Forget The Pain, Running Injuries Can Be Depressing!!

Earlier this year I treated a patient who ran the Houston Marathon and jumped right into training for the upcoming triathlon season the following week, against my advice, while nursing a painful case of posterior tibial tendon tendonitits. Unfortunately this approach eventually sidelined him and forced him to scrap the entire triathlon season in order to undergo surgery and recover from his injury. This eventually led to a major case of depression which far outlasted his recovery from injury and almost kept him out indefinitely.

By nature, athletes have an extremely high tolerance for pain and at times tend to view their injuries as a normal part of their training regimen often to the point of ignoring serious symptoms. Posterior tibial tendonitis is a common injury in runners usually resulting from chronic overpronation and overuse caused by the repetitive force and trauma asociated with overtraining. Symptoms usually begin as soreness along the inside of the ankle and/or arch when pushing off and can eventually lead to weakness and severe pain. Left untreated, it can progress to a tear which usually requires lengthy immobilization or surgical intervention causing a major delay in any training regimen. However, if the injury is caught early and treated aggressively, it can be done without any interruption or possibly a slight, brief alteration in the training schedule while avoiding a lengthy delay which can spoil any runner's plans.

In this particular case, my patient underwent approximately 8 weeks of physical therapy, anti inflammatories and forced rest. During this time he became discouraged, angry and unmotivated, even though I recommended cross training to maintain at least some level of fitness so that his return to running would not be so traumatic. He resisted the entire time and even admitted to feeling "worthless" at one point. Once he was pain free, he was still afraid to resume running for fear he would reinjure his foot and it would sideine him again.

About 3 months after stopping running completely to rehabilitate from his injury, he began cycling, swimming and using the elliptical machine gradually. More recently, he resumed running starting at a much reduced distance than where he left off, and he is starting to regain confidence and a sense of self worth.

He now realizes what caused his depression and I have no doubt that he will return stronger than ever. More importantly, I think the lesson he learned and one that all athletes should learn, particularly runners, is not to ignore any injury. No matter how small or insignificant you may think the injury is, it can become significant if it is not addressed early and aggressively. The resulting depression from the mental trauma of having something so meaningful and enjoyable taken away can lead to an even more prolonged layoff from which you may never fully recover, long after the injury has healed.

Five Items Every Runner Should Have On Their Holiday Wish List

The holiday season is here yet again. With only a few weeks left before all the holiday madness begins it is time to start thinking about what to put on your holiday wish list for this year. If you are a runner or maybe just someone who will want to run off the extra holiday pounds below are 5 items that everyone will want to have on their list this year.

1) A new pair of running shoes - Let’s face it, running shoes tend to be one of those things many people push off replacing. Whether you are busy preparing for the holidays or if you are just really partial to one pair of running shoes, a new pair of shoes can really help to keep your feet and body injury free. Although experts vary on how often to replace a pair of shoes, a good standard to go by is to replace your shoes every 350 miles or six months, whichever comes sooner.

2) Moisture Wicking Socks - The best pair of shoes in the world won’t be nearly as beneficial without a good pair of moisture wicking socks. Although it may seem extreme to have to pay $5 for a pair of specialty socks when you can get a 5 pack of cotton socks for the same price, socks are one thing you don't want to skimp on. They help keep your feet and toes stay dry in order to prevent blisters from forming.

3) Nike Fit - I really have to hand it to Nike because the Nike Fit is an extremely helpful tool for runners of all skill levels. This device allows you to track your runs, pace, and states of each workout through a chip in your shoe that can later be downloaded on to your computer to monitor your runs. If Nike isn’t the right shoe for you, there are adapters you can purchase to use the technology with other brands of shoes.

4) Running Utility Belt - If you have ever run a long distance race then you have probably seen those people with the belts around their waist that have little pouches to held various items. This is a great item for people who are long distance runners. The belt is ideal to hold little bottles of water, gel food packs or even your keys or cell phone.

5) Road ID - Although this last item may seem a bit much it is one of those things that it is better to be safe than sorry. A Road ID is an identification bracelet that runners and cyclists wear in case of an emergency so they can be identified. Accidents happen every day between athletes and automobiles, Road ID is a simple way to protect yourself in case anything were to ever happen to you while you are out on a run.

