IT Band Syndrome

As the weather warms up and marathon and race season approach, we start to see an increase in running related injuries in our office. A very common one is lateral knee pain, or pain on the outer side of the knee. This may be referred to as Ilio-tibial Band Syndrome (ITB Syndrome). Common complaints associated with lateral knee pain are “it hurts going downstairs or running downhill” and “it hurts more the longer I run.”

What is the IT Band?

It is a tendinous and fascial band that extends from the gluteal muscles (glutes) and tensor fascia latae (TFL). It runs down the side of the thigh and attaches just below the lateral knee.

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Why does it hurt?

Well, just like many other conditions in our bodies, the site of the pain isn’t always where the cause of the pain is. Very often, this lateral knee pain is not a knee problem, but rather a hip problem. We have many muscles in our pelvic area that move our legs and provide stability to our pelvis and hips while we are in motion. When these muscles become weak, or are not properly activated, we may lose stability in our hips causing abnormal pressure to be placed on our knees. As shown in the figure below, when the muscles of the hip are inadequate, they do not support the pelvis properly, which creates an imbalance when we walk or run.

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In the picture above, figure (a) shows this imbalance; in that the muscles on the left side of the pelvis are not stabilizing the pelvis when all of the weight is on the left leg. Therefore the right hip drops, creating too much pressure on the outside of the left knee when you walk or run. The abnormal pressure on the left knee may cause pain on the lateral or outside part of the knee.

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How do I fix it?

In the past, many practitioners have tried symptomatic treatments like stretching, massage or other types of myo-fascial release, dry needling, braces, or simply to stop running or doing what aggravates it. While these techniques may have some benefit, if you don’t correct the imbalance in the hip the knee pain may not fully resolve. If the hip problem is simply hip weakness, some simple glute strengthening exercises may be enough to stabilize the hips to take the abnormal pressure off of the knee. Below are a few examples of glute strengthening exercises.

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Perhaps you are someone that has IT Band Syndrome and has done everything you know to treat it as well as a million glute strengthening exercises, and are still having this problem? There may be other issues contributing, such as meniscus injury, ligament injury, or inhibition in your hip muscles, which are prohibiting your muscles from firing properly. In this case, you should have it assessed by a trained professional.

While IT Band Syndrome is not a serious or life threatening issue, it can be very frustrating to runners or other active people. If you are struggling with this, you don’t have to stop running or just deal with it. We treat this condition as well as many other running related injuries in our office every day and would love to help you keep functioning at your best.

Written by Dr. Goodman, Greenapple Sports & Wellness

Managing Your Marathon

The marathon distance is a long and challenging endeavor. When you embark on marathon training it takes daily motivation and many miles of running. You must stay injury-free by monitoring proper build and recovery phases. In my opinion, if you are able to accomplish the daunting feat of training for a marathon, you have already earned your finisher’s medal! But of course the reward is not complete until you cross that 26.2 finish line. There are many variables that can affect your performance and I believe there are a few things you can manage during the race to increase your chances of success. It just takes planning and follow through.

Manage Your Hydration: Depending on the weather and the individual's sweat rate, a runner can easily lose 2-4 lbs of fluid per hour! During training, you should always weigh yourself before and after a couple runs to get an idea of your personal sweat rate. I personally lose about 32 oz/hour…that's 2 lbs of fluid (1 lb = 16 oz). Once you figure out your sweat rate, make an attempt to replace at least 50-75% of your loss through the aid stations of the race. You may want to carry fluid if it's an unusually hot marathon and I would consider a hot marathon to be 60 degrees or higher. Also, make sure to experiment with electrolyte replacement in training. Low sodium primarily will ruin your day as quickly as dehydration. Salty pretzels, electrolyte tabs, or fluid replacement drinks are all great options.

Manage Your Nutrition: Secondly, you want to make sure you are good on carbohydrates. Carbs are your main fuel source. Your energy flame burns as carbs and fat. Fat is burned but much less efficiently. In a marathon, your pace is likely burning about 80% carb and 20% fat. This will vary of course depending on your fat burning capabilities. Training lower carb can be a great way to teach your body to use more fat for fuel and spare carbs for your race-day effort. Your body can store about 2,000 calories of carbohydrates ready for use, if you have carb loaded properly the week before the marathon. For example, say you hit the start line fully-loaded at 2,000 calories and you burn 125 calories per mile. At a 80/20% carb/fat flame, you're burning through 100 carb calories per mile. Therefore, if you did not take in any nutrition during the race, you would BONK at mile 20. Plan wisely by taking in some carbs during the race through fluid replacement drinks and gels. In the days prior to the race, eat a lower fat diet, rich in carbohydrates. This should allow your body to top off your carbohydrate tank that is generally half-full during training. Choose more fruits and vegetables and plenty of my favorite, POTATOES!

