2011 Summary
1) Malakoff Penang, 26km, Mar 27, 3:08.41@7.23"/km (2010 3:32)
2) Energizer Night Race (ENR), 21km (actual : 19.82km), Apr 16, 2:21.35@7.09"/min (2010 2:52)
3) Larian Hari Keputeraan Sultan Azlan Shah (LHKSAS), 14km (14.65km), May 22, 1:32:32@6:18"/km, #215/464 (Men's Open), Overall #367
4) SPCA Charity Run, 10km (9.34km), May 29, 53:34@5:51"/km
5) SCKLM, 21km (21.46km), Jun 27, 2:18:31@6:45"/km
6) SAFRA Bay Run, 10km (10.3km), Sep 4, 54:38@5:19"/km, #351/3488 (overall field), #8th Malaysian runner, #46/528 (Mens Master)
7) Tourism Taiping Heritage Run (TTHR), 21km (21.04km), Sep 11, 1:58:25@5:38"/km, #54 for Men's Junior Veteran
8) Adidas King of The Road (KOTR), 16.8km (16.71km), Oct 2, 1:37:30@5:50"/km, #428
9) KWYP City Run, 10km (8.09km) , Oct 16, 41:06@5:05"/km
10) PJ Half Marathon, 21km (20.76km), Oct 30, 2:13:31@6:26"/km, #175 / 337 Men's Veteran
11) Rock to Rock Run, 3.8k (4km), Nov 13, 18:43@4:41"/km
12) Penang Bridge International Marathon (PBIM), 42km (43km), Nov 20, 4:58:22@6:56"/km, 242/1190
13) Standard Chartered Marathon Singapore (SCMS), 21km (21.17km), Dec 4, 2:10:52@6:11"/km,
#929, top6% of the field
2012 Look Ahead
Not many races planned in 2012 as it's still early and i am trying to limit to the number of races but focus on quality (=better timing) and also to better optimize my weekend trips.. 2012 will be a crucial year for my gal, so will imit the travels..
What I have so far..
1) Jan 8th - Multi Purpose Insurance Run 2012 (MPIR) 12km - Padang Merbok (registered)
2) Mar ? - Malakoff Penang 26km
3) May 26th - Sundown Marathon 42km (registered)
4) Jun 24th - SCKLM Marathon 42km
No plans for Bali Marathon in April, Phuket Marathon in June though I would have loved to go to SCBM on 12 Feb 2012 !
Sunday, December 18, 2011
Monday, December 12, 2011
US races !? Fancy them ?? :-)
Stepping into 2012, 2nd half poses an unknown as my assignment may come up and I might be doing my 'tour-of-duty' at the States for the technology transfer ! So I am trying to squeeze in as many races as possible in the first half and we shall see..
If I do really end up in the States in 2nd half, I will surely miss my PBIM 2012, and SCM 2012.. But what the heck ! I am now looking forward to some breath-taking races in US, God's willing, if time permits !!
High in the priority list (based on $ and time affordability also lah sicne I can't be taking time off from my work that much...)
1) Chicago Marathon - Oct 10, 2012
2) California International Marathon (Sacramento) - Dec 2, 2012
3) Tucson Marathon (Tuscon) - Dec 9, 2012
4) Arizona Rock and Roll series - Jan 2013
5) Sedona Marathon - Feb 2013
6) Phoenix Marathon - Mar 2013
and the list goes on and on...
Who says I will miss the races in this part of the world.. LOL !
http://www.runnersworld.com/cda/racelocation/1,7912,s6-239-283-284-0-0-0-0-AZ,00.html
If I do really end up in the States in 2nd half, I will surely miss my PBIM 2012, and SCM 2012.. But what the heck ! I am now looking forward to some breath-taking races in US, God's willing, if time permits !!
High in the priority list (based on $ and time affordability also lah sicne I can't be taking time off from my work that much...)
1) Chicago Marathon - Oct 10, 2012
2) California International Marathon (Sacramento) - Dec 2, 2012
3) Tucson Marathon (Tuscon) - Dec 9, 2012
4) Arizona Rock and Roll series - Jan 2013
5) Sedona Marathon - Feb 2013
6) Phoenix Marathon - Mar 2013
and the list goes on and on...
Who says I will miss the races in this part of the world.. LOL !
http://www.runnersworld.com/cda/racelocation/1,7912,s6-239-283-284-0-0-0-0-AZ,00.html
Friday, December 9, 2011
Plantar Fasciitis - repost from Mok Ying Ren's facebook post
Treatment Plan for Plantar Fasciitis
by Mok Ying Ren on Wednesday, December 7, 2011 at 10:41pm.What is it?
Plantar fasciitis is the inflammation of the plantar fascia. If you wake up in the morning and your first step towards the bathroom hurts, you are likely suffering from this condition. Inflammation suggests the migrating of inflammatory cells towards the area, however, some doctors insist that it is not inflammation as if a biopsy was done, no inflammatory cells can be found. But that doesn't really matter because the pain you feel is an inflammatory type of pain - a pain that gets worse after prolonged rest (such as sleep) and gets better after some walking (or even running).
As seen from the picture (photo 1), the pain is felt near the attachment of the fascia to the heel bone on the inner side of your foot.
Treatment
Treatment can be divided into conservative or surgical. However, surgery is usually not necessary. Thus, lets focus on what you can do for yourself at home.
1. Night Splint (Photo 2)
The night splint is a good device however compliance can be as low as 10% for patients who are prescribed this device. I also sometimes get woken up by it in the middle of the night and remove it. Our plantar fascia is usually lax when we sleep as our foot normally goes into a plantar-flexed position as the foot droops down towards the bed. This means that when we wake up and take our first step, the fascia is stretched, causing pain at the attachment. The night splint works by keeping your foot in a dorsiflexed position through the night and almost eliminates the pain on your first step in the morning. Once again, compliance can be a problem for you.
2. Golf Ball (Photo 3)
If you do not play golf, go run around a golf course and get one or two. The golf ball is used to massage the entire sole of your foot. Put it on the floor while at your desk and roll it around. I once thought that it is good to massage the area that hurts as it does feel better after that. However, Dr Benedict Tan from Singapore Sports Medicine Center told me that by doing that, it is equivalent to rubbing an open wound. You wouldn't rub an open skin wound would you? Similarly, you do not want to aggravate the painful area. Thus, massage everywhere except the painful spot. Have a golf ball with you all the time - at work, at home and infront of the TV.
3. Stretch your calves
The calves are attached to the same heel bone as your plantar fascia. Imagine the heel as the fulcrum. As your calves get tight, it pulls on the heel which in turns pulls on the plantar fascia. Stretch daily and as often as possible. Note that there are 2 calves muscles and you need to stretch both. Stand facing the wall and stretch first with your knee straight (Photo 5) and then with your knees bent (photo 4). You should feel a different sensation each time.
4. Non steroidals Anti Inflammatory Drugs (NSAIDs)
These are different from painkillers like padanol that works on your nerves and "bluffs" your body to thinking there is no inflammation. NSAIDs work directly at the area of inflammation and reducing the reaction there, directly leading to less pain. However, these drugs have their fair share of side effects and you will need to consult a doctor to see if you are suitable for it.