With the holidays being right around the corner don't forget to add these 5 items to your wish list this year so that you can have the gear you need to run off all those extra holiday calories.
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The Nike Free Running Shoe

Nike has developed a line of shoes called the Nike Free that has become very popular among long distance runners, track and field athletes, and football and basketball players. Nike Free is unique because it has a special design incorporating new technology that simulates barefoot running mechanics while still wearing shoes. The goals that barefoot running technique strives to reach, and that Nike Free has adapted, is attempting to strengthen the intrinsic muscles of the foot and leg thus preventing long term injuries.

Although Nike Free has become popular among runners there are some important things to take into consideration when deciding to buy these shoes or not.

1) Versions - If you do a little research on the Nike Free you will come to find out that there are actually many different versions of this shoe. The Nike Free can be ordered on a scale of 10.0 to 3.0 with 10.0 being the most supportive shoe and the 3.0 being the least supportive and most similar to barefoot running.

2) Ease into the Shoes - If you have never done any barefoot running, or ran in any minimalist shoes that strive to achieve the same goal as Nike Free shoes, then it is important to ease your way into these shoes. It is recommended to start off running a mile in these shoes and then gradually increasing your distance based on your body’s response to the shoes.

3) They aren't for everyone - Although Nike is continuously trying to find ways to make small changes and adding versions to the Nike Free to allow the largest population of runners to use them, these shoes still aren't for everyone. If you don't run consistently, need extra-cushioned running shoes, or are prone to ankle sprains, I would not recommend these shoes to you. The Nike Free is really built for routine runners with no other major foot problems. Furthermore, barefoot-style running requires significant changes in running mechanics to be successful. If you run in these shoes just as you would in a structured running shoe, you will put yourself at risk for becoming injured.

Nike Free technology has really changed the face of running shoes, opening a whole new vision into what running shoes could do for your feet and body. Although these shoes are becoming increasingly more popular in the running community, these shoes simply aren't for everybody. Be sure to visit with your sports podiatrist who can help recommend the right shoe for you.

Should You Change The Way You Run For Greater Speed?

In one study quoted all over the internet, it was found that long-distance runners were faster if they used forefoot or midfoot strike patterns.  People were encouraged to speed up their running by changing the pattern of running.  Newer studies have made these findings less clear...

According to Joseph Hamill, PhD, a professor of kinesiology at the University of Massachusetts at Amherts, which found some mild differences to the running patterns.  They even found that midfoot running took slightly more energy than rearfoot running.  But even more importantly was the findings that midfoot or forefoot runners should not change their running patterns to rearfoot running, as it would not be as efficient.  It was recommended instead that you continue the natural pattern.  Let me explain:

- If you are a rearfoot runner or a midfoot or forefoot runner, you will get more benefit from adjusting your running efficiency by correction of your stride length and arm motion. 
- Correct shoegear to allow highest quality of running pattern will also increase efficiency. 
- I would agree with the findings of the study that it is "better to just do what's normal for you."

Run smart and run fast.  Just remember that you can do it the way your foot functions without learning a new way to run.

How Weather Conditions Affect Running Performance

If you are an outdoor runner you certainly have noticed that the weather can dictate how well you feel during your run. You may be surprised to learn that your performance during a run or race is directly related to the weather. The "perfect running temperature" has been scientifically debated to be somewhere around 50-54 degrees!! Most people begin to slow after 55 degrees and can really "hit the wall" if the temperature rises above 65 degrees while racing.

For people who live in chronically warmer states, such as we are in Houston, TX, it is essential to try and get your runs done in the early in the morning or later at night in order to avoid the heat of the day. However if you are stuck running in the hot weather, there are a couple of things to keep in mind. First, the hotter it is the more your body must work to cool you down by producing sweat. Sweating takes up energy, causing you to tire more quickly and lose fluids and electrolytes more rapidly, making it essential to replenish your fluid levels during and after runs. Increased heat also causes your feet to become moister in your shoes which can cause blisters. Make sure that on hot days you are wearing extra moisture-wicking socks to prevent your feet from blistering.

