occasions previously (eg 13 July 2010), two studies by Antii Kiviniemi and colleagues from Oulu in Finland demonstrate that adjusting one’s training regime according to a daily measurement of high frequency HRV (such that training intensity is decreased on days when HRV is reduced) can lead to greater improvement in fitness than training according to a fixed schedule [6.7].  However, my own experience is that high frequency HRV fluctuates erratically from day to day unless you adopt a standardized procedure for the measurement.

I have found that the most consistent measurements are obtained by recording HRV during two minutes shortly after getting out of bed each morning.  To standardise my physical state, I stand in a relaxed posture while breathing slowly and regularly.   To standardise the state of my mind I practice mindfulness.  I focus on the flow of air into and out of my lungs, the pulsation of my heart in my chest and the tension of my postural muscles.  Although I merely observe my thoughts and feeling in a manner that is not goal orientated, the awareness of oxygen flowing into and out of my body often prompts thoughts along the paths related to James Lovelock’s Gaia hypothesis – the proposal that all living organisms can be considered as components of a single self-regulating organism capable of keeping the earth’s environment healthy [8].  Sometimes I am reminded of the lesson that Hilary Stellingwerff learned during high altitude training in Ethiopia; ‘Finally, on all my recovery runs, the Ethiopian athletes stressed the importance of running on soft ground in the forest to make sure you go slow enough to really recover. They don’t worry too much about their pace, but instead about “getting good oxygen” from the trees and “soft ground” for the body.’

I believe that my daily ritual serves two purposes.  First, it leads to relatively consistent day-to-day HRV measurements.  Significant departures from the usual range of values indicate either excessive stress from training or from some other aspect of my life, as described in my post on 29th August, and help me adjust training intensity appropriately.  Second, in light of my hectic lifestyle, I think that starting the day with two minutes of relaxed contemplation makes a small but valuable contribution to maintaining a degree of calm throughout the day.  But the value of this is speculative, and I agree with Carl Valle that measurement of HRV is of limited proven value so far.  My own motivation is as much driven by a curiosity about what might work as by what is proven.

There is a third and even more speculative purpose in my ritual.  To what extent can training in mindfulness create the ability to invoke that mental state in which the body produces its best without the need for potentially obstructive gritty determination; a state in which there is time and space to savour the moment, to feel grace and power while running? Maybe this is an unrealistic romantic goal.  It flies in the face of our inclination to believe that it is only by disciplining our bodies in training and while racing, that we can achieve our peak.  But perhaps in the attempt to get the most from our minds and bodies we exult the power of discipline and struggle, and we lose the magic that allowed Usain Bolt to celebrate his victory in Beijing 15 metres before the tape.

My own experience provides some limited evidence that mindfulness can improve running performance.  When running intervals, my breathing rate increases to around 85 breaths per minute when I become anaerobic.  If at this point I focus on the distance still to be run, my breathing feels laboured and painful.  If instead I focus on the sensation of powerful expulsion of air from my lungs and then the subsequent surge of air back into my lungs, the feeling is usually an exhilarating sense of power.  When I employ a similar exercise in mental focus during intervals on the elliptical cross trainer (which has a power meter) my power output increases by an extra few percent without a corresponding increase in conscious effort.

Why not simply listen to the body?

One might argue that there is no need to invest in a heart rate monitor with the capacity to record R-R intervals in order to learn how to listen to the body.  I accept that the findings of the studies of HRV guided training by Kiviniemi and colleagues [6.7] are encouraging but not compelling.  Nonetheless, the evidence demonstrates that HRV can be a good index of autonomic nervous system function if interpreted appropriately, and that autonomic nervous system function is a useful index of the interactions between mind and body that mediate inflammation and recovery.  Perhaps the autonomic system also plays a key role in producing the optimal interaction between mind and body while running.