5. Cross Train
At the moment, run less. Cut your mileage and cut your intensity. Running is the ultimate weight bearing sport and it is difficult to find a sport that allows you to bring your heart rate as high as running. Thus, stick to non impact sports like swimming, cycling and water running while your heel recovers. Do as much as you can to retain your fitness especially if you have an important race coming up.
6. Extracorporeal Shock Wave Therapy (Photo 6)
This is a treatment that was once invented to treat kidney stones (now still). It is now approved to treat injuries like plantar fasciitis. By using a shock wave to hit the area, it stimulates recovery and new tissue growth. Institutions like Changi Sports Medicine Centre, Singapore Sports Medicine Centre offer these treatment. I went through 2 cycles with Dr Cormac at the Singapore Sports Institute and found it rather effective. However, response can differ from patient to patient.
7. Insoles
Orthotics can help you with PF especially if you have underlying biomechanical issues such as over pronation. Research has shown that the effectiveness of off-the-shelf insoles are as effective as custom made ones. See a podiatrist to get one and see if it helps. I have gotten a pair from the Singapore Sports Institute and I find that it does help. However, during my runs, I wear off-the-shelf insoles which are usually softer and more comfortable for the heel.
8. Taping
Low-Dye taping (Photo 7) is a technique i tried. It is a well documented taping technique which was invented by Dr Ralph Dye to off load the plantar fascia. Check out this video: http://www.youtube.com/watch?v=V_SEfgm6uZU. I find that it does not seem to work well for me. Thus, I abandoned the taping after a few days. It is also very messy as you can see it requires lots of tape. You can get the tape from Watson's, called leukoplast. (Photo 8). Try it - it may work for you.
9. Footwear
Now you need to think if your office shoes is suitable for your feet. For me, I prefer to wear crocs which has a very soft sole and thus very cushioning for the point that hurts. It is also wise to wear a shoe with good support in your home to ensure your feet gets the necessary support. You may choose to buy off the shelf heel cups to add cushion to the heel area to provide it some comfort. I personally use the Dr Scholl heel cushion (Photo 9) from Watsons as it not only cushions the heel but also provides a certain extent of arch support.
Summary
These are techniques that I used to cope with my injury in the past 3 months and allowed me to complete a marathon safely. I hope that these techniques can help you too. However, in some situations, the injury make take months to recover. But most importantly. you MUST not give up and PERSIST in doing the above. I wish you all the best and hope you can get back onto the roads.
Disclaimer: This is a compilation of my knowledge as a medical student and my experience as a runner. Please use this only as a guide. If pain persists, please consult your doctor to get a proper diagnosis and treatment.
Photo 1
Photo 2
Photo 3
Photo 4
Photo 5
Photo 6
Photo 7
Photo 8
Photo 9
by Mok Ying Ren on Wednesday, December 7, 2011 at 10:41pm.What is it?
Plantar fasciitis is the inflammation of the plantar fascia. If you wake up in the morning and your first step towards the bathroom hurts, you are likely suffering from this condition. Inflammation suggests the migrating of inflammatory cells towards the area, however, some doctors insist that it is not inflammation as if a biopsy was done, no inflammatory cells can be found. But that doesn't really matter because the pain you feel is an inflammatory type of pain - a pain that gets worse after prolonged rest (such as sleep) and gets better after some walking (or even running).
As seen from the picture (photo 1), the pain is felt near the attachment of the fascia to the heel bone on the inner side of your foot.
Treatment
Treatment can be divided into conservative or surgical. However, surgery is usually not necessary. Thus, lets focus on what you can do for yourself at home.
1. Night Splint (Photo 2)
The night splint is a good device however compliance can be as low as 10% for patients who are prescribed this device. I also sometimes get woken up by it in the middle of the night and remove it. Our plantar fascia is usually lax when we sleep as our foot normally goes into a plantar-flexed position as the foot droops down towards the bed. This means that when we wake up and take our first step, the fascia is stretched, causing pain at the attachment. The night splint works by keeping your foot in a dorsiflexed position through the night and almost eliminates the pain on your first step in the morning. Once again, compliance can be a problem for you.
2. Golf Ball (Photo 3)
If you do not play golf, go run around a golf course and get one or two. The golf ball is used to massage the entire sole of your foot. Put it on the floor while at your desk and roll it around. I once thought that it is good to massage the area that hurts as it does feel better after that. However, Dr Benedict Tan from Singapore Sports Medicine Center told me that by doing that, it is equivalent to rubbing an open wound. You wouldn't rub an open skin wound would you? Similarly, you do not want to aggravate the painful area. Thus, massage everywhere except the painful spot. Have a golf ball with you all the time - at work, at home and infront of the TV.
3. Stretch your calves
The calves are attached to the same heel bone as your plantar fascia. Imagine the heel as the fulcrum. As your calves get tight, it pulls on the heel which in turns pulls on the plantar fascia. Stretch daily and as often as possible. Note that there are 2 calves muscles and you need to stretch both. Stand facing the wall and stretch first with your knee straight (Photo 5) and then with your knees bent (photo 4). You should feel a different sensation each time.
4. Non steroidals Anti Inflammatory Drugs (NSAIDs)
These are different from painkillers like padanol that works on your nerves and "bluffs" your body to thinking there is no inflammation. NSAIDs work directly at the area of inflammation and reducing the reaction there, directly leading to less pain. However, these drugs have their fair share of side effects and you will need to consult a doctor to see if you are suitable for it.
5. Cross Train
At the moment, run less. Cut your mileage and cut your intensity. Running is the ultimate weight bearing sport and it is difficult to find a sport that allows you to bring your heart rate as high as running. Thus, stick to non impact sports like swimming, cycling and water running while your heel recovers. Do as much as you can to retain your fitness especially if you have an important race coming up.
6. Extracorporeal Shock Wave Therapy (Photo 6)
This is a treatment that was once invented to treat kidney stones (now still). It is now approved to treat injuries like plantar fasciitis. By using a shock wave to hit the area, it stimulates recovery and new tissue growth. Institutions like Changi Sports Medicine Centre, Singapore Sports Medicine Centre offer these treatment. I went through 2 cycles with Dr Cormac at the Singapore Sports Institute and found it rather effective. However, response can differ from patient to patient.
7. Insoles
Orthotics can help you with PF especially if you have underlying biomechanical issues such as over pronation. Research has shown that the effectiveness of off-the-shelf insoles are as effective as custom made ones. See a podiatrist to get one and see if it helps. I have gotten a pair from the Singapore Sports Institute and I find that it does help. However, during my runs, I wear off-the-shelf insoles which are usually softer and more comfortable for the heel.
8. Taping
Low-Dye taping (Photo 7) is a technique i tried. It is a well documented taping technique which was invented by Dr Ralph Dye to off load the plantar fascia. Check out this video: http://www.youtube.com/watch?v=V_SEfgm6uZU. I find that it does not seem to work well for me. Thus, I abandoned the taping after a few days. It is also very messy as you can see it requires lots of tape. You can get the tape from Watson's, called leukoplast. (Photo 8). Try it - it may work for you.