Besides the temperature, another weather factor that can impact your performance is rain. How rain impacts performance really depends on the amount of rain. If there is a light drizzle coming down on you while you run then the cooling effect of the moisture on your body can actually help enhance your performance. If the precipitation is more extreme, leading to conditions where you are getting totally drenched, then your performance is going to be hindered for a couple of reasons. First, your performance suffers during heavy rain because, whether consciously or not, you run more cautiously in order to prevent slipping on the wet surface that you are running on. Also, heavy rain can get your clothing so wet that you can develop blisters very quickly which can become painful. Some of the most common places to develop blisters from rain are on your feet, between your thighs, and around a woman's sports bra.

Although Mother Nature is not so kind as to provide 53 degrees cloudy running weather every day, there are some ways to make sure your run goes as smoothly as possible for the conditions that you face while running. The easiest way to make sure that the temperature does not negatively impact your performance is to plan ahead and anticipate any obstacles that the weather may provide.

How do I begin to train for my first marathon?

This is a question that comes often in our office, so here are a few things to keep in mind:

Running a marathon requires both physical and mental strength, focus, commitment, and time. If you do take this step and make the commitment, you will find that completing a marathon could be one of the most satisfying experiences of your life.

Getting Started:
*Training to run a marathon will test your physical limits and stretch the boundaries of your endurance. Before you hit the pavement and before you purchase equipment, you must first formulate a plan and educate yourself on all aspects of marathon training. It is similar to planning a trip. Once you find out where you want to go you have to figure out how to get there. Give yourself at least 6 months of training to get there.
*Set a date. Find out when the next marathon in your area will be by checking a marathon calendar or a marathon guide.
*Start running regularly. It will be extremely helpful to have your body used to running when you start a 16-week training program.
*If you haven't exercised in some time, allow yourself more time to train and try an 8-week conditioning program. Listen to your body. Your body might adjust quickly, or it might take a little longer to be ready for the marathon training program.

Invest in the proper running equipment:
*Running shoes are the most important purchase you will make on your quest to successfully train and participate in a marathon. You will be putting more miles on them per week than all of your other shoes combined. The right shoes will alleviate stress in your legs and back. Before you visit a running shoe store, check with your podiatrist to see what it is that YOU need in a running shoe. Is it stability, cushion, motion control, or would you be best off with a light weight trainer? Your podiatrist can help you with this by evaluating your foot type and your gait pattern.
*Having the right running clothes isn't as important as having the right shoes. However, you must know what type of clothes to avoid and what clothes can aid you while you train.

Preventing Injury:
*Once you begin your training program, injury prevention will be of utmost importance! Stretching, warm-ups, proper training, and nutrition will all come into play during your training in order to prevent running injuries.
*If you do experience pain in your feet or ankles while running, it is very important to visit your podiatrist right away to diagnose the problem and get proper treatment. Don't make the mistake that many people do when they think "it will go away eventually."

Training for a Half Marathon

Half marathons are a very popular length race to run. For those runners who are well trained, hard-core athletes the half marathon has its appeal because it can help train them for a full marathon. Many training schedules include a half marathon as one of its long runs in order to help get an athlete in prime condition for a marathon. In fact some marathons will even take half marathon times for qualification for a starting corral.

For other runners who are maybe just getting into running, very young or very old, or people who don't have as much time to train, a half marathon has an appeal for an entirely different reason. For the beginners a half marathon is seen as a reachable goal. Many new runners may be overwhelmed by how far a marathon is, but the option of running a half marathon seems to be a much more feasible, yet still respectable goal. For those people who fall into the category of being very young or very old, a half marathon is a popular option to prevent them from getting injured by attempting to run a full marathon.

Whether you are the well trained athlete, the beginner, or on either end of the age spectrum there are some things about training for and racing a half marathon that apply to all runners. First, always pick a training schedule that is right for your experience level. There are many free training programs out there that range from beginner to expert. It is important to use these schedules in order to know that you are not over working your body too quickly and making sure you get the right amount of rest that your body requires to replenish its essential chemicals. Second, it is important to always stretch before and after each run to help prevent injuries from occurring. Third, remember that the more that you run the more you must eat and drink to compensate for the extra calories and sweat you’re burning. Lastly, make sure you have a good pair of running shoes that give you the right stability and support you need to sustain the number of miles you will run throughout your training and race.

