Riding to recover

My calf muscles were pretty beat up from the Boston marathon. They have been hurting all week and I was stiff and had trouble getting up. At night I was restless and woke up many times. Walking did help but running was pretty much out of the question -until yesterday when I took a brief jog in a parking lot. So I have been riding my bike. Swimming might have helped better but we no longer have our pool membership so biking was my only option.

After flying back on Tuesday, April 20, I rode for 35 min on rollers Wednesday. Surprisingly enough I could ride pretty well and even spinning at a high cadence was no problem. Getting off the bike though was less than pleasant. It felt as if I had been sitting for hours. It is remarkable how different parts of the muscle are used for different activities. Sore from running worked fine for biking and I have experienced the opposite in IM races.

On Thursday I rode 28 miles, including a climb up Redwood Road. Then on Friday I rode the Briones loop, affectionately known as "The Bears" in Berkeley. I added Pig Farm hill just to top 21 miles. Saturday I took Alistair to the Wente Road Race and rode some 15 miles in Livermore, up Patterson Pass Rd. and up Altamont and Flynn Road. I climbed Flynn a few times which was great fun.

On Sunday I rode the loop over Altamont, Midway and Patterson Pass. The weather was great and the winds were calm, which made for a pleasant ride. Normally, the loop can be a real challenge. The west winds usually start before noon and one goes out with a monster tailwind, flying down Altamont at 40 mph, only to hit the wall at Midway and suffer a constant headwind up Patterson. None of that I am happy to say. Just a calm breeze to keep things honest.

Boston comparison

Boston marathon. A comparison between '09 (blue) and '10 (red). Each bar, except the last one, represents 5K (3.1 mi). The last bar represents 2.2 K or 1.37 miles.

Speed is in mph. A 3:15 marathon -my target- requires a speed of 8.06 mph. In '09 I ran a 3:22 or a speed of 7.78 mph average. In '10 I finished in 3:41 or 7.11 mph average.

The uphill sections on the course run from mile 16 to mile 21 or from Km 25.75 to 33.8. These are the slowest blocks in the '09 race. In '10 the 20-25 block is slower because I was forced to take a potty break losing several minutes there. After that the speed goes up a bit but then crashes on the last part, hovering around 6 mph as I was forced to walk more frequently and for longer stretches.

Boston disaster

I guess you can say the answer is in. Doing a fair number of medium distance (12-16 mile) runs is not as good as doing fewer, shorter (8-10 mile) runs combined with some serious 20 minute tempo runs and intervals. For some odd reason, I expected this all along and expressed my concern on this blog prior to going into Boston. It had just dawned on me that, although I had run a lot, I had done very little intensity-wise this year.

Blame the weather and fact that I had no treadmill.

The fundraising too was a disaster. It started out well with some great early donations. But then everyone let me down and I was unable to gain traction. Unlike last year, most people did not even bother to reply or come up with some (lousy) excuse. They simply ignored my pleas. I find it hard to believe that the economic hardship is that great.

In short, the marathon was a disaster. It started out somewhat ominously when I woke up a week before with back pain. The back pain eventually went away and it did not play a major role in what happened, other than darken my mood a bit. Then there was the weather. Although Boston had seen nice weather all week, the day I arrived it got cold and started raining. No fun.

Miraculously it all went away on Monday and the day was near perfect for a marathon. It was nice, not too hot, and sunny. Blue skies at last. Perhaps the only problem was a chilly breeze although some might argue it was a tailwind for much of the distance.

I took it easy in the days leading up to the race and I felt pretty good going into it. I ran easily and the first 12 miles were fine. Maybe I started out a bit too fast but it didn't feel that way and I wasn't overly excited or pumped up with coffee. I actually drank very little coffee that day.

But in Natick things started to fall apart. First I slowed down, not because I was breathing hard, but because my legs failed me. I had some trouble leaving the town and heading up the small hill to Wellesley College. Then I suffered some more on the downhill into town, where Andrew and Andreas were ready to cheer me on. Once I headed into the second half things only got worse. By mile 16 I started suffering from cramps in my calf muscles and an upset stomach. I was forced to take a potty break. That is never a good sign. However, I still felt I could salvage a 3:25 or close to that.

On Commonwealth, even before heartbreak hill I had to start walking because of the cramps. By the time I hit the top it was really bad. Not even the downhill offered any respite, and those final 9 miles of downhill and flats were hell. The cramps got worse and the jogging -I wasn't running any more- stretches shorter and shorter as I was forced to walk more distance and more often. I was still hoping for a 3:30 or maybe a 3:35.

The last 2.2 km (1.4 mi) were especially painful and it took almost 15 minutes for me to finish. I walked large stretches of Boylston with the finish line in full view. Not even the near-hysterical Boston crowds could alleviate my misery. By the time it was all over, I had used up nearly 3:42 and I continued to suffer cramps, which would last for hours afterwards.