Manage Your Pace: Now that you've got the hydration and nutrition squared away, you must consider a marathon pace; especially if it's your first marathon. Keep in mind there is no exact predictor of a marathon finish time based on shorter distance races. Everyone's muscle types are different and the 26.2 distance brings in a crucial strength factor. If it's your first marathon, I would advise you to run at a "brisk conversation pace" for 20-22 miles. This will ensure you are running below your lactate threshold and able to finish the last few miles at or above your initial pace. This is hands down the best way to experience your first marathon. Now, if you are a veteran marathon runner and looking to set a personal best, race pace can be tricky. If you have logged the training miles, gained strength, and improved your 5-10K times can certainly push the limits. You will be able to run the marathon at or just below your lactate threshold. LT is the heart rate level, once exceeded, causes you to produce more lactic acid than your body can get rid of. The only way to know this exact heart rate is through lab testing. My tip today comes from perceived exertion. Run as quickly as you can with as little effort as you can. This means 2-3 sentence conversation pace. Feels like an 80% effort and make sure to ease back on the hills to avoid any burn sensation in the legs. By maintaining this pace or effort for 20-22 miles, you will begin to experience some difficulty. Your perceived effort level will feel more like 85%. At 85% you will likely avoid talking much and your stride length and leg turnover will become shorter and slower. Do your best to focus on the task at hand! My guess is that the training all those weeks was much much harder than surviving another 3-4 miles on sore, tired, painful legs. Finish what you started, the reward is sweet!

Happy New Year Everyone!

It was a great 2018 as we saw plenty of new faces and old faces come together working successfully through the cold, rain, humidity, and those tough TRiYON workouts. I truly believe that a healthy lifestyle, consistent training, and successful racing takes a support team to stay motivated and excited. I appreciate everyone continuing to come out in the dark morning hours and look forward to another fun year of seeing many new personal bests!

Also in 2019 I will continue to endorse YonBons. So many of you have trusted me on 50-25-25 nutrition and have been using YB's with great results. I was grateful to have the opportunity this past Summer to create them and now look forward to spreading the word.

I often use My Fitness Pal to check on macros percentages and was please to see this recent article in my inbox. It's a great simple explanation of food, energy, and training. I hope to see everyone this week at Freedom Park for a hill workout to start off 2019! Make sure to check the Wednesday workout locations listed below for our next 4 weeks!

"When you jump out of bed at the buzz of your 5:30 a.m. alarm for an early morning workout, eating breakfast might be the last thing on your mind. But after fasting all night, your energy stores are depleted — and the last thing you want to hear during a grueling workout is your stomach growl.

While simple carbohydrates found in sports drinks, energy gels and cereal provide a quick source of energy, they might not sustain you through a longer workout. Pairing these energy-boosting carbohydrates with a small amount of fat and protein is the best way to ensure sustained energy while working out. Adding in a dose of protein floods your bloodstream with amino acids right when you need them the most, allowing for muscle-building optimization. Healthy fats slow the digestion process, promoting a gradual release of energy throughout a longer workout.

The size of your pre-workout meal will vary depending on the length of your workout and your energy needs. Going for a long or high-intensity workout? Consider a more energy dense meal, but keep in mind it may take 3-4 hours to fully digest. A lower-intensity workout will require less energy. Aim for a small meal that can be digested in about 2–3 hours. But, if you’re working out early in the morning, you won’t have 2 hours to spare. Consider a 100–200 calorie snack; these will take you less than an hour to digest and won’t weigh you down"

- My Fitness Pal

Purposeful Running!

Finding a purpose to get out for a run or workout is often challenging more times than not. How do you find the motivation to start your workout? You can certainly create a habit whether it be healthy or not healthy, but if there's no underlying purpose, the habit will quickly dissolve. The feeling of burnout will come with anything that is challenging. Finding a purpose to do it can help sustain your motivation and passion.

The last several years people often ask me how or why I keep training and racing. The answer for me may not be a simple one, because when I ask myself this question, several answers came to mind. 

Here are my top TEN reasons to get out the door every day and try to find the comfort in the uncomfortable!

  1. Experiencing the reward of accomplishing the uncomfortable.
  2. Staying young and looking good for high school reunions.
  3. Putting my name on race entry.
  4. Pleasing the person waiting for me at the workout.
  5. Not having to buy new clothes since middle school.
  6. Having my kids think I'm stronger than they are.
  7. Getting to eat two turkey burgers, not 1.
  8. To run away from my phone.
  9. To test out workouts and eliminate client "feedback."
  10. Because my coach told me to.

Stay Hydrated!

The temperatures are rising so it's time to raise our hydration and nutrition game! Not only does hydration come from drinking, but also from eating healthy. In these higher temperatures and humidity levels, it is very important for us to eat right and take in additional antioxidants and electrolytes. Foods that are rich in antioxidants and electrolytes are also foods that carry extra water. In a sense, we can drink while we eat.