Half marathons are a great length because they allow people of all running abilities to participate. As long as the runner follows a training schedule, stretches, and takes care of their feet they will have a healthy and successful race.

Here Comes Summer...Runners Beware

As the Houston summer quickly approaches, so do those long summer days with the scorching hot sun and humid conditions. If you are a runner this means that you are going to have to prepare yourself to bear the heat if you want to keep up the pace during the summer months. One of the most important aspects of running, no matter what time of year it is, is staying hydrated. I can still remember my high school cross country coach telling the team that training doesn’t end when you leave practice but continues with everything you put in your body because this will affect your run tomorrow and the next day. He would say that you can tell if you are drinking enough water if you are urinating clear. Back in those years I thought this was a silly analogy to be teaching high school students but thinking back on it now it was actually a very clever way to tell if I was truly drinking enough fluids to keep up with the toll I was taking on my body with each run.

There are many other ways to make sure you stay fully hydrated during hot and humid runs. Many runners choose to wear camelbacks, because they are relatively lightweight and don’t require you to stop if you want a sip of water. There are also many fuel belts on the market that allow runner to wear a belt that holds containers for water or juices.

It is important to consider that sometimes water is not the best choice in hot circumstances because you are not merely losing water when you run but also essential electrolytes. Alternatives such as Gatorade, Vitamin Water, and PowerAid are great products that help to keep you hydrated and replenish your electrolytes.

When you run in the heat you also sweat more. Make sure you wear socks that are made out of a material that can wick the increased perspiration away from your feet. If you wear cheap cotton socks you will have a greater risk of developing blisters.

However you choose to help quench your thirst and dodge the heat while running in the summer months always keep in mind that you must be especially in tuned with your body during this time. Don’t push yourself to hard. If you start feeling heat cramps, dizziness, or lightheadedness coming on stop immediately and seek shade and water.

Join National Running Day on June 3, 2009

Running is one of the most popular means of exercise around. The reason is, it's easy and accessible! We have our feet, there's road outside our door...all you need to do is step outside. National Running Day is a national initiative whereby many of the major organizations within the running industry are joining forces in an unprecedented unified effort to nationally and locally promote running.

There will be cities around the country hosting organized runs for all ages and levels. Houston, TX is definitely a participant and the Chevron Houston Marathon is a sponsor. If you do not live in or near a participating city, that's no problem! Just go outside and run!

Don't run alone either!! Run with your husband or wife, boyfriend or girlfriend, fraternity or sorority. Run with your kids or run with your parents. Run with your dog (dog's love to run with you.) Run around your block, go to a park and run, or run on a high school track. It doesn't matter where...it doesn't matter with who...just get out and go!

For more information, visit http://www.runningday.org

Running Uphill Correctly

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). To help others avoid overuse injury while running hills, I will give my recommendations for hill running:

1. Run 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).

2. 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).

3. 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.

4. Break hills into reachable mental goals. A majority of hill running is mental (as is most running) and setting short goals helps keep you moving up the hill. 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 program, and can provide you with an edge when racing. Run smart and keep running...

Don't forget your stretches before you run!!!

As podiatrists, we treat all types of foot and ankle injuries, but we also want to PREVENT foot and ankle injuries...so we encourage our patients (and friends and family) to always remember to do their stretching before running and exercising.

We practice what we preach!!! Although we all have different styles of exercising and running, we all do our stretches first. Feel free to ask us questions about your stretches and techniques. We're here to help you!

Here are some simple stretches that you can try:

HEEL CORD STRETCHES #1 (Gastrocnemius Wall Stretch)

1. Lean against a wall with one knee locked and the other bent. You will feel a pull in your calf muscles.

2. Hold the stretch for 15 seconds & alternate the locking and bent knees.

3. Relax for 15 seconds & do 10 REPS.

4. Repeat this exercise 2-3 times a day.

HEEL CORD STRETCHES #2 (Soleus Wall Stretch)

1. Position is silimar to Gastrocnemius stretch but with both legs bent and the buttocks dropped. Make sure you are facing straight and not turned out.