Fortunately, Andreas had decided to come into the city and pick me up. Although I had trouble getting into the car, I felt quite relieved. As expected the delayed-onset muscle soreness also came with a vengeance. Today I woke up sore and stiff and I have trouble walking stairs. Perhaps the best part was that the flight home was rather pleasant and uneventful.

The good news for the weekend is that Alistair won the Sea Otter Road race for the second year in a row, and he did so in a very dramatic solo breakaway, which vindicated my status as his coach.

TeamCindy in the news

A story about TeamCindy at the Boston Marathon in the Examiner.

TeamCindy

On Monday I will be running the Boston marathon. I am dedicating my effort to the memory of Cindy Sherwin, a New York triathlete and runner, who died at the age of 33 from a ruptured brain aneurysm.

The Boston Marathon will be my third TeamCindy event. I finished the Arizona Ironman, raising nearly $15,000, two years ago. Then last year I raised another $3,000 at Ironman Lake Placid. This year I hope to raise $2,000 at the Boston marathon.

To support my effort and help raise funding and awareness for brain aneurysms, please visit

my webpage at TeamCindy. Any and all donations are welcome. No amount is too small or insignificant. All monies raised will go the Brain Aneurysm Foundation. Donations are tax deductible to the extent permitted by law.

If you want to find out more about brain aneurysms and their symptoms, please visit this page. Here you can learn more about a disorder that affects 1 in 50 people and often leads to death and disability. You will also learn that there are often warning signs that may help you prevent an acute incident.

Visit TeamCindy on Facebook.

Infection and injury

I believe infections and the body's response to infections underly most, if not all illnesses. That includes conditions and illnesses that were traditionally viewed as non-infectious in origin. As we learn more about biology it is becoming apparent that that view is too limited and wrong. Infections and/or the body's response to infections are likely triggers for atherosclerosis, heart attacks, strokes, cancer, auto-immune diseases, and many other so-called non-infectious illnesses.

Infections are caused by other organisms, known as parasites. The group comprises viruses, bacteria, yeasts, fungi and other organisms that are also referred to "parasites" in a more narrow sense. Parasites are the main drivers of evolution and they are directly responsible for sexual reproduction. Without parasites there would be no genders.

The body responds to parasites using a large array of defensive mechanisms that are not well understood. The terminology used reflects our lack of understanding and to say it is confusing is an understatement. A term that is frequently used is the immune system. But the immune system proper is only a small part of it and its role in fighting infection is limited.

I am convinced that many, if not all, so-called use or overuse injuries are also caused by infections or the response to infections. That includes the Achilles tendonitis example I discussed yesterday.

We already know that stiff neck syndrome and other muscle stiffness can be caused by viruses. Flu syndromes include muscle, esp. lower back muscle pain. But it is unlikely that Achilles tendonitis is caused by a viral infection.

A more likely scenario runs as follows. From time to time the tendon gets injured from exercise. We know that scenario well and often after hard exercise, muscles, tendons and ligaments can be painful and sore. The condition happens more frequently, but not exclusively, when there are underlying mechanical issues. There is probably also an underlying genetic component (strength of protein for example).

In nearly all cases, such soreness goes away in a few days. Rarely it does not. I suspect that that is because the injury is aggravated by an immune system cross-reaction to an infectious particle. The infection may have happened weeks or months before the injury and it may or may not have been clinically apparent. It could have been a simple cold or flu.

In such cases we see tendonitis with obvious inflammation. Once again, most of these cases will heal by themselves, although now it will take several weeks to several months. They heal because the tendon gets repaired and the immune response is essentially self-terminating.

A very small number of those will not heal but get worse. The condition may become chronic with acute exacerbations. In most cases it will still be limited to the tendon or tissue of origin. But in a few individuals, it may expand its scope and blossom into a full-blown auto-immune disease like lupus, RA, etc. Fibromyalgia as an entity also resides here. It seems likely that a genetic predisposition is needed for such expansions (be they in time or in scope, or both).

That sums up my hypothesis. It neatly explains why many overuse injuries appear out of the blue. It explains the bilateral, symmetric cases. Those invariably point to a systemic cause.

It also explains why the lesions go away pretty much regardless of treatment, which is nothing more than symptomatic in any case. Mechanical correction, although frequently applied is probably of no use in 99% of cases. If it is useful at all, it is probably limited to those cases with gross deformity and the reason it helps is because it reduces (but does eliminate) the likelihood of primary injuries.

Injuries

A recent post on the cycling coaches' google group reminded me of a few basic things I learned in medical school. The post was in reference to an athlete who had developed bilateral Achilles tendonitis and was asking a coach for help. The original email was detailed and repeatedly mentioned that the athlete had done nothing special to provoke the injury and furthermore he recalled had stressed his achilles much more on many previous occasions with no consequences.