Electrolytes will allow our bodies to stay hydrated, operating correctly during these hot workouts. The fluid is stored and used in different areas of the body, while sodium is the electrolyte that will keep us in balance. Water tends to chase sodium, so if our levels drop, water will leave its designated area. This scary condition is called hyponatremia or "water intoxication" and can cause us to feel weak and be very dangerous in extreme cases. Let's everyone start eating those healthy fruits and vegetables and avoid burnout and injury. Here's a quick list of some of my favorites power foods:

  1. All Berries!
  2. Other fruits (bananas, plums, oranges, apricots, and grapes)
  3. Colorful Veggies (tomatoes, bell peppers, spinach, sweet potato)
  4. Whole Grains (quinoa, oats, rice)
  5. Nuts and Seeds (sunflower seeds, almonds, walnuts, chia seeds)
  6. Himalayan Salt and Seasoning!

The Benefits of Cinnamon!

Did you know that many spices have health benefits? Well it is great to know that one of our favorites is a power house! Cinnamon is a spice that comes from the bark of an Asian tree. It tastes great and is a good addition to recipes, coffee, and even desserts!

When choosing the right type of cinnamon, make sure to buy Ceylon cinnamon. Other inexpensive choices can be damaging to the liver in high dosages (Greater than 1/2 tsp per day). Ceylon cinnamon is the true champion of its kind. Here are some health benefits from adding this spice into your daily diet.

  • Rich with antioxidants which protects from free radicals
  • Fights inflammation throughout your body
  • Helps lower cholesterol and high blood pressure
  • Protects brain function helping to prevent Parkinson's and Alzheimer's
  • Fights diabetes by slowing the amount of glucose released into the blood.
  • Fights infection and viruses
  • Benefits skin health
  • Helps fight allergies

These are just some of the benefits of cinnamon as the list goes on. I personally use Ceylon cinnamon in recipes at home for the sweetness, without having to add sugar. I also use it in the TRiYON ENDURE Performance Nutrition Bites that I am producing for athletes. So enjoy your cinnamon today and know that you are eating something that is good for you!

Running Hill Repeats

Running hill repeats is a tough, challenging workout physically and mentally. I have to say it's one of the hardest workouts to face head-on in a training program. However, running hill repeats is, by far, the best fitness booster for runners. It is also the perfect cross-training for cyclists.

Our goal as runners, cyclists, and triathletes is to cover the pavement as quickly and efficiently as possible. As your body becomes fitter, it will move you over the asphalt farther with each stride and farther with each pedal stroke. Running fast on an uphill grade puts a greater stress on the glutes, hamstrings, calves, and core. This increased resistance is adding strength work to your run workout. By changing the angle of the road and allowing gravity to take its effect, you are stressing the total body and asking the heart to pump more blood per beat. I love the feeling of running hills because it has an even effect on the muscular and cardiovascular systems.

In training, we do not make big changes in our run turnover or pedal cadence, but we do in our ability to go farther per stride or pedal stroke. Hill repeats will produce strength in your run push-off and power in your cycling pedal stroke. The goal is more distance per stride and bigger gears, all at the same turnover or cadence... Getting fitter as an athlete is simply going farther at the same effort level in the same amount of time.

My coaching goal is to make you stronger, fitter, and faster. Grow stronger to be fitter, and fitter to be faster. Your efforts will not change, just the distance you cover.

Building Food for Endurance!

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The last few months I have been experimenting with a new endurance food product. With the onset of energy and recovery bars, it is very challenging to find a product that is best suited for fueling performance. Your goal in a bar should be one that provides sustained energy and a continuing recovery from training and daily activities. Common questions people ask are: 

• How many carbs should I take in? 

• How much protein does my body need? 

• How much fat should I eat?

All these questions need to be answered correctly if you want to grow stronger, recover faster, and become healthier. After 30 years of training and racing, the answer for me has been to maintain a diet that is, what I call, 50-25-25 nutrition. A diet that is lower in carbohydrates at 50%, rich in protein at 25%, and rich in healthy fats at 25%. Through this macro breakdown you can teach your body to be an endurance, fat burning machine and experience lean muscle gains while losing unwanted body fat. 

My mission is to provide you a healthy “on the go” snack that will steadily fuel your workouts and help you recover throughout the day. It’s an hourly boost before, during, and after workouts and is the perfect energy boost between meals. 

The Benefits: 

• Helps you maintain high levels of mental clarity and focus. 

• Provides preventive ingredients which fight inflammation and disease. 

• Improves endurance and teaches your body to use fat for fuel. 

• Speeds recovery by optimizing ongoing muscle restoration. 

Look forward to your feedback!