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rec.running FAQ, part 4 of 8

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Archive-name: running-faq/part4
Last-modified: 10 Mar 2003
Posting-Frequency: 14 days

See reader questions & answers on this topic! - Help others by sharing your knowledge

Medical / Injuries

-------------------------------- Achilles tendonitis (sorry, forgot the

General advice:

1. Warm up before you stretch. This could be in the form of a slow jog as
you start your run. When I feel it necessary, I stop for a few minutes and
stretch during the early stages of a run.

2. Stretch after your run. This has proven the best solution for me.
Whenever I skip this part, I end up stiff the next day. The muscles are
nice and warm after a run and respond well to stretching. My flexibility
has improved as a result of this practice, too.

3. With regards to an injury, you've got to be tough and rest it in order
for it to heal. This might be a good time to concentrate on strength
training with weights.


The good news: since this seems to be your first injury, and your training
load is light, your tendinitis is probably due to the most simple cause -
leg length imbalance. Get someone to mark how far you can bend to each
side, if these are different heights then you might find a heel raiser
under the bad leg will both even out the side-bend _and_ speed up the

The bad news: achilles is notoriously slow to heal even with the correct
treatment. And the chances of recurrence are quite high. However the
condition you describe shouldn't prevent your training, as long as you
promote healing with stretching, massage (calf/inner thigh/groin), ice,

Shin splints (Harry Y Xu (Doug Poirier
os2user@dougp.austin (Rodney Sanders

Excerpts from _The SprotsMedicine Book_ G. Mirkin, MD. and M. Hoffman:

``Shin splints are....condition that can result from muscle imbalance. They
are characterized by generalized pain in front of the lower leg and are
particularly comon in runners and running backs.... The most common cause
is a muscle imbalance where the calf muscles--which pull the forefoot
down--overpower the shin muscles--which pull the forefoot up. As the
athlete continues to train, the calf muscle usually becomes proportionately
much stronger than the shin muscles.

The treatment for shin splints is to strengthen the weaker muscles (shins)
and stretch the stronger muscles (calves).

To strengthen the shins, run up stairs. To stretch the calves,...(do
stretching exercises for the calves, et. the wall push-ups)'' *end of


In my experience, I have found that stretching is the real key to avoiding
shin-splints. I believe there's a book with stretches by Bob Anderson that
you may want to check. Also, back issues of running magazines sometimes
have helpful information. Basically, I do the standard "lean on the wall
stretch" and a stretch by standing flat-footed on one leg and bending at
the knee to stretch the achilles. I then top these off with a few toe
raises (no weights!) before I head out to run... If you're having trouble,
I'd recommend stretching 2-3 times a day until you get over the problem.
Start slowly!

Also, you probably should avoid hills and extremely hard surfaces until the
situation improves. I've known several people who've had shin splints and
gotten over them by stretching. (Of course, you should be careful in case
the shin splints are the result of a more severe problem...)


Help with shin splints.

1. Try picking up marbles with your toes and holding onto them for a few

1A. While recovering from shin splints, it may help to use a wedge in the
heel of your shoes. By raising the heel, you are reducing the pull on the
muscles and tendons on the front.

2. Stand on the stairs with your heels out over the edge. Lower your heels
as far as they will go without undue discomfort, and hold for 15 seconds.
Slowly raise yourself up on your toes. Repeat 5 million times. (Sherwood

3. If you can, rig something with either surgical tubing or a large
rubberband. For example: put the tubing around one of the back legs of your
desk in some sort of a loop. Reach under the tubing with your toes, with
your heel as a pivot pull the tubing toward you. This will work the muscle
in the front of the shins. Repeat 6 million times. It's easier than the
stair exercise

4. Run on different terrain, preferably grass. It'll absorb the shock.

5. This normally affects knees, but it might affect shins. Don't run on the
same side of the road all of the time. It is sloped left or right to let
the water run off. Running on the same slope for long periods of time will
cause adverse effects to the ankles, shins...etc.... If you are running on
a track, alternate your direction of travel, as the lean when you are going
around the corners is at least as bad as the crown slope of a road. This is
especially true of small indoor tracks.