2. Gently lean into the wall and keep your heels on the floor while bending both knees, putting a little more weight on the back leg.

3. Continue until you feel stretching in your lower calf.

4. Hold the stretch for 30 seconds.

5. Repeat 2-3 times on each side.

HEEL CORD STRETCHES #3 (Gastrocnemius Stair Stretch)

1. Stand with the ball of the foot on the edge of a stair and heels off of the step.

2. Rise as high as possible on the toes and then lower yourself slowly as far as you can without rolling the foot inward or outward until you feel a stretch in the calf.

3. Hold this position for 1-2 seconds.

4. Repeat 10-20 times.

PLANTAR FASCIAL STRETCHES

1. Raise toes toward you while bending your ankle as high as you can.

2. Hold this position for 15 seconds.

3. Alternate doing this with the opposite foot 10 times.

4. Perform this exercise 2- 3 times a day.

HAMSTRING STRETCHES

1. Lie with your back flat to the floor with your eyes focused upward.

2. Grasp the back of the thigh with both hands and, with the leg bent, pull the thigh until it is perpendicular to the floor.

3. Slowly straighten the knee.

4. Repeat the exercise with the other leg.

My 4 Keys To Marathon Recovery

After my recent marathon, I had near complete resolution of my muscle pain and weakness after just 48 hours. Since many runners are seaking keys to quicker recovery, I felt it was benefitial to list my current recovery regimen.

1. Cool Down
As recommended in research, 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. If the cool down is done effectively, it will alleviate some of the after marathon recovery.

2. Refuel
Since exercise related pain is due to lactic acid or protein (muscle) breakdown, refueling is a key.
In a study by the University of Illinois on rats in 1999, quicker recovery was found from refuelling quickly after exercise with Leucine (an amino acid) containing products. Leucine is found in protein products such as meats and dairy products, as well as in protein bars and some sports drinks. 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. (For addition information on this research, visit my original post.)

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?
Although 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 science behind 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.

These four steps or keys find me nearly painfree 48 hours following a strenuous 26.2 miles. 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.

For additional information on my running: http://www.utahrundoc.blogspot.com/

Treadmill Running...Just Slow Down!!

I was reviewing the post about Madonna falling off of her treadmill and started thinking of the multitude of injuries I see due to the perceived safety of a treadmill. True, the surface of a treadmill does absorb shock, but there is a major natural pitfall with using a treadmill.

When you run - for real, with real forward progression - you are in control. As you tire, what happens? You slow down, of course! Not so on a treadmill. We typically set a speed and stick with it the whole way, for better or for worse. Some can maintain that steady pace, but most can not. As we tire, we'll naturally shift the upper body forward and the running gait will be more unnatural. What will happen? The anterior muscle group of the lower extremity (the front of the leg) will be overworked, as will the Achilles tendon. Then comes the pain...shin splints most commonly along with Achilles pain.

So what do you do to stop it? Well, just slow down! Not by a lot...every so often, maybe after the first third of the run or walk, lower the speed by 0.2 mph. This will allow for the natural fatigue of your baby.

If you wait too long and start to feel some discomfort, drop the speed even more, by as much as 0.5 mph to even a full mph. Then, depending how you feel, slowly increase your speed. If the pain persists, be sure to visit your podiatrist sooner than later.

A treadmill is not meant to be a passive experience. Be sure to listen to your body and make appropriate adjustments along the way.

It's Just a Step To The Left...

No, this isn't doing the "Time Warp!" I'm more interested in my runners who come in complaining about foot, ankle, shin, knee, or hip pain ON ONE SIDE. Here in Houston, TX we have major drainage issues, so all of our streets are banked.

So when runners come into my office, they have done online searches and have a million reasons why they are hurting. They have bought all sorts of supports and liniments to make them feel better...but they don't seem to work. They come in complaining of their IT band hurting, or some shin splint pain on one side and expect me to run a whole barrage of tests to tell them in a high-tech way why they hurt and how to solve it. Then, after I listen to them, I ask the most important question:

What surface are you running on?

Invariably I'll hear an answer that they're running on the side of the road, or another similar uneven surface. I watch as they brace to hear a lecture on how "asphalt is a terrible surface" or "never run on concrete." Instead I ask my next question:

Where on the road do you run?

This is a loaded question...I know pretty well that they're not running in the middle of the road (if they were, there would be bigger problems than limb pain). They're, of course, running harmlessly on the side of the road. A-ha!!

When someone runs on the side of a banked surface, like the local Houston roads, they are essentially creating a leg length difference. This will cause the two feet to function very differently. One limb is going to compensate by attempting to lengthen and the other is going to shorten. A significant imbalance will result and can cause a variety of pains. My great wisdom for these runners?

Take a step to the left...

That's all? That's what they came in for? Well...yes. Sometimes a simple change makes a huge difference. By running on a more even surface, it allows for a more stable and even base and doesn't overwhelm the mechanics. My advice is to not take time off. Nurse the injury with ice and some anti-inflammatory medication, and be more aware of where they're running. I ask them to call me in a week to tell me how they're doing.

The results are amazing! A small adjustment like this causes the lower extremity to even up and makes a huge impact on the biomechanics. The pain gradually improves with essentially no time away from training!

Cramps Slowing Down Your Run?

Tim just completed the White Rock Marathon in Dallas this weekend. Weather was warm and extremely windy, but he was feeling good and managing to keep his pace through the half way mark. The race was going perfect and pacing was exactly as planned all the way until about mile 18. As he passed the 18 mile marker, he started feeling small cramps in his calves. He tried to slow down a bit to make them go away, but by mile 19 they hit so hard if felt like a ball bearing digging into his calf muscle and the pain literally brought him to the ground in the middle of an intersection. (Much to the traffic cop’s surprise) He had to stop, stretch and hobble along until they stopped. He had to walk for awhile, until they went away and then slowly started to run the last few miles. The cramps did not disappear and he had to stop again and stretch once or twice every mile. So much for his time goal!!

Question is, why do cramps happen and how can you prevent them? They have never occurred during his extensive training, so why in the middle of a race?

Muscle cramping usually occurs due to a depletion of ‘The Big 4′: sodium, potassium, magnesium, and calcium. Also, if an athlete is dehydrated, even slightly, going into a race, muscle cramps can be common (no matter how spot-on race day hydration is). Cramping can occur due to the depletion of one or a combination of these four minerals. One area that I would first examine is your everyday fueling. I realize that conventional thinking says that if an athlete cramps up during a race, then it must have been something nutritionally that went awry during the race. This may be the case, but actually the answer usually lies in one’s everyday nutrition and hydration.

The first thing I would suggest is to monitor your hydration levels before and after training (especially long training days). This can easily be done with a body fat scale that also measures body water percentage. Take this reading each night before bed for 7 days straight so you can determine an average body water percentage; then, after training sessions, re-measure your water percentage. You will probably notice a reduction in your water percentage, as this is normal. Your goal now is to refuel and rehydrate in order to get this water percentage back to its ‘normal’ level. Another easy way to monitor your hydration level is to pay close attention to your urine color. The goal is to keep your urine color in a range from clear to a very light yellow. If one’s urine color is a darker yellow, this can be a sign of dehydration (be aware, that if you take a multiple vitamin, the B-vitamins will turn your urine color yellow, and this is normal; not a sign of dehydration). Following a long training run or race…get your urine clear and keep it clear throughout the day, as this will ensure proper hydration.

In regards to the Big 4, try to consume a fluid replacement drink that contains all four of these minerals, and be sure to consume this fluid replacement drink during training and racing. Also, be sure to use your “sodium capsule” of choice during training, and not just on race day (you may already be doing this). If you find yourself avoiding sodium in your daily nutrition, try to lightly salt your foods with sea salt. Also, drinking vegetable juice is a great source of sodium and potassium (be sure to check with your physician that there are no blood pressure issues that would contraindicate the use of additional sodium).

So, in summary, my advice to Tim would make everyday hydration and fueling your focus as this will get you to the start line in a state of optimal hydration. This should help avert any nasty cramps in your next race!