9. Footwear
Now you need to think if your office shoes is suitable for your feet. For me, I prefer to wear crocs which has a very soft sole and thus very cushioning for the point that hurts. It is also wise to wear a shoe with good support in your home to ensure your feet gets the necessary support. You may choose to buy off the shelf heel cups to add cushion to the heel area to provide it some comfort. I personally use the Dr Scholl heel cushion (Photo 9) from Watsons as it not only cushions the heel but also provides a certain extent of arch support.
Summary
These are techniques that I used to cope with my injury in the past 3 months and allowed me to complete a marathon safely. I hope that these techniques can help you too. However, in some situations, the injury make take months to recover. But most importantly. you MUST not give up and PERSIST in doing the above. I wish you all the best and hope you can get back onto the roads.
Disclaimer: This is a compilation of my knowledge as a medical student and my experience as a runner. Please use this only as a guide. If pain persists, please consult your doctor to get a proper diagnosis and treatment.
Photo 1
Photo 2
Photo 3
Photo 4
Photo 5
Photo 6
Photo 7
Photo 8
Photo 9Running Doc's steps to avoid sudden collapse - repost from NYDaily News
Running Doc's steps to avoid sudden collapse
Tuesday, November 01, 2011
Dr. Maharam: I have noticed that most half-marathon and marathon deaths seem to be happening before the finish. I understand there is discussion about research on this but do you have any thoughts as to why runners are collapsing at this specific spot? - LeeAnn, Wheeling, W. V.
LeeAnn: I am so glad you asked. We at the International Marathon Medical Directors Association have been discussing this. Given the recent death at the LA Rock n Roll Half Marathon last weekend, I now get a chance to explain what medical directors are doing. The race course is really the safest place to be on a race day unless you are standing in the middle of an Emergency Room. We are all stationing paramedic units at that very spot - what we call the "X-Spot" where runners first see the finish line and know they are going to finish.
The prevailing theory about sudden death (fatal cardiac arrhythmia) in healthy patients in an endurance event, as we have discussed here before, is that either a caffeine load of more than 200 mg has caused enough decreased blood flow to disrupt an ischemic area’s electrical rhythm, or the release of muscle byproducts has caused a small plaque to activate platelets and a small clot to form in a coronary artery. Either of these things can cause a fatal arrhythmia. Limiting caffeine and taking a baby aspirin should help eliminate these possibilities.
The X-spot is where a runner knows he (or she) is going to finish the race, or where he can see the finish line and push to a hard sprint finish. This adrenaline rush, we think, might push the electrical system of the heart to an arrhythmia if the muscle is ischemic by one of the two mechanisms described above or if the participant has underlying heart disease. Not pushing yourself that last mile and taking it as you have the last few miles might make participating safer. So would encouraging announcers not to goad runners by saying things like, "If you can hear my voice you can break 4 hours!"
I am looking forward to our next IMMDA meeting when our group will be outlining a worldwide study on sudden death in our sport. As of now we only have some small evidence from a few studies and a lot of anecdotal evidence and theory. Our study should put more science into our recommendation.
In the meantime, as I've said repeatedly, we continue to advise the following on race day:
1. Take a baby aspirin (81mg) the morning of the event.
2. Limit caffeine that morning to less than 200 mg.
3. Take the last mile like the previous without a fast sprint.
These recommendations make sense to me and my fellow marathon medical directors. When our patients ask us, "How can I prevent becoming the next one?" our advice - right after urging them to get a comprehensive physical - consists of the three steps listed above. I hope you follow this advice, in conjunction with your physician, as well.
***
Lewis G. Maharam, better known as Running Doc™, is the author of the Running Doc's Guide to Healthy Running. He is the medical director of the Rock 'n' Roll Marathon series and the Leukemia & Lymphoma Society's Team in Training program. He is past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
http://articles.nydailynews.com/2011-11-01/news/30347967_1_lewis-g-maharam-sudden-death-caffeine
Tuesday, November 01, 2011
Dr. Maharam: I have noticed that most half-marathon and marathon deaths seem to be happening before the finish. I understand there is discussion about research on this but do you have any thoughts as to why runners are collapsing at this specific spot? - LeeAnn, Wheeling, W. V.
LeeAnn: I am so glad you asked. We at the International Marathon Medical Directors Association have been discussing this. Given the recent death at the LA Rock n Roll Half Marathon last weekend, I now get a chance to explain what medical directors are doing. The race course is really the safest place to be on a race day unless you are standing in the middle of an Emergency Room. We are all stationing paramedic units at that very spot - what we call the "X-Spot" where runners first see the finish line and know they are going to finish.
The prevailing theory about sudden death (fatal cardiac arrhythmia) in healthy patients in an endurance event, as we have discussed here before, is that either a caffeine load of more than 200 mg has caused enough decreased blood flow to disrupt an ischemic area’s electrical rhythm, or the release of muscle byproducts has caused a small plaque to activate platelets and a small clot to form in a coronary artery. Either of these things can cause a fatal arrhythmia. Limiting caffeine and taking a baby aspirin should help eliminate these possibilities.
The X-spot is where a runner knows he (or she) is going to finish the race, or where he can see the finish line and push to a hard sprint finish. This adrenaline rush, we think, might push the electrical system of the heart to an arrhythmia if the muscle is ischemic by one of the two mechanisms described above or if the participant has underlying heart disease. Not pushing yourself that last mile and taking it as you have the last few miles might make participating safer. So would encouraging announcers not to goad runners by saying things like, "If you can hear my voice you can break 4 hours!"
I am looking forward to our next IMMDA meeting when our group will be outlining a worldwide study on sudden death in our sport. As of now we only have some small evidence from a few studies and a lot of anecdotal evidence and theory. Our study should put more science into our recommendation.
In the meantime, as I've said repeatedly, we continue to advise the following on race day:
1. Take a baby aspirin (81mg) the morning of the event.
2. Limit caffeine that morning to less than 200 mg.
3. Take the last mile like the previous without a fast sprint.
These recommendations make sense to me and my fellow marathon medical directors. When our patients ask us, "How can I prevent becoming the next one?" our advice - right after urging them to get a comprehensive physical - consists of the three steps listed above. I hope you follow this advice, in conjunction with your physician, as well.
***
Lewis G. Maharam, better known as Running Doc™, is the author of the Running Doc's Guide to Healthy Running. He is the medical director of the Rock 'n' Roll Marathon series and the Leukemia & Lymphoma Society's Team in Training program. He is past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
http://articles.nydailynews.com/2011-11-01/news/30347967_1_lewis-g-maharam-sudden-death-caffeine
Philly Marathon deaths raise questions - repost from NY Daily News
Philly Marathon deaths raise questions
DR LEWIS MAHARAM
Monday, November 21, 2011
Dear Running Doc:
Given the two deaths at the Philadelphia marathon this past weekend, please fill me in why young people can have heart attacks. Im really worried I'll be the next one. What can I do? Stephen L. Great Neck, NYC.
Thanks for writing, Stephen. Whenever a runner goes down, we get this same question. My office telephone has been ringing off the hook and I've been getting tons of letters in the wake of the tragedy in Philadelphia in which two runners went down: Their identities haven't been released yet, but a police spokesman said one was a 21-year-old Asian male and the other was a 40-year-old white male.