6. Strenghening the front muscles: Make a training weight by tying a strip
of cloth to a pop bottle. Sit on the kitchen counter top, hang bottle from
toes, and raise it up and down by flexing your ankle. Weight can be
adjusted by adding water or sand to the bottle. (Sherwood Botsford

7. Scatter a few chunks of 2x4 around the house where you tend to stand,
say kitchen and bathroom. Now everytime you are at the stove or at the
bathroom (in front of either fixture) stand on 2x4 and rest your heels on
the floor. One in front of the TV and used during every commercial will
either stretch you, or stop you from watching TV.

------------------------------ Side stitches (Jack Berkery

The Latest Word on Stitches

In the May-June 1992 issue of Running Research News there is an article by
Dr. Gordon Quick about the causes of and cures for stitches. To summarize:

1) Stitches are a muscle spasm of the diaphragm. The cause of the spasm is
that the organs below it are jouncing up and down and pulling down as it
wants to pull up. The liver being the largest organ is the biggest culprit
which is why most stitches are on the right side. A stomach full of food
may also contribute to the problem for the same reason. Stitches also occur
more often when running downhill or in cold weather.

2) The cure seems almost too simple. Breathe out when your left foot
strikes the ground instead of when the right foot strikes so that the
organs on the right side of the abdomen are jouncing up when the diaphragm
is going up. The organs attached to the bottom of the diaphragm on the left
aren't as big, so exert less downward pulling strain. If this is not enough
to get rid of it, stop and raise you arms above your head until the pain
goes away and when you resume, be a left foot breather. (Conversely, if
your stitch occurs on the left side, switch your breathing to exhale on the
right foot.)

3) Do not eat anything for an hour before running if you are prone to
stitches, BUT PLEASE DO DRINK WATER. Water empties from the stomach faster
than solids and the risk of complications from dehydration far exceed the
problems one may have with a stitch.

4) In the long term, exercises to strengthen the abdominal muscles will
help prevent stitches because tighter abs will allow less movement of those
internal organs. Practice belly breathing instead of chest breathing as
recommended by Noakes. For the most part, stitches diminish over time.
While they are not strictly a novice runner's problem (about 1/3 of all
runners get them from time to time) they usually will go away after a few
weeks of conditioning.


By Tim Noakes Oxford Uni. Press, 1985. Quoted  from "Lore of Running"

Proper breathing prevents the development of the `stitch'. The stitch is a
condition that occurs only during exercise and which causes severe pain
usually on the right side of the abdomen, immediately below the rib margin.
Frequently the pain is also perceived in the right shoulder joint, where it
feels as if an ice-pick were being driven into the joint. The pain is
exacerbated by down-hill running and by fast, sustained running as in a
short road race or time trial. For various complex anatomical reasons, the
fact that the stitch causes pain to be felt in the shoulder joint suggests
that the diaphragm is the source of the pain.

It has been suggested that when breathing with the chest too much air is
drawn into the lungs, and not all is exhaled. This causes a gradual and
progressive accumulation of air in the lungs, causing them to expand which
in turn causes the diaphragm to be stretched and to encroach on the
abdominal contents below it. During running, the over-stretched diaphragm
becomes sandwiched between an over-expanded chest above, and a jolting
intestine pounding it from below. It revolts by going into spasm, and the
pain of this spasm is recognized as the stitch.

Although there is really not a shred of scientific evidence for this
belief, I have found that diaphragm spasm is almost certainly involved in
the stitch and that belly-breathing can frequently relieve the pain.

The runner who wishes to learn how to belly-breath should lie on the floor
and place one or more large books on his stomach. He should concentrate on
making the books rise when he breathes in and fall when he exhales. As it
takes about two months to learn to do the movement whilst running fast, it
is important to start practicing well before an important race.