The responses were very typical. Many coaches quickly tried to tie the injury to a recent event. Those of you in medical practice are probably smiling or trying to suppress a smile. Patients and their caretakers almost always come up with a reason for their condition. It is just human nature to try to find a cause and pick up on a spurious correlation.

Secondly, people pick causes that they understand and can work with. So nearly all coaches immediately laid the blame on poor bike fit and other mechanical issues. Many offered solutions although some -no doubt fearing liability issues- quickly pointed out a doctor was needed. One was bold enough to admit that doctors are often as much at loss as to the cause as everyone else.

I happen to have suffered an Achilles tendonitis a few years ago. It had all the visible signs of inflammation including the pain, the swelling and the rubbing, which could easily be felt by an outsider touching the skin over the tendon. I consulted my HMO and was prescribed an anti-inflammatory dose of ibuprofen, ice packs, exercises to strengthen the triceps, and physiotherapy. I was also told to bag my plans to run an IM (two months into the future at that time), and to rest a lot.

In the end, I did finish the two week anti-inflammatory treatment course, which helped maybe a bit -but not much. I applied plenty of ice-packs and later heat packs, which offered the best subjective relief. I participated, albeit somewhat halfheartedly, in a few physical therapy sessions, and I backed off somewhat from running and cycling -the two worst offenders. I did run the ironman though and was able to finish within a reasonable time, although my Achilles did hurt and was rubbing during the run.

Even so, the injury got better and went away by itself after a few months. I finished another IM race before it healed up completely. I made no lasting changes to either my running shoes or bike fit, and I continue to run in the same brand shoes and with the same bike fit to this day. It has been two years now and I haven't had a problem yet.

It would be easy for me to correlate the betterment with all the medical attention, and many would be tempted to do so, but I disagree. If I had changed my bike fit, I would not doubt believe it made a difference and helped me heal, but that too would be bogus.

I can clearly state that the injury came out of the blue and disappeared (months later) all by itself. And I have seen many similar incidents in people I know since that time and they all behaved the same way. It seems likely that these types of injuries go away on their own and that just backing off a bit is the only thing one really needs to do.

I also don't doubt that in a few rare instances this may not happen and things will deteriorate further. Such is the nature of human existence. We also suffer illness and injuries but most of us will heal just fine on our own, with or without medical intervention. A few don't and they suffer chronic illness or disability. But there is simply no way for us to know in advance who will and who won't, nor -IMHO- would we be able to prevent it from happening even if we knew who.

I will advance a hypothesis that explains these matters in my next post.

Workouts this week:

Tuesday, 33 mile bike ride, to top Redwood plus some extras

Wednesday, 8 mile run in the hills with intervals

Thursday, 30 mile ride with Alistair

Friday, 8 mile run to Montclair with intervals

Run baby, run

One reason for training in a group is that it is far easier to push yourself when others are around. Groups are naturally competitive and almost any group run (or group ride) will contain some high intensity stretches. It is also easier to suffer when others around you suffer too.

When you are by yourself pushing hard is much more difficult to do. You have to motivate yourself and then you have to make sure you follow through. That is much worse than it sounds, and it may be one of the reasons why people like gadgets. A gadget like a speedometer or a heart rate monitor (or a power meter on the bike) lets you know how hard you are going. That makes it much tougher to cheat or delude yourself.

The Boston marathon is coming up. There are less than two weeks to go and although I ran a lot this year, I haven't done much speed work. So this past week I decided to add some intensity. It started out well but in the end I did not do as much as I should have.

On Tuesday I ran 8 miles in the hills, including a two mile stretch on Grizzly at 9 mph. That was pretty hard. I had expected to run 8.5 but was able to hold 9 despite the rollers so I felt great afterwards.

On Wednesday I added a 7.5 mile run with a fast one-miler. On Thursday I ran to Montclair and back for a total of 7.5 miles. This stretch is not flat either but it has more flat sections than my usual 7.5 mile run and parts of it are similar in feel to the Boston course. On Friday I rode on rollers for 1 hour. Here I focused on spinning to add some leg speed.

On Saturday I drove Alistair to Milton/Copperopolis for his race, but it was too cold out there to run. The temperature was at 47 F/8 C with a nasty wind. I had counted on sun and so I did not bring warm clothing. Fortunately, as soon as we got back home the sun came out and it felt quite a bit warmer. I set out at 3 PM to do an 8 mile loop but ended up running 10.5 on Shepherd.

On Sunday we had a late winter storm and the weather was pretty horrible all day, except for early morning. I decided it would be better if I rested. I spent my time watching the Ronde and shopping around for flights to Boston.

Today I ran 8 miles to Montclair and back. There were showers in the morning but by afternoon the sun came out and it was warm and pleasant. I tried to do some speed work too, although I am not sure how effective it was.

My fundraising effort for the Brain Aneurysm Foundation is going so-so. In some ways it is going better than I expected, but on the other hand, I can't really say I am bringing in the dough. I'll be happy if I reach $1,000, and overjoyed if I can hit my target of $2,000.