As I said in my first column for the Daily News, asking the the right questions is the first step in understanding any issue:
What is “sudden cardiac death” and what is its incidence?
Physicians define “sudden death” in young athletes (women as well as men, ages 35 and younger) as a nontraumatic, nonviolent, unexpected death due to cardiac causes within one hour of the onset of symptoms.
One study estimated that the incidence of sudden cardiac death in unscreened men during exercise is 1 in 280,000 per year. In studies of the risk of death in marathons, it's been estimated that one death would occur in 50,000-88,000 marathon finishers.
In a study I published with Dr. Steve Van Camp in 2004, we found that the risk in distances between 10-K and half-marathon was significantly lower: 3.1 deaths per million finishers. There have also been reports of one sudden cardiac death per 4,000-26,000 in active men; 56X greater risk during exercise in sedentary men and only 5X greater risk during exercise in active men.
What is an enlarged heart?
Exercise causes normal blood flow and electrical changes seen on an EKG. During intense aerobic exercise, the oxygen consumption of muscle tissue increases and cardiac output must rise to meet the demands. Over time, aerobic training results in increased left ventricular mass, decreased resting heart rate, increased ventricular stroke volume, and increased cardiac output, among other effects. This is called an “Athlete’s Heart” — it is normal and nothing to worry about.
But there are enlarged heart conditions that can lead to sudden death. Although more than 20 pathologic entities have been identified as causes of sudden death in young athletes, a few lesions are responsible for most of these deaths that are reported:
Hyperpertrophic Cardiomyopathy
Although rare in the general population (0.1% to 0.2% prevalence), this is the most common cause of sudden cardiac death in young athletes It is inherited and 60% of individuals with this have an affected first-degree relative. On autopsy, patients with hypertrophic hearts are found to have a larger-than-normal heart with a distinctively enlarged left ventricle. Hypertrophy of the ventricular septum is often disproportionate to that of the left ventricular free wall, an asymmetry not seen in the “athlete's heart.” In addition to the increased size, the asymmetric thickening of the septum may act as an obstruction to the flow of blood into the aorta during pumping. Microscopic changes include abnormalities of the small arteries and "myocardial disarray," a bizarre arrangement of muscle cells with diffuse interstitial fibrosis.
The hallmark physical examination finding is a murmur that decreases in intensity with the athlete lying down. This contrasts with functional outflow murmurs common in athletes, which increase in intensity with lying down. Approximately 90% of patients with hypertrophic hearts have abnormal EKG results. In many, but not all, cases, this can be diagnosed by echocardiographic findings.
Despite the above information, individuals may present with sudden cardiac death as their first and only symptom of a hypertrophic heart.
Coronary Artery Abnormalities
A variety of inherited coronary artery abnormalities combine to represent the second leading cause of sudden death in young athletes. Only about one third of affected individuals are thought to be symptomatic (experiencing angina, syncope, or shortness of breath with exercise) before sudden death. The mechanism of sudden death in all cases here is thought to be an arrhythmia (abnormal heart rhythm) triggered by heart tissue ischemia or infarction (heart attack). Some cases may be suspected on echocardiography, but a definitive diagnosis is made by coronary angiography, computed tomography, or magnetic resonance imaging.
Myocarditis Acute
myocarditis is an inflammatory condition of infectious origin. Coxsackie B virus causes more than 50% of all cases, but a variety of causes have been implicated. Symptoms are often overshadowed or preceded by symptoms of viral illness such as vomiting, fever, nausea, diarrhea, and muscle aches. However, many individuals are asymptomatic, and again sudden death may be the only presenting sign. The infected myocardium becomes inflamed, creating an unstable site where a potentially terminal arrhythmia may arise. In other cases, involvement of the conduction system may lead to a fatal heart rhythm as well.
Marfan Syndrome
Marfan syndrome is an inherited connective tissue disorder occurring in about 1 in 10,000 people. Affected individuals are at increased risk for sudden death as the result of progressive dilatation of the aortic root, ending in complete dissection or bleeding internally.
The diagnosis of Marfan syndrome is based on a good physical exam (although genetic testing may be appropriate in families with several affected members). Clinical features include tall stature, long and thin limbs, an arm span substantially greater than height, diminished upper body-to-lower body ratio, and a long, thin face.
Electrophysiologic Abnormalities
Abnormalities of the conduction system may lead to fatal cardiac arrhythmias. Their incidence is likely underreported since autopsy findings may be inconclusive. Approximately 60% of patients present with symptoms related to physical activity or strong emotional response, primarily fainting, seizures, or heart palpitations. One third of previously "healthy" young adults present with sudden death. The mechanism of death is a fatal arrhythmia. The EKG results are abnormal in nearly all affected individuals. Treatment generally involves betablocker medication (sometimes with permanent cardiac pacing or internal defibrillator) and avoidance of intense physical exertion.
Other Causes A number of illicit drugs have also been implicated in sudden death. Cocaine abuse may cause local ischemia and infarction due to clamping down of the blood vessels, whereas inhalant use has resulted in fatal arrhythmias. Additional deaths have also been linked to performance-enhancing agents such as erythropoietin, diet medications and anabolic steroids.
So is pre-screening useful?
Yes Stephen, there is no substitute for a yearly physical exam by your primary physician. And if there is a suspected anomaly, referral to a cardiologist for further investigation is warranted. It is interesting to note that in Italy, where healthcare is universal and everyone gets full pre-screening, the rates of sudden cardiac death are no different than in the USA where not everyone gets pre-screened. This tells us that we, as a scientific community, do not yet have an accurate way to predict this tragic outcome.
What can you do?
Exercising is still far better than stopping. We know that active individuals are far healthier and have a better chance of surviving a cardiac event than our sedentary friends. What you can do to help you and your physician decide how much exercise is good for you is be aware of the following:
* Investigate your family history and be aware of any cases of sudden cardiac death in your family. This is the best predictor. Help your doctor to help you by knowing your history.
* Be aware of your body. Report to your doctor immediately chest pain or abnormal shortness of breath that comes on with exercise or in your training.
* Keep your cholesterol level within a good profile. Don't be afraid of taking a statin pill to lower your cholesterol if recommended by your physician. Keeping those coronaries clean is important.
* Follow your doctor's advice. Once you have a respected doctor, resist doctor searching for the answer you want to hear. We all do this. Realize, it may be the wrong answer.
***
Lewis G. Maharam is the author of the Running Doc's Guide to Healthy Running and medical director of the Rock 'n' Roll Marathon series and the Leukemia & Lymphoma Society's Team in Training program. He is past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
http://articles.nydailynews.com/2011-11-20/news/30423444_1_lewis-g-maharam-marathon-deaths-marathon-medical-directors
DR LEWIS MAHARAM
Monday, November 21, 2011
Dear Running Doc:
Given the two deaths at the Philadelphia marathon this past weekend, please fill me in why young people can have heart attacks. Im really worried I'll be the next one. What can I do? Stephen L. Great Neck, NYC.
Thanks for writing, Stephen. Whenever a runner goes down, we get this same question. My office telephone has been ringing off the hook and I've been getting tons of letters in the wake of the tragedy in Philadelphia in which two runners went down: Their identities haven't been released yet, but a police spokesman said one was a 21-year-old Asian male and the other was a 40-year-old white male.
As I said in my first column for the Daily News, asking the the right questions is the first step in understanding any issue:
What is “sudden cardiac death” and what is its incidence?
Physicians define “sudden death” in young athletes (women as well as men, ages 35 and younger) as a nontraumatic, nonviolent, unexpected death due to cardiac causes within one hour of the onset of symptoms.
One study estimated that the incidence of sudden cardiac death in unscreened men during exercise is 1 in 280,000 per year. In studies of the risk of death in marathons, it's been estimated that one death would occur in 50,000-88,000 marathon finishers.
In a study I published with Dr. Steve Van Camp in 2004, we found that the risk in distances between 10-K and half-marathon was significantly lower: 3.1 deaths per million finishers. There have also been reports of one sudden cardiac death per 4,000-26,000 in active men; 56X greater risk during exercise in sedentary men and only 5X greater risk during exercise in active men.
What is an enlarged heart?
Exercise causes normal blood flow and electrical changes seen on an EKG. During intense aerobic exercise, the oxygen consumption of muscle tissue increases and cardiac output must rise to meet the demands. Over time, aerobic training results in increased left ventricular mass, decreased resting heart rate, increased ventricular stroke volume, and increased cardiac output, among other effects. This is called an “Athlete’s Heart” — it is normal and nothing to worry about.
But there are enlarged heart conditions that can lead to sudden death. Although more than 20 pathologic entities have been identified as causes of sudden death in young athletes, a few lesions are responsible for most of these deaths that are reported:
Hyperpertrophic Cardiomyopathy
Although rare in the general population (0.1% to 0.2% prevalence), this is the most common cause of sudden cardiac death in young athletes It is inherited and 60% of individuals with this have an affected first-degree relative. On autopsy, patients with hypertrophic hearts are found to have a larger-than-normal heart with a distinctively enlarged left ventricle. Hypertrophy of the ventricular septum is often disproportionate to that of the left ventricular free wall, an asymmetry not seen in the “athlete's heart.” In addition to the increased size, the asymmetric thickening of the septum may act as an obstruction to the flow of blood into the aorta during pumping. Microscopic changes include abnormalities of the small arteries and "myocardial disarray," a bizarre arrangement of muscle cells with diffuse interstitial fibrosis.
The hallmark physical examination finding is a murmur that decreases in intensity with the athlete lying down. This contrasts with functional outflow murmurs common in athletes, which increase in intensity with lying down. Approximately 90% of patients with hypertrophic hearts have abnormal EKG results. In many, but not all, cases, this can be diagnosed by echocardiographic findings.
Despite the above information, individuals may present with sudden cardiac death as their first and only symptom of a hypertrophic heart.
Coronary Artery Abnormalities
A variety of inherited coronary artery abnormalities combine to represent the second leading cause of sudden death in young athletes. Only about one third of affected individuals are thought to be symptomatic (experiencing angina, syncope, or shortness of breath with exercise) before sudden death. The mechanism of sudden death in all cases here is thought to be an arrhythmia (abnormal heart rhythm) triggered by heart tissue ischemia or infarction (heart attack). Some cases may be suspected on echocardiography, but a definitive diagnosis is made by coronary angiography, computed tomography, or magnetic resonance imaging.
Myocarditis Acute
myocarditis is an inflammatory condition of infectious origin. Coxsackie B virus causes more than 50% of all cases, but a variety of causes have been implicated. Symptoms are often overshadowed or preceded by symptoms of viral illness such as vomiting, fever, nausea, diarrhea, and muscle aches. However, many individuals are asymptomatic, and again sudden death may be the only presenting sign. The infected myocardium becomes inflamed, creating an unstable site where a potentially terminal arrhythmia may arise. In other cases, involvement of the conduction system may lead to a fatal heart rhythm as well.
Marfan Syndrome
Marfan syndrome is an inherited connective tissue disorder occurring in about 1 in 10,000 people. Affected individuals are at increased risk for sudden death as the result of progressive dilatation of the aortic root, ending in complete dissection or bleeding internally.
The diagnosis of Marfan syndrome is based on a good physical exam (although genetic testing may be appropriate in families with several affected members). Clinical features include tall stature, long and thin limbs, an arm span substantially greater than height, diminished upper body-to-lower body ratio, and a long, thin face.
Electrophysiologic Abnormalities
Abnormalities of the conduction system may lead to fatal cardiac arrhythmias. Their incidence is likely underreported since autopsy findings may be inconclusive. Approximately 60% of patients present with symptoms related to physical activity or strong emotional response, primarily fainting, seizures, or heart palpitations. One third of previously "healthy" young adults present with sudden death. The mechanism of death is a fatal arrhythmia. The EKG results are abnormal in nearly all affected individuals. Treatment generally involves betablocker medication (sometimes with permanent cardiac pacing or internal defibrillator) and avoidance of intense physical exertion.
Other Causes A number of illicit drugs have also been implicated in sudden death. Cocaine abuse may cause local ischemia and infarction due to clamping down of the blood vessels, whereas inhalant use has resulted in fatal arrhythmias. Additional deaths have also been linked to performance-enhancing agents such as erythropoietin, diet medications and anabolic steroids.
So is pre-screening useful?
Yes Stephen, there is no substitute for a yearly physical exam by your primary physician. And if there is a suspected anomaly, referral to a cardiologist for further investigation is warranted. It is interesting to note that in Italy, where healthcare is universal and everyone gets full pre-screening, the rates of sudden cardiac death are no different than in the USA where not everyone gets pre-screened. This tells us that we, as a scientific community, do not yet have an accurate way to predict this tragic outcome.
What can you do?
Exercising is still far better than stopping. We know that active individuals are far healthier and have a better chance of surviving a cardiac event than our sedentary friends. What you can do to help you and your physician decide how much exercise is good for you is be aware of the following:
* Investigate your family history and be aware of any cases of sudden cardiac death in your family. This is the best predictor. Help your doctor to help you by knowing your history.
* Be aware of your body. Report to your doctor immediately chest pain or abnormal shortness of breath that comes on with exercise or in your training.
* Keep your cholesterol level within a good profile. Don't be afraid of taking a statin pill to lower your cholesterol if recommended by your physician. Keeping those coronaries clean is important.
* Follow your doctor's advice. Once you have a respected doctor, resist doctor searching for the answer you want to hear. We all do this. Realize, it may be the wrong answer.
***
Lewis G. Maharam is the author of the Running Doc's Guide to Healthy Running and medical director of the Rock 'n' Roll Marathon series and the Leukemia & Lymphoma Society's Team in Training program. He is past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
http://articles.nydailynews.com/2011-11-20/news/30423444_1_lewis-g-maharam-marathon-deaths-marathon-medical-directors
Know Your Heart Condition and Sports - blog repost from Trisupe's blog
I like this article from a blog by a fellow Malaysian runner / Facebook friend (Trisupe).. This came about after a 22 year old seemingly healthy & fit Singaporean man collapsed and died after crossing the SCMS 2011 Half Marathon @ 1:53. There has been many cases of heart related deaths related to running, cycling and some endurance sports. I still recalled ~2 months ago, 2 deaths were reported at Philadelphia Marathons 2 weeks ago....
********
Know Your Heart Condition And Sports
Another life was lost last weekend during the SCMS 2011 run. A young 22 years old man by the name of Malcolm Sng (RIP) was known to be a fit person that earned the nickname "Man Of Steel" from those that know him. He was one of the fitter ones in his Basic Military Training (BMT), according to those that know him during his National Service days. He ran the 21km race in 1:53 - collapsed upon crossing the line and pronounced dead at 9.30am - an hour after he collapsed. His last run before this was in September 2011.
If all of you remember, there was another death in our country Malaysia during the SCKLM run in 2010 where a 10km participant collapsed with about 2km to go. Runners that saw that rushed to his aid and some even performed CPR on him. Sadly, medical was insufficiently equipped (no AED or defibrillator) and many would remember the inaction by authority that could had used his radio to call for ambulance.
Some would say that Singapore is so perfect - since the organizers was not apprehended on social media unlike what happened in KL. Lets look at the two incident objectively. Both has a young man passing on while running. Both started racing recently (before the incident) and both are at the best of their health, fitness wise. While one received immediate medical attention upon collapsing the end results for both were the same - they could never come back again.
While the investigation is underway for Malcolm, the condition that caused the Malaysian boy to pass on was attributed to under laying heart condition.
In fact, he was not the first one. Remember the other race in Shah Alam where another young man collapsed and died while walking to his car?
Or the national junior badminton player that suffered the same fate after his training just recently?
Closer to home, i lost two friends; one an online friend i never met physically and the other, Kharis or TSB recently - both due to heart condition.
Here are the coincidental cause - cardiovascular or heart failure.
One of the most common cause is abnormal heart rhythm or arrhythmia. Lets look at what this foreign sounding medical terms (as with all medical terms too) is.
Arrhythmia is best described as irregular heartbeat. It has nothing to do with you getting excited when you see someone you love (aka skipping a heartbeat). It can occurs even with someone that has regular heartbeat (50-100bpm), low heartbeat (less than 50) or high heartbeat (more than 100). It can cause by a few factors such as:
1. electrolyte imbalance mostly due to natrium(sodium) - kalium (potassium) imbalance.
2. injury from heart attack or recovery from heart surgery, of which either one would contribute to changes in the heart muscle function/memory
3. Irregular heart rhythm which include other medical condition such as heart flutter, abnormal contraction of artery and/or ventricle.
As you can see, many of us that does the sports (swim and/or bike and/or run) are relatively "fit". Many of us are not aware of under laying condition of our own health, despite getting health screening perhaps only when the job job requires us to. Many a time, we would not be able to recognise the tell-tale sign, but the typical symptoms are:
1. palpitation of the heart (where you feel your heart skipping a beat or suddenly felt like it is drumming away)
2. Pain or tightness in the chest (oh-uh...)
3. Feeling light headed or dizziness
4. short of breath
5. feeling tired even though just doing menial task.
I have experienced up to all five of the above at any one time. Sometimes, we thought we are having low blood pressure or low iron level, but in actual fact, the cause could be more severe. Those that often misses out on their sleep and worked through the night will experience palpitation and feel lightheaded. Reason why rest is crucial for athletes as much as it to train.
So, the next question would be how one could actually strike out all possibilities and actually know what is causing the symptoms above? A comprehensive medical examination that includes ECG or electrocardiogram test, or a stress test (running on treadmill with HR and blood pressure monitored) could be an inexpensive way to prediagnose this condition.
Arrhythmia condition could be treated via drug usage, usually to thin the blood (such as aspirin) to prevent possibility of stroke due to blood clot. If the condition could not be treated by drugs, it will usually requires a lifestyle change.
We human are habitual beings, lifestyle change will be difficult to some and often it requires discipline and life-changing decision. Some of the suggested changes that should be incorporated includes quitting smoking, limits the consumption of alcohol and caffeine (including soft drinks) and perhaps even a diet revamp for a more holistic cardiovascular health including the health of the arteries and lipid (fat) profile. One of the more difficult change would be to limit the activities that causes the condition, especially if it involves the activities we love such as the swimming, cycling and running. The key to this would be a very conscious effort to STOP if we have fainting spell or tightness or pain in the chest. That would be the first indication.
Arrhythmia could lead to more deadly repercussion if not recognised such as heart attack.
Putting all the equations above, i could very generally equate the recent death of some of our fellow friends to possible over training with imbalance diet (electrolyte imbalance - could meant under or over dosing) while pushing very hard to accomplish to obtain a personal best timing possibly with inadequate rest due to anxiety before race days or running up to race day.
I am not a doctor, but my common sense tells me that the sign is always there and it is ourselves that choose to ignore them.
I often race with a heart rate monitor (HRM) so i could monitor my own condition if i am pushing myself too hard or within my own limits. I even stopped running once when i felt immense tightness on my chest just after 2km of running at an easy pace. It is never nice to just "drop dead" - life is too short to let it end that way.
Stay conscious, stay informed and stay alive. There will always be another race for another day.
http://www.tristupe.com/2011/12/know-your-heart-condition-and-sports.html
********
Know Your Heart Condition And Sports
Another life was lost last weekend during the SCMS 2011 run. A young 22 years old man by the name of Malcolm Sng (RIP) was known to be a fit person that earned the nickname "Man Of Steel" from those that know him. He was one of the fitter ones in his Basic Military Training (BMT), according to those that know him during his National Service days. He ran the 21km race in 1:53 - collapsed upon crossing the line and pronounced dead at 9.30am - an hour after he collapsed. His last run before this was in September 2011.
If all of you remember, there was another death in our country Malaysia during the SCKLM run in 2010 where a 10km participant collapsed with about 2km to go. Runners that saw that rushed to his aid and some even performed CPR on him. Sadly, medical was insufficiently equipped (no AED or defibrillator) and many would remember the inaction by authority that could had used his radio to call for ambulance.
Some would say that Singapore is so perfect - since the organizers was not apprehended on social media unlike what happened in KL. Lets look at the two incident objectively. Both has a young man passing on while running. Both started racing recently (before the incident) and both are at the best of their health, fitness wise. While one received immediate medical attention upon collapsing the end results for both were the same - they could never come back again.
While the investigation is underway for Malcolm, the condition that caused the Malaysian boy to pass on was attributed to under laying heart condition.
In fact, he was not the first one. Remember the other race in Shah Alam where another young man collapsed and died while walking to his car?
Or the national junior badminton player that suffered the same fate after his training just recently?
Closer to home, i lost two friends; one an online friend i never met physically and the other, Kharis or TSB recently - both due to heart condition.
Here are the coincidental cause - cardiovascular or heart failure.
One of the most common cause is abnormal heart rhythm or arrhythmia. Lets look at what this foreign sounding medical terms (as with all medical terms too) is.