A change in breathing pattern may help relieve the stitch. Within a short
period of starting running, breathing becomes synchronized with footfall.
Thus one automatically breaths in on one leg and out when landing either on
the same leg - that is 2, 3 or 4 full strides later - or on the opposite
leg - that is 1 1/2, 2 1/2, or 3 1/2 strides later. Thus the ratio of
stride to breathing may be 2:1, 3:1, 4:1; or 1.5:1, 2.5:1, 3.5:1.

This phenomenon was first reported by Bramble and Carrier (1983). Of
particular interest was their finding that most runners are `footed', that
is the beginning and end of a respiratory cycle occurs on the same foot,
usually in a stride to breathing ratio of either 4:1 whilst jogging or 2:1
whilst running faster. Runners then become habituated to breathing out on
the same let, day after day. This produces asymmetrical stresses on the
body and could be a factor in both the stitch and in certain running
injuries. I am `left-footed' and have also suffered my major running
injuries only on my left side. If changes in breathing patterns do not
prevent the stitch then the last step is to increase abdominal muscle
strength. The correct way to strengthen the abdominal muscles is to do
bent-knee sit ups with the feet unsupported.


EDITORS NOTE: Readers response to "Belly Breathing" definition above.
"Belly Breathing" (Lamont Granquist

While I wasn't breathing with my chest, I wasn't really "Belly Breathing".
When I exhaled, what I was doing was pulling my stomach muscles in. I found
out that this is *not* the way to "Belly Breathe". The idea is to throw
your gut out as much as possible -- try and look as fat & ugly as you can
when you run. For the suggestion in the FAQ of lying on your back and
lifting a book, it should probably be noted that when exhaling you want to
try to keep the book lifted up (of course naturally, you don't want to try
to do this all so hard that it becomes difficult to exhale -- the idea is
that breathing this way should be comfortable).

Stitches continued (Sunil Dixit

1. Since it is a cramp, I try not to drink or eat too soon before my runs,
and I try to limit my intake during runs.

2. I stretch my abs extensively before a run. Putting my arm over my head
and leaning to the opposite side until I'm pulling on the side of my
abdominals works well.

3. I regulate my breathing by breathing in through my nose, and out through
my mouth. This sounds like zen-crap, but believe me, it works amazingly
well in eliminating all types of cramping. When you first do it, it'll feel
like you're not getting enough oxygen, but if you persist the technique
will become very comfortable.

4. I run with my back fairly straight, even up hills. This keeps the lungs
from bending over in my body, and makes it much easier to breathe.

5. If none of these work, I keep going anyway. After about 3 miles, it
usually goes away . . . if you're lucky.

------------------ Lactic Acid (Rob Loszewski

"Lactic acid buildup (technically called acidosis) can cause burning pain,
especially in untrained muscles. Lactic acid accumulation can lead to
muscle exhaustion withing seconds if the blood cannot clear it away. A
strategy for dealing with lactic acid buildup is to relax the muscles at
every opportunity, so that the circulating blood can carry the lactic acid
away and bring oxygen to support aerobic metabolism. ...much of the lactic
acid is routed to the liver, where it is converted to glucose. A little
lactic acid remains in muscle tissue, where it is completely oxidized when
the oxygen supply is once again sufficient." Understanding Nutrition, 5th
ed., Whitney, Hamilton, Rolfes., West Pub. Comp. 1990, pg402- 403.

------------------ Loose Bowels (Rodney Sanders

Some general advice to take care of loose bowels.

(1) Look for offending foods in your diet. For example, many people have a
lactose intolerance which can cause all sorts of fun if you had a triple
cheese pizza the night before the run...

(2) If you run in the morning, eat lightly and early the night before... I
try to make sure I eat the least problematic foods close to my workouts...
I've personally found baked chicken/fish, baked potatoes, and pasta with
light sauces (no alfredo!), to be pretty good...

(3) I read that Bill Rodgers drinks a cup of coffee in the morning before
heading out...The caffeine stimulates one to take care of things completely
before getting out...This has helