Better Living Through Chemistry?

Suzanne and I were on the west coast...of Michigan, last week, for our son's wedding.  We were changing into our fine attire and lacing up our tennis shoes - a 'fashion statement' if you're not a runner; otherwise it's another day in rubber soles - when Suzanne asked, "do you have any ibuprofen?"

"Well, no," was my reply. 

When Suzanne and I travel, the first thing/s packed are (one or more pairs of) running shoes, shorts, socks, t-shirts, and my Garmin 310XT.  Whatever space I have in my luggage after that goes to "civilian" clothes once the personal care items, electronic device chargers, reading materials and drugs are tucked away.  This was not a "typical" road trip for me; I did not plan on running, therefore I did not expect to endure (my) "typical" running-related aches and pains.  Fortunately for me there was a store up the block from the reception hall, so I was able to grab up a non-steroidal anti-inflammatory drug (NSAID) of choice, in this case ibuprofen. 

Suzanne can get pain relief from almost any over-the-counter NSAID (aspirin, acetaminophen, ibuprofen, or naproxen being the most common versions), whereas I am a little more picky.  I have to be.  I rummaged through the kitchen cabinet, desperately searching for ibuprofen last week, when Suzanne pulled out a box of "ibuprofen with diphenhydramine" capsules.  I graciously declined, and informed her that the Benadryl she offered along with the ibuprofen would make the ache go away to my satisfaction, but I would be on the couch for the afternoon.  Sometimes I'm anal retentive like that.  (One of the few times where my 14-year medical transcription career was beneficial after college.)

So why can some folks take any NSAID and others (like me) require a specific compound? 

When we do damage to ourselves the body begins to repair the damage through the inflammatory response.  This response involves the release of enzymes and chemicals which begin the restoration of damage...and transmit "it hurts when I do that" messages to the brain so we will stop doing what hurts.  NSAIDs are divided into two categories: selective inhibitors and non-selective inhibitors, based on the enzyme which is inhibited from production (and transmission), known as COX-1 and COX-2.  Inhibit the COX-1 enzyme too much and you run the risk of ulcers, stomach bleeding, and prolonged bleeding time.  Most of the over-the-counter NSAIDs are pretty much non-selective, which means they inhibit  both enzymes in varying degrees.  Selective inhibitors (all of which require a prescription) focus more closely on the COX-2.  Runners who might be taking drugs to thin their blood, or bruise easily might want to take an NSAID other than aspirin, since aspirin can slow the clotting of blood for 4-to-7 days, where other drugs only slow blood clotting for a few hours.

The best over-the counter NSAID for each person, like any training plan or shoe, depends on age, cause and severity of the pain, as well as what your stomach can tolerate.  After a week take the time to figure out if the drug helped ease the inflammation with no side effects.  A single-blind test of over-the-counter NSAIDs found naproxen gave greatest relief from pain, followed by aspirin and ibuprofen.

But NSAIDs do not heal pain, they decrease the inflammatory response and the pain messages sent to the brain.  No drug can replace the common sense factors of rest, analysis of what caused the pain, and correction of the causes.  After you figure out what happened then it's time to get back out on the road.

Instant Running?

I was "batching it" last week, as Suzanne was out of town at an internet telephony conference.  There are benefits and drawbacks to these one-week separations.  The benefit, I guess, you could say, is that I become sort of a hermit; I focus all of my attention on taking care of the dog, as well as my training runs/cross-training.  That meant I had to wake up early enough to feed and walk the dog before getting ready for work.  We do have a coffeemaker with a timer on it, which if I prepare accordingly will awaken me with the aroma of mountain-grown goodness.  Unfortunately, we ran out of "real" ground coffee and I had to settle for freeze-dried instant coffee. 

When you're desperate enough, even freeze-dried coffee tasted pretty darn good.  I wrote myself a little mental note: "stop at the local grocery by the gym; don't forget the beans, stupid."  But, naturally, all I wanted to do once my afternoon workout was completed was get home, change out of my wet soppies, feed the dog and grab a cold beer.  Each morning I kicked myself in the behind for my laziness.  Each evening I conveniently forgot the need to go to the store.  Until Suzanne got home and we needed to go shopping to replace the freezer-to-table, microwave-friendly entrees with frozen veggies, bread, meat, and our other "real" food staples.  Oh, and beer.

We are a lazy, "instant" generation.  I can hear all of the responses from here:  "Duh," you say.  Microwave ovens make freezer-to-table entrees possible for even the most ham-fisted and inept of cooks.  Writer/chef Anthony Bourdain dedicates a chapter in his book "Medium Raw" to the need for culinary literacy for all persons, not just married women.  Face it.  You never know when you're going to have to fend for yourself. 

But we always have a deadline standing in our face; a target which we need to hit at least once a year, sometimes twice.  How many persons do you know who race one event a year; train for six weeks, eight weeks, do the race, then nothing for the next 40. 

It happens every October in my workplace.  The training manager who works next to administers the twice-yearly fitness testing and weigh-in.  If I had a dollar for every time an instructor questioned him, "how soon do I have to be fit?"  Duh.  Isn't that part of your profession?  Aren't you supposed to be ready to go do your job whereever your employer (and mine) tells you? 

The great New Zealand running coach Arthur Lydiard didn't have a lot of nice things to say about American runners, which probably had a lot to do with the American "overnight success" mentality.  He said that to become a good runner (besides winning the genetics and parenting lotteries) it took "...a lot of hard work for five, six, or seven years.  There is no secret formula.  There is no shortcut..."

Unless you're participating in a program where there's at least one pop icon serving as a judge, I cannot think of any other "American Idol." "The Voice," or "X-Factor," I can think of no human endeavor where success occurs quickly or instantly.  Definitely not running, as I've seen while watching the ups and downs of guys like Dathan Ritzenhein.  Or in rehabilitation; my own stumbles and failures have made me much more compassionate, or at least emphathetic, to the struggles of persons who "would love to run" but are perplexed by physiological, psychological, or economic (and when I say economy, I'm talking time, which definitely is a limited commodity) barriers.

It's easy to go the "microwave" route and focus on running for that all-too-brief period of the year, ending up with something that really doesn't satisfy the taste buds and looks like, well, like something that's been microwaved.  There are smells, sights, sensations and feelings which can be found from running throughout the year...even if most of the mileage is done on a treadmill...which we all need to "read," to "loan out" to our friends, and perhaps to "write about" on occasion.

Pump Up Or Chill Out Pre-Race? It's Not That Big A Stretch

In Running With The Bulls, Chris Lear describes a scene at a collegiate cross-country meet where one team huddled up before the start and chanted "Motivate!  Motivate! Ooh, aah, gonna kill somebody!  Ooh, aah, gonna kill somebody!"  The Colorado University coach or one of the runners made a comment along the lines of "yeah, that's going to work..." 

I can't say I've seen anything quite that agressive when I've looked across the start corral, but then again, I haven't been inside the music player of every running enthusiast.  There are most likely as many shades of "pump-up" or "cool-down" on race day as there are shades of race-day attire.  So what is the best state to be in so you can run your best race?

Donohue, Miller, Beisecker, Houser, et. al. (2006) studied the effects of brief yoga exercises and motivational preparatory interventions in distance runners.  They had participants to a one-mile baseline run, then randomly assigned them to participate in either brief yoga exercises, motivational shouting exercises, or no preparation about 20 minutes before a second one mile trial. 

Participants assigned to the motivational intervention improved their running performance significantly more than those assigned to the other two conditions (British Journal of Sports Medicine, Vol. 40, Ed. 1., Jan 2006).  But if you're not into screaming bloody murder just before a race to pump you up, perhaps you might want to try the yoga. 

Men's Journal magazine provides a series of yoga poses they, and coach/author Sage Rountree, propose will "make you a better runner, improve running form and balance."  While Rountree is quoted in the article, "We're not trying to get runners to touch their toes or get their feet behind their head," there's a yoga pose where the runner takes their leg behind their head.  "We're trying to keep them fluid through the range of motion they use for running," she says, "so there isn't a hitch in their stride" which leads to lower extremity overuse injuries.  Some of the poses are below.  If you are interested in the rest of the poses you can either grab up the September 21 edition of Men's Journal or check on-line at  http://www.mensjournal.com/expert-advice/10-yoga-poses-for-runners-20120921#ixzz283da22FR

Low Lunge - To get into the Low Lunge, put one foot forward and lunge so that the front knee is over the front ankle and the back knee is down. Move the hands from the floor to the knee and, if steady, overhead. Hold the position for five to 10 breaths and then switch legs (always do both sides in yoga).  This position works all kinds of muscle groups – thighs, groin, abs – and improves flexibility in the split-legged position that's similar to a running stride.

Low Lunge With Twist - From the Low Lunge position, Twist your torso toward the front leg, putting one palm on the ground and the other hand on the knee. Hold for five to 10 breaths. This will stretch the outer hip and the IT band of the front leg, both of which tend to be tight in runners. The twisting should also relieve some tension in the lower back.

Downward-Facing Dog - Start on the hands and knees, with your knees below the hips and the hands just in front of the shoulders. Then, walk your knees back six to 10 inches, turn the balls of the feet to the floor, spread your fingers wide against the mat, and lift your hips into an upside-down V. Hold for 10 breaths.  This is a traditional yoga pose that lengthens your back and stretches everything from the arches up through the shoulders. It also builds upper body strength so you don't end up with tree trunk legs and broomsticks for arms.

Child's Pose - This is a mild stretch for the lower body which can also help with focus and relieve tension. Get into a kneeling position. Then lay your stomach on your thighs and put your head on the ground. Your arms can be lengthened in front of you or simply rest, fingers pointed behind, next to your legs. You should feel lengthening through the back and stretching in the hips, thighs, ankles, and feet. This is a resting position, so you can hold for 10 breaths or stay longer.

Squat - Also called the Garland Pose, the squat in yoga isn't all that different from the one you've done at the gym, form-wise. To get into the position, squat with your knees over your toes – legs at a 45-degree angle from the midline – and hold your hands together like you're praying. The heels don't necessarily need to touch the ground. Hold for five to 10 breaths. The squat stretches the back, inner thighs, calves, and feet – everything that tightens up from running. This encourages a fluid range of motion and helps with plantar fasciitis and ITBS.

Locust - The Locust is a simple and essential pose for distance runners. To do it, lay on your stomach with your hands by the hips, then lift your torso, arms, and legs simultaneously. Hold this for five to 10 breaths and repeat three times.  It's not as easy as it looks. This position strengthens the muscles in your neck, back, and the backs of the arms and legs. You'll find that it improves your posture, especially toward the end of a marathon-length run, when those core support muscles start to give way. Plus, you'll have a little more protection from lower back injuries.

Legs Up The Chair - Legs swell, sometimes for a few days, after long runs. You can wear compression socks, which seems a little silly during warm summer months.  Another way to help the body recover is to move your seat to the base of a chair or coffee table and rest your calves on top of it so that you have 90-degree angles at the knees and hips. Stay there for 20 breaths or more. This will help with cramped, swollen legs, and will also encourage relaxation after an intense run.

Rountree also believes yoga improves focus before and during the race, when mental staying power is as important as physical endurance.  Her most recent book is "The Runner's Guide to Yoga," and is published by VeloPress.