My own experience suggests that achieving optimum consistency in measuring HRV requires development of the skill of mindfulness – the objective awareness of one’s own bodily and mental function.  I suspect that this mindfulness has some similarity to the state of detached contemplation advocated by Buddha, though I suspect Buddha might have concluded that any concern with quantitative measurement was alien to his concept detached contemplation.  However, Buddha did not have the benefit of our current knowledge of physiology and neuroscience.  I believe that both the traditional oriental understanding of the interaction between mind and body, and the understanding provided by modern neuroscience, are useful models of reality.  Like all scientific theories, both are only models. As outlined by Isaac Asimov in his famous essay entitled ‘The Relatively of Wrong’ charting the development from mankind’s belief in a flat earth to our current understanding of a slightly pear shaped earth, all scientific models are wrong [10]; most have some utility within a certain domain in which they fit the observed evidence.  Better models provide a more accurate description over a wide range of circumstances.  I believe that it is likely that a traditional oriental understanding of the interaction between mind and body can be very helpful in creating as situation in which mind and body harmonise to produce maximal performance, but if this is the case, the traditional understanding must also harmonise with the evidence from modern science.

If we adopt the simplistic view that the goal of training is merely to improve physiological quantities such as aerobic capacity or strength, we might miss out on some of the wisdom embedded in traditional oriental understanding of mind-body interactions.  Some approaches to running, such as that advocated by Danny Dreyer in his method of Chi running [11], appeal to traditional oriental wisdom.  Insofar as such approaches encourage harmony between mind and body they might be helpful, though I think that ultimately it is likely to be more effective to integrate traditional wisdom with a realistic application of knowledge of physiology, mechanics and neuroscience.  Chi running, like Pose, assigns a mystical role to gravity that is contrary to the laws of Newtonian mechanics.  Hence, while Chi and Pose might be useful for many recreational runners whose major goal is avoiding injury, especially for individuals prone to knee injury, these methods are unlikely to be of much use for elite runners who need not only to harmonise mind and body but also need to maximise the efficiency of movement.

I think that the skill of mindfulness might play a useful role in helping integrate traditional oriental wisdom into an approach to training that also takes account of modern science.  Hence, I believe that curiosity in this concept is well justified, even though I cannot at this stage claim compelling evidence that it is worthwhile. I am not trying to sell snake oil.  There is no point expecting that simple mental exercise will abolish the need for training.  Without well developed aerobic capacity and adequate strength, running is unlikely to be either graceful or powerful, but neither will it be so without good coordination between mind and body.

References

[1]  http://www.elitetrack.com/blogs/details/5343/#When:09:39:23Z

[2] Kabat-Zinn J (1990)  Full Catastrophe Living: Using the wisdom of your body to face stress, pain and illness. Delcorte press, New York

[3] Williams M, Teasdale J, Segal Z and Kabat-Zinn J (2007) The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness.  Guilford press, New York & London

[4]  Haensel A, Mills PJ, Nelesen RA, Ziegler MG, Dimsdale JE (2008) The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology 33, 1305—1312.

[5] Taylor AG, Goehler LE, Galper DI, Innes KE, Bourguignon C. (2010) Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research.  Explore (NY). 6(1):29-41.

[6] Antti Kiviniemi, Arto Hautala, Hannu Kinnunen & Mikko Tulppo (2007) Endurance training guided individually by daily heart rate variability measurements. Eur J Appl Physiol. 101(6):743-751.

[7] Kiviniemi AM, Hautala AJ, Kinnunen H, Nissilä J, Virtanen P, Karjalainen J, Tulppo MP . (2010) Daily exercise prescription based on Heart Rate Variability among men and women. Med Sci Sports Exerc. 42(7):1355-63

[8] Lovelock JE and Margulis L. (1974). “Atmospheric homeostasis by and for the biosphere- The Gaia hypothesis”. Tellus 26 (1): 2–10.

[9]  http://www.powerbar.com/articles/266/living-the-high-life-training-in-ethiopia.aspx

[10] Asimov I. (1989) The Relativity of Wrong. The Skeptical Inquirer, 14 (1), 35-44

[11]  http://www.chirunning.com/shop/home.php

Metatarsals

September 6, 2010

My post on 4th September was motivated largely by Ewen’s recent question about my plans for running a half marathon this year.  My running has been disrupted by several health problems and now these have receded into the background, I am trying to build up training volume.  However, I am struggling against the re-emergence of several long standing musculo-skeletal problems.  Currently my most troublesome problem is metatarsalgia.