Arrhythmia is best described as irregular heartbeat. It has nothing to do with you getting excited when you see someone you love (aka skipping a heartbeat). It can occurs even with someone that has regular heartbeat (50-100bpm), low heartbeat (less than 50) or high heartbeat (more than 100). It can cause by a few factors such as:
1. electrolyte imbalance mostly due to natrium(sodium) - kalium (potassium) imbalance.
2. injury from heart attack or recovery from heart surgery, of which either one would contribute to changes in the heart muscle function/memory
3. Irregular heart rhythm which include other medical condition such as heart flutter, abnormal contraction of artery and/or ventricle.
As you can see, many of us that does the sports (swim and/or bike and/or run) are relatively "fit". Many of us are not aware of under laying condition of our own health, despite getting health screening perhaps only when the job job requires us to. Many a time, we would not be able to recognise the tell-tale sign, but the typical symptoms are:
1. palpitation of the heart (where you feel your heart skipping a beat or suddenly felt like it is drumming away)
2. Pain or tightness in the chest (oh-uh...)
3. Feeling light headed or dizziness
4. short of breath
5. feeling tired even though just doing menial task.
I have experienced up to all five of the above at any one time. Sometimes, we thought we are having low blood pressure or low iron level, but in actual fact, the cause could be more severe. Those that often misses out on their sleep and worked through the night will experience palpitation and feel lightheaded. Reason why rest is crucial for athletes as much as it to train.
So, the next question would be how one could actually strike out all possibilities and actually know what is causing the symptoms above? A comprehensive medical examination that includes ECG or electrocardiogram test, or a stress test (running on treadmill with HR and blood pressure monitored) could be an inexpensive way to prediagnose this condition.
Arrhythmia condition could be treated via drug usage, usually to thin the blood (such as aspirin) to prevent possibility of stroke due to blood clot. If the condition could not be treated by drugs, it will usually requires a lifestyle change.
We human are habitual beings, lifestyle change will be difficult to some and often it requires discipline and life-changing decision. Some of the suggested changes that should be incorporated includes quitting smoking, limits the consumption of alcohol and caffeine (including soft drinks) and perhaps even a diet revamp for a more holistic cardiovascular health including the health of the arteries and lipid (fat) profile. One of the more difficult change would be to limit the activities that causes the condition, especially if it involves the activities we love such as the swimming, cycling and running. The key to this would be a very conscious effort to STOP if we have fainting spell or tightness or pain in the chest. That would be the first indication.
Arrhythmia could lead to more deadly repercussion if not recognised such as heart attack.
Putting all the equations above, i could very generally equate the recent death of some of our fellow friends to possible over training with imbalance diet (electrolyte imbalance - could meant under or over dosing) while pushing very hard to accomplish to obtain a personal best timing possibly with inadequate rest due to anxiety before race days or running up to race day.
I am not a doctor, but my common sense tells me that the sign is always there and it is ourselves that choose to ignore them.
I often race with a heart rate monitor (HRM) so i could monitor my own condition if i am pushing myself too hard or within my own limits. I even stopped running once when i felt immense tightness on my chest just after 2km of running at an easy pace. It is never nice to just "drop dead" - life is too short to let it end that way.
Stay conscious, stay informed and stay alive. There will always be another race for another day.
http://www.tristupe.com/2011/12/know-your-heart-condition-and-sports.html
Time to Rest ?
Pay attention to 10 body indicators to gauge when to run and when to back off.
By Jayme Otto
Image by Saverio Truglia
From the June 2011 issue of Runner's World
After disappointing performances in a couple of key tune-up races last fall, a depleted Ryan Hall made the hard decision to withdraw from the Chicago Marathon. Too many grinding 15-mile tempo runs at a five-minute-per-mile pace at 7,000 feet with too little rest afterward had finally caught up with him. "I love to push my body," he says. "Recovery is the hardest part of training for me."
Problem is, if you don't take time for proper R&R, your body won't adapt to the stress of your training—you won't get stronger or faster, explains Stacy Sims, Ph.D., at the Stanford Prevention-Research Center, School of Medicine. Neglect recovery for too long, and you will start to lose strength and speed. You'll sink into the black hole known as overtraining.
First, your sleep patterns and energy levels will feel the effects. Eventually, your immune system crashes, and you lose your appetite. It's like burning out your engine. And you don't have to be logging 100-mile weeks to suffer. Recreational runners can overtrain, too. "With deadlines, chores, bills, kids, and lack of sleep, it's more challenging to recover properly from your runs," says Sims.
So in preparation for the 2011 Boston Marathon, Hall used an online recovery-tracking program called Restwise, which looks at simple biological markers input by the athlete first thing each morning, calculates a daily recovery score from 1 to 100, then trends it over time. (Rest-wise subscriptions start at $119 for six months; go to restwise.com.)
Pay attention to the following 10 markers. If three or more of these indicators raise a red flag, you should consider a few easy sessions or off days so you can return to running strong (see box, right). Says Hall, "Now I'm learning to love to rest."
1 BODY MASS: You lost weight from yesterday
A two percent drop in weight from one day to the next indicates a body-fluid fluctuation. Most likely, you didn't hydrate enough during or after your last workout. Dehydration negatively impacts both physical and mental performance, and could compromise the quality of your next workout.
2 RESTING HEART RATE: Your resting heart rate is elevated
Take your pulse each morning before you get out of bed to find what's normal for you. An elevated resting heart rate is one sign of stress. It means your nervous system prepared for fight or flight by releasing hormones that sped up your heart to move more oxygen to the muscles and brain. Your body won't know the difference between physical and psychological stress. A hard run and a hard day at work both require extra recovery.
3 SLEEP: You didn't sleep well or enough
A pattern of consistently good sleep will give you a boost of growth hormones, which are great for rebuilding muscle fibers. Several nights in a row of bad sleep will decrease reaction time along with immune, motor, and cognitive functions—not a good combination for a workout.
4 HYDRATION: Your pee is dark yellow
This can be an indicator of dehydration, barring the consumption of vitamins, supplements, or certain foods the evening before. The darker the color, the more you're struggling to retain fluids, because there's not enough to go around. You need H2O to operate (and recover).
5 ENERGY LEVEL: You're run down
If your energy level is low, there's something amiss. The key is honesty. Athletes can block out signs of fatigue to push through it, thinking it will make them stronger. It won't always work that way.
6 MOOD STATE: You're cranky
When your body is overwhelmed by training (or other stressors), it produces hormones like cortisol that can cause irritability or anxiety. Stress also halts chemicals like dopamine, a neurotransmitter in the brain that has a big bummer effect on mood when depleted. Crankiness probably means not enough recovery.
7 WELLNESS: You're sick
Any illness, or even a woman's menstrual cycle, will increase your need for energy to refuel your immune system, which is having to work overtime. This means fewer resources available for recovering from training.
8 PAIN: You're sore or nursing an injury
Whether you're sore from overworked muscles or an injury, your body needs more energy to put toward repair, lengthening total recovery time.
9 PERFORMANCE: Your workout went poorly
This is a subjective measure of workout quality, not quantity nor intensity. If you felt great on yesterday's run, you'd evaluate that as good. If you felt sluggish on that same run, you'd count it as poor. Trending workout quality—multiple poors in a row—is one of the easiest ways to identify the need for more recovery.
10 OXYGEN SATURATION: Your oxygen level has dipped
The amount of oxygen in the hemoglobin of the red blood cells can be measured by placing your fingertip in a portable pulse oximeter, a gadget available online for about $40. The higher the percentage, the better: Above 95 percent is the norm at sea level or for an athlete who is fully acclimated to a given altitude. This is a new area in recovery science, requiring more research, but there may be a link between low oxygen saturation and the need for more recovery.
Count Your Red Flags
The restwise algorithm assigns more weight to some markers (e.g., performance) than others (e.g., mood), along with other factors to generate a precise recovery score. But you can get a sense for your ballpark recovery quality by tallying the red flags (left) you average per day in a week.
0-1 GREEN LIGHT
You are clear to train hard.
2-4 CAUTION
You can go ahead with a hard workout if your training plan calls for it, but cut it short if it feels too hard. Better yet, take an easy day, or a day off.
5-6 WARNING
You're entering the danger zone, which could be intentional according to your periodization or peaking protocol. If not, back off.
7-10 DANGER
You require mandatory time off, ranging from a day to a week, depending on the severity of your fatigue and what you've seen over the previous few days and weeks. You may need to visit your doctor.
FEEL Better: Too much rest has its own problems: Your performance stalls. On your recovery days, do something active; go for a bike ride, walk, or do yoga.
MUSCLES NEED 48 HOURS TO RECOVER AFTER AN INTENSE RUN. DURING THIS TIME, CELLS ARE REPROGRAMMED TO BE STRONGER.
http://www.runnersworld.com/article/0,7120,s6-238-267--13950-2-1-2,00.html
By Jayme Otto
Image by Saverio Truglia
From the June 2011 issue of Runner's World
After disappointing performances in a couple of key tune-up races last fall, a depleted Ryan Hall made the hard decision to withdraw from the Chicago Marathon. Too many grinding 15-mile tempo runs at a five-minute-per-mile pace at 7,000 feet with too little rest afterward had finally caught up with him. "I love to push my body," he says. "Recovery is the hardest part of training for me."
Problem is, if you don't take time for proper R&R, your body won't adapt to the stress of your training—you won't get stronger or faster, explains Stacy Sims, Ph.D., at the Stanford Prevention-Research Center, School of Medicine. Neglect recovery for too long, and you will start to lose strength and speed. You'll sink into the black hole known as overtraining.
First, your sleep patterns and energy levels will feel the effects. Eventually, your immune system crashes, and you lose your appetite. It's like burning out your engine. And you don't have to be logging 100-mile weeks to suffer. Recreational runners can overtrain, too. "With deadlines, chores, bills, kids, and lack of sleep, it's more challenging to recover properly from your runs," says Sims.
So in preparation for the 2011 Boston Marathon, Hall used an online recovery-tracking program called Restwise, which looks at simple biological markers input by the athlete first thing each morning, calculates a daily recovery score from 1 to 100, then trends it over time. (Rest-wise subscriptions start at $119 for six months; go to restwise.com.)
Pay attention to the following 10 markers. If three or more of these indicators raise a red flag, you should consider a few easy sessions or off days so you can return to running strong (see box, right). Says Hall, "Now I'm learning to love to rest."
1 BODY MASS: You lost weight from yesterday
A two percent drop in weight from one day to the next indicates a body-fluid fluctuation. Most likely, you didn't hydrate enough during or after your last workout. Dehydration negatively impacts both physical and mental performance, and could compromise the quality of your next workout.
2 RESTING HEART RATE: Your resting heart rate is elevated
Take your pulse each morning before you get out of bed to find what's normal for you. An elevated resting heart rate is one sign of stress. It means your nervous system prepared for fight or flight by releasing hormones that sped up your heart to move more oxygen to the muscles and brain. Your body won't know the difference between physical and psychological stress. A hard run and a hard day at work both require extra recovery.
3 SLEEP: You didn't sleep well or enough
A pattern of consistently good sleep will give you a boost of growth hormones, which are great for rebuilding muscle fibers. Several nights in a row of bad sleep will decrease reaction time along with immune, motor, and cognitive functions—not a good combination for a workout.
4 HYDRATION: Your pee is dark yellow
This can be an indicator of dehydration, barring the consumption of vitamins, supplements, or certain foods the evening before. The darker the color, the more you're struggling to retain fluids, because there's not enough to go around. You need H2O to operate (and recover).
5 ENERGY LEVEL: You're run down
If your energy level is low, there's something amiss. The key is honesty. Athletes can block out signs of fatigue to push through it, thinking it will make them stronger. It won't always work that way.
6 MOOD STATE: You're cranky
When your body is overwhelmed by training (or other stressors), it produces hormones like cortisol that can cause irritability or anxiety. Stress also halts chemicals like dopamine, a neurotransmitter in the brain that has a big bummer effect on mood when depleted. Crankiness probably means not enough recovery.
7 WELLNESS: You're sick
Any illness, or even a woman's menstrual cycle, will increase your need for energy to refuel your immune system, which is having to work overtime. This means fewer resources available for recovering from training.
8 PAIN: You're sore or nursing an injury
Whether you're sore from overworked muscles or an injury, your body needs more energy to put toward repair, lengthening total recovery time.
9 PERFORMANCE: Your workout went poorly
This is a subjective measure of workout quality, not quantity nor intensity. If you felt great on yesterday's run, you'd evaluate that as good. If you felt sluggish on that same run, you'd count it as poor. Trending workout quality—multiple poors in a row—is one of the easiest ways to identify the need for more recovery.
10 OXYGEN SATURATION: Your oxygen level has dipped
The amount of oxygen in the hemoglobin of the red blood cells can be measured by placing your fingertip in a portable pulse oximeter, a gadget available online for about $40. The higher the percentage, the better: Above 95 percent is the norm at sea level or for an athlete who is fully acclimated to a given altitude. This is a new area in recovery science, requiring more research, but there may be a link between low oxygen saturation and the need for more recovery.
Count Your Red Flags
The restwise algorithm assigns more weight to some markers (e.g., performance) than others (e.g., mood), along with other factors to generate a precise recovery score. But you can get a sense for your ballpark recovery quality by tallying the red flags (left) you average per day in a week.
0-1 GREEN LIGHT
You are clear to train hard.
2-4 CAUTION
You can go ahead with a hard workout if your training plan calls for it, but cut it short if it feels too hard. Better yet, take an easy day, or a day off.
5-6 WARNING
You're entering the danger zone, which could be intentional according to your periodization or peaking protocol. If not, back off.
7-10 DANGER
You require mandatory time off, ranging from a day to a week, depending on the severity of your fatigue and what you've seen over the previous few days and weeks. You may need to visit your doctor.
FEEL Better: Too much rest has its own problems: Your performance stalls. On your recovery days, do something active; go for a bike ride, walk, or do yoga.
MUSCLES NEED 48 HOURS TO RECOVER AFTER AN INTENSE RUN. DURING THIS TIME, CELLS ARE REPROGRAMMED TO BE STRONGER.
http://www.runnersworld.com/article/0,7120,s6-238-267--13950-2-1-2,00.html
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