By way of introduction to the topic, I had devoted most of my post on 4th September to the rather tortuous history of Dathan Ritzenhein’s metatarsals. Despite a very bright career as a high school athlete and many subsequent major achievements, including a brief tenure as the 5,000m US record holder, and a bronze medal in the world half-marathon championships in 2009, his potential has frequently been hampered by metatarsal fractures.  Most dramatically, metatarsal pain led him to drop out halfway through the 10,000m at the Athens Olympics in 2004.

He is currently a member of the elite team of US distance runners participating in the Nike Oregon project.  Under the guidance of his coach Alberto Salazar he has made three major adjustments to deal with his metatarsal problems.  First, he moved from the beautiful but austere environment of Boulder Colorado, where the trails are rock-hard, to the soft moist terrain of Portland, Oregon.  Secondly, Nike’s head of biomechanics, George Valiant, deigned some shoe inserts which relieve the pressure on the downward protruding head of the third metatarsal of his right foot.  Finally, and in my opinion, most controversially, he has, abandoned heel-striking for something approaching a mid-foot landing.  I presented my reasons for questioning the wisdom of third of these changes in my post on 4th September.  Now it is time to describe the history of my own metatarsals.

The history of my metatarsals

Although by nature a forefoot runner, I have always had problems with my metatarsal heads.  Since birth, the second metatarsal head in both my right and left feet has protruded downwards.  In childhood , I used to wear out my shoes from the inside.  By the time I reached my teens, a few months after I obtained a new pair of shoes, a hole appeared in the insole as a result of abrasion by the callous on the underside of my forefoot.  Perhaps surprisingly, my feet scarcely suffered at all. I ran all of my marathons in the same pair of Onitsuka Tigers – the fore runner of today’s minimalist shoes.  Although I had to take special precautions to deal with my congenitally peculiar toes, I suffered no pain in the vicinity of the metatarsal heads.  I think that in those days my body’s ability to repair itself far outstripped the rate of tissue damage.  I simply developed thicker callous. However, that has changed as the fat pads between the metatarsal heads and the callous have disappeared with age, and my capacity for tissue regeneration has waned.

About a decade ago, I went shopping for a new pair of street shoes and was frustrated by the fact that every pair I tried caused pain in my forefoot.  I was puzzled as to why I had not had such a problem before.  Even the worn old shoes that I had worn into the shop were quite comfortable.  At first I failed to draw the obvious conclusion but later when I started to suffer serious metatarsalgia (pain beneath the metatarsal heads) while running, the answer came to me.  My old shoes were comfortable because the insole have been hollowed out by the abrasive action of my foot.

I therefore hollowed out the insole of my running shoes, in a similar manner to the way George Valiant created inserts for Ritz eight years later.  The pain diminished substantially, though unfortunately did not resolve entirely.  Perhaps I lacked George’s engineering skills but I suspect the main problem was that I had developed inflammation of the fascia on the underside of the forefoot.  Although the hollowed-out insole shifted the pressure away from the metatarsal head, stress was transferred to a different region of the fascia, which continued to tug on the inflamed area.  I think that is why orthotics rarely provide full relief from plantar fasciitis.

However as the inflammation settled, I found that I could run without pain. Nonetheless, as an extra precaution, I avoided running on hard surfaces as much as possible.  In addition I embarked on regular exercising of the intrinsic muscles of my feet – mainly variations on toe curling – with the expectation that strengthening these muscles would improve their ability to help distribute the load at foot strike thereby controlling the rise in in the tension in the fascia. Together these precautions proved quite effective. Since taking up running again three years ago, I have had minimal trouble from metatarsalgia.

The price of complacency

Eventually I became a little complacent.  I stopped doing the exercises to maintain strength in the intrinsic foot muscles and I became lackadaisical about hollowing out the insole when I obtained new shoes.  There were slowly evolving signs that all was not well: since the episode of acute arthritis in the early months of this year, I had been aware of an increase in forefoot pain, but in the setting of the various other aches and pains that afflicted me, it appeared trivial and I ignored it.  However, I suffered a rude awakening two weeks ago when I set out for my ill fated tempo run. Because I had been late home from work, I ran along a paved sidewalk rather than risk the uneven riverside path in the dark.  I am not sure what was the main culprit: lack of hollowed insole; the hard surface; the alteration of gait due to my knee problems; the effect of lingering systemic inflammation or the accumulation of stress due to my recent return to running.  Whatever the cause, the outcome was a sharp pain in the forefoot.  The metatarsalgia had returned with a vengeance.  The following morning I could scarcely bear to put my foot on the ground.  Hollowing-out the insole of my street shoes provided only slight relief. I was amazed at the ferocity of the sudden exacerbation.   I wondered whether or not it might be a stress fracture.  Focal tenderness of the second metatarsal head added weight to this possible diagnosis, though my experience of similar pain in the past indicated that it would be unwise to jump to a rapid conclusion.

An abrupt drop in high frequency Heart Rate Variability that morning confirmed that I was markedly stressed, no doubt mainly due to the widespread minor musculoskeletal trauma arising from my tempo run, to which the metatarsalgia was only one contributor.  As shown in the figure presented in my post of 30 August, HRV remained depressed for two days, but then returned to a healthy level, indicating that my recovery mechanisms had risen to the challenge and dealt with the systemic stress level.  The focal pain in my forefoot was also substantially reduced but nonetheless, still quite appreciable.  Even with a hollowed-out insole, I could not bear to take my weight on my forefoot while standing.  Running was unthinkable.

Becoming a heel-striker

Gradually the pain in my forefoot diminished and by the fourth morning after the tempo run I decided it was time to try to run.  However it was clear that landing on my forefoot was out of the question.  Circumstances dictated that I should become a heel-striker. To minimise the force at each foot fall, I adopted a quite high cadence and short stride.  To my delight, I found this high cadence, heel-striking style was actually less painful than walking.  After a few Km, the pain in my forefoot had disappeared entirely, a time course typical of pain due to chronically inflamed connective tissue, which tends to feel better once recently formed local adhesions have been remodelled and local blood flow has increased.  This is not the usual time course of pain from a fracture, which tends to increase as the distance run increases.  So I was relived to realise that stress fracture was unlikley.

I was feeling very relaxed at a pace between 5:30 and 6 min per Km.  There was no sign of the discomfort in my knee that had plagued me in recent weeks.  I had intended to run about 6Km. but was feeling so relaxed that I extended this to almost 14 Km.  Although I still felt comfortable, I stopped simply because this was several Km further than I had run in the preceding two months, and I feared that accumulating tiredness would increase the risk of further injury.  My average pace was 5:45 Km/min and average heart rate 120, confirming the previous evidence that my loss of aerobic fitness has not been severe.  Later in the day I suffered the expected aches in knee and forefoot, but on the whole, my body had coped well.

In subsequent days my forefoot has remained tender. When I stand-up from a sitting position pain from the patella-femoral joint and also from the point where the ITB rubs against the lateral femoral condyle confirms that I still have lingering irritation of tissues in these areas, but provided I run with a mild degree of heel-strike and a high cadence, both my forefoot and my knees are comfortable when running.

The future

What the next few weeks will bring remains uncertain, but I have growing optimism that conversion from forefoot striking to slight heel striking, at least during low-aerobic training runs, might be the key to building up to an adequate volume of training.  If I can achieve a reasonable volume of running, I would like to run a half-marathon before the end of the year. Currently, I have the Worksop Halloween half marathon pencilled into my diary.  However that is less than two months away, and in the intervening period I will be doing some travelling.  I am scheduled to deliver talks at conferences in both Germany and China in October.  Unfortunately attending conferences does not diminish the load of routine work, so October will be a busy month.  Therefore, it is far from clear that I will be able to get my legs adequately conditioned for a half marathon by the end of October, and it would be foolish to race if my legs are seriously ill-prepared.

Whatever happens with my own race preparations, I am of course looking forward eagerly to the outcome of Dathan Ritzhenhiem’s experiment with the transition from heel-striking to mid-foot striking.  I hope that on 7th November in New York he at least improves upon his previous best marathon time even if he does not win what promises to be a great race.  But even if his experiment has a successful outcome, I am dubious about Alberto Salazar’s belief that there is one ‘best way’ to run.  I am increasingly inclined to think that while there are indeed rational principles that govern running mechanics, each individual needs to discover how best to apply those principles to his or her own situation.  The heel-strike debate is probably one of the least important issues for most marathon runners, but for Ritz, I think that it is potentially an important issue, and that in abandoning heel-striking he is taking a risk.

Can Dathan Ritzenhein win the 2010 New York City Marathon?

September 4, 2010

After Meb Keflezighi’s victory in the New York City Marathon last year and his fifth place in Boston this year, he will start as one of the favourites this year, though it promises to be a great race.  Haile Gebreselassie will be making his New York debut, but he is in no other sense a debutante.  It will fascinating to see whether or not he still has the form that carried him to the world record in Berlin in 2008.  I understand that Tesfaye Jifar who set the course record almost a decade ago, will be back again this year.  Among the somewhat younger contenders in New York on 7th November will be Dathan Ritzenhein [1].  He made a rather disappointing New York debut in 2006 but is returning to New York after some strong performances on the track, and a bronze medal at the World Half-Marathon Championships in a time of 60:00 in Birmingham in 2009.

But really this blog post and the next will be about me almost as much as Dathan Ritzenhein, and the sub-title might well be ‘Will Canute be fit enough to run the Worksop Half marathon on Halloween?’  I am writing this in response to Ewen’s recent question about my prospects of running a half marathon this year in light of the fact that my year has been blighted by illness.  In my return to running two weeks ago, I struggled to maintain a pace of 5 min/Km during an attempted modest tempo run.   The reason for a rather far-fetched comparison of myself with one of  America’s leading  distance runners is that Ritz has also frequently been sidelined by injury, and if one digs a little deeper into the details, there are some interesting parallels, but also interesting differences in the way that we have responded to a similar problem.

My main problem this year has been an episode of arthritis that started in January and lingered for many months.  It started in my neck, and then spread to my knees, especially the left knee.  Although the acute inflammation settled several months ago, I have subsequently been plagued by a variety of irritating problems around the knee joint, especially  patello-femoral pain and also irritation of the iliotibial band.  I suspect that both of these problems can be attributed largely to a temporary  alteration of my gait to protect the femoro-tibial joint (the main load-bearing joint at the knee) during the period when the acute arthritis was resolving. However, I think the presence of acute systemic inflammation and/or my altered gait has also unsettled several of my other long-standing trouble spots, including my metatarsals.     At present my most frustrating problem is metatarsalgia.

The history of Ritz’s metatarsals

Dathan Ritzenhein  has suffered metatarsal  problems for years.  After a promising display of talent in high school athletics, culminating in a bronze medal at the IAAF World Junior Cross-Country Championships in 2001, he had went to college in Boulder, Colorado.  Following a successful freshman year, his sophomore year was blighted by two metatarsal stress fractures.   The next year he won the National Collegiate cross country championship but again suffered a stress fracture, and limped home in last place in the 10,000m trials for the 2004 Olympics.  Nonetheless due to various mishaps to the initially selected runners, he made the Olympic team, but dropped out halfway through the race in the Athens on account of pain from the stress fracture.   After the Olympics he left college athletics to become a professional and joined Brad Hudson’s coaching group in Boulder.

Boulder is a quirky university town set in awe-inspiring but austere landscape on the eastern slope of the Rockies.  I knew Boulder as it was in the days before Ritz attended college there, but I do not expect that the terrain has changed greatly in the past decade.   Within the city are many paved cycle paths, including the well known creek- side path, which at first sight appears an attractive running route,  but the concrete surface is very hard.  Extending up into the nearby foothills is a further network of unpaved trails but these are mostly hard earth and rock.    Being in the centre of the north American landmass, Boulder also happens to be more than a mile (1600m) above sea level.   It is not as high as towns such as Eldoret in the Rift Valley district of western Kenya, or the mountains near Addis Ababa in Ethiopia, where high country lying between 2000 and 3000m above sea level  has become a Mecca for athletes seeking the secrets of African distance runners.  However Boulder’s  combination of thin air, hard rocky ground and relatively few trees create an environment that is hard on the body of a serious  distance athlete.

In her account of  training in the mountains of Ethiopia,  Hilary Stellingwerff noted ‘Finally, on all my recovery runs, the Ethiopian athletes stressed the importance of running on soft ground in the forest to make sure you go slow enough to really recover. They don’t worry too much about their pace, but instead about “getting good oxygen” from the trees and “soft ground” for the body.’ [2]

I will return to the question of whether or not  the harshness of the environment makes an appreciable contribution to the risk of injury in a future post when I respond to Ewen’s other recent question about the value of monitoring Heart Rate Variability.  However I think it is plausible that the austere environment, and especially the hard trail surfaces of Boulder contributed to several of Ritz’s injuries and illnesses over the years.

Softer ground

In May 2009 Ritz left Brad Hudson to joint Alberto Salazar’s group at the Nike Oregon project in Portland.   Although I do not know Portland, I had lived for almost a decade in Vancouver, BC, and I am fairly familiar with the Pacific Northwest.  I find it hard to imagine anywhere in the world  that could be more congenial to the body and spirit of a distance runner than the moist and verdant Pacific Northwest.  Added to the idyllic natural surroundings is the high tech support provided by Nike, which includes a house with artificially thinner air.  The athletes can live and sleep in the rarefied atmosphere that encourages accumulation of red blood cells, yet avoid the stress of high altitude training by doing their rigorous training at normal atmospheric pressure.  However even in this runners’ paradise, Ritz continued to suffer injury.   So the hard surfaces of Boulder were not the only cause.

In an interview with Peter Gambaccini for the Racing News blog at Runner’s World in July of this year Salazar admitted  ‘Dathan continues to have some foot problems which he’s had for years. I had thought that just by keeping him on soft surfaces and making sure that he’s recovered that this would be taken care of.’ [3]

Shoe inserts

In an attempt to overcome the continuing problems Salazar and the Nike team have implemented two changes.  First they identified the fact that the head of Dathan’s third metatarsal on the right foot protrudes downwards.  To relieve the pressure,  Nike’s head  of biomechanics, George Valiant, produced a hollowed-out insert for his running shoe.  This produced an immediate relief  which I find understandable, because I had made a similar modification to the insoles of my own running shoes about 8 years ago, and , as I will describe in my next post, this provided a partial relief to my own problems.   In the interview reported in the Racing News blog  Peter Gambaccini also spoke to Dathan himself.  He reported ‘I feel really comfortable now. The inserts feel real good. There’s still a little bit of refining on them, but at this point, I feel like when I train daily now, it feels good and my body’s getting used to it.’

Changing  from heel-striking to mid-foot landing

Salazar’s other innovation was to encourage Dathan to change from heel-striking.  Alberto Salazar believes that there is a right way to run and that right way does not include heel-striking.   In the interview for the Racing News blog, Gambaccini asked about the change from heel striking and Dathan repliedI was definitely more of a heel-striker, so I’m definitely getting on to my midfoot more. I wouldn’t say I get all the way up to my toe. I think I’m more pretty much efficient for the marathon if I stay in more of a midfoot stance anyway. ……. Initially, the problem was we tried to focus solely on changing that without being strong enough to do it. We went back to trying to build it up from the strength side so it (the stride change) naturally took over instead of trying to think about it consciously

It is of interest to note that Ritz emphasized the necessity of building strength to support the transition from heel-strike towards the forefoot.  In that interview he did not give further details, but  I suspect he was referring largely to the greater calf strength required when running on the forefoot, though I wonder whether he was also referring to the necessity for greater strength of the intrinsic muscles of the foot, which are called upon to take a larger role in distributing the  forces of impact.  I seriously doubt Salazar’s wisdom in the decision to change from heel-striking for a runner with metatarsal problems, and will return to that issue when I focus on my own tentative approach to my metatarsal problems.

Is the heel-strike debate a red herring?

In my own speculation about running style (described in ‘Running: a dance with the devil’ in the side panel)  I have advocated forefoot landing, but I believe that even more important than forefoot landing in a high cadence and short time on stance.  A recent study by Heiderscheit and colleagues from Wisconsin [4] confirms that increasing cadence by 10% without making any conscious attempt to  change  other aspects of running style results in a substantial reduction in stress at knee and hip.   I continue to believe that if there is one change that is worth making to running style, it is increasing cadence, at least up to a rate in the range 180-200 steps per minute.  I think that above 200 there are diminishing benefits, except when sprinting.  But the nagging question remains: is it also worthwhile to change from heel-strike to forefoot strike.

There are three main arguments favouring a change.  First, it would be expected that landing on the forefoot will result in greater capture of the energy of impact as elastic energy in the muscles and tendons of the foot and calf, and that this energy might be recovered at lift-off from stance.  Secondly, the absorption of impact energy as elastic energy will prevent the sharp rise in ground reaction force immediately after foot-strike.  The jarring effect of this rise in force transmitted upwards through knee and hip might be expected to increase risk if musculo-skeletal injury, though there is little evidence supporting this.   Thirdly, from the evolutionary perspective, it is probable that the human frame evolved to facilitate barefoot running, and barefoot runners usually land on mid or forefoot.

However, the extensive anecdotal evidence of increased rate of calf injuries following transition to forefoot landing suggests that the injury risk associated with the transition is high unless the runner makes a determined effort to strengthen the muscles of foot and calf.   Studies such as the Capetown study of Pose [5] suggest that the transition can be associated with less stress at the knee, but the more recent study by Heiderscheit and colleagues [4] indicates that the reduced  stress on the knee with Pose style might be due at least in part to increased cadence. With regard to the evolutionary argument, it might well be that forefoot striking was best suited to the barefoot running on the African savannah 2 million years ago, but most of us now run on paved surfaces much of the time.  Furthermore the elegant longitudinal arch of the foot suggests to me that the human foot evolved to absorb and store impact energy efficiently when both forefoot and heel are grounded.

In principle heel -striking and forefoot striking are distinctly different, but in fact there is a continuum.  At one extreme, the entire force of impact is borne by the heel; at the other extreme the impact is taken entirely on the forefoot.  I consider that both of these extremes are likely to increase risk of injury.  In the middle of the range is mid-foot striking in which the initial impact is taken equally on forefoot and heel.  In this style, the impact forces within the foot are immediately distributed along the length of the longitudinal arch.  But of course, the runners’ stance is a dynamic event in which the peak vertical ground reaction force occurs around mid-stance, and perhaps that it the point at which it is most beneficial to have both forefoot and heel grounded.

If one is aiming to have both forefoot and heel grounded around midstance, the possibilities for ankle posture at foot-strike stance range from  plantar flexion to mild dorsiflexion, but I suspect that the factor that plays the greatest role in determining the softness of the landing is the degree of flexion of the knee.  As the knee flexes at impact, the quads, which are far bulkier than any muscles below the knee,  will absorb impact energy.  If the degree of tension in the quads is low, the landing will be soft and the risk of injury low, but the recovery of elastic energy will be relatively slow.  If higher tension is maintained in the quads, the leg will act like a stiff spring, retuning energy rapidly and promoting efficiency, at the price of somewhat greater initial rate of rise of the vertical ground reaction  force and possibly greater risk of injury.

I suspect that there is an inevitable trade-off between efficiency of energy recovery and risk of injury, determined largely by the amount of tension in the quads.  I also suspect that for a long distance runner, the orientation of the ankle matters relatively little provided it is within the moderate range that allows an equable dissipation of impact forces along the longitudinal arch by midstance.  If so, the heel-strike v fore-foot debate is largely irrelevant, unless the athlete has anatomical features that make a particular part of the foot more vulnerable.  For a runner with downward protruding metatarsal heads, I suspect that a mild degree of heel-strike might actually be preferable.

I have taken a particular interest in the way Dathan Ritzenhein has dealt with his problem because I have faced some similar issues.  By trial and error I had discovered some of the same strategies as Ritz, though in one potentially important respect I have taken a different path.  But this post is already long enough so I will defer the history of my own metatarsal problems to my next post.

[1] http://dathanritzenhein.competitor.com/2010/07/20/new-york-city-marathon/

[2] http://www.powerbar.com/articles/266/living-the-high-life-training-in-ethiopia.aspx

[3] http://racingnews.runnersworld.com/2010/07/a-brief-chat-with-dathan-ritzenhein-and-alberto-salazar.html

[4] Heiderscheit, BC.; Chumanov, ES.; Michalski, MP.; Wille, CM.; Ryan, MB (2010) Effects of Step Rate Manipulation on Joint Mechanics during Running. Medicine & Science in Sports & Exercise: doi: 10.1249/MSS.0b013e3181ebedf4; Jun 23. [Epub ahead of print]

[5] Arendse RE Noakes TD, Azevedo LB, Romanov N, Schwellnus MP, Fletcher G.  (2004) Reduced Eccentric Loading of the Knee with the Pose Running Method. Medicine & Science in Sports & Exercise: Vol 36 pp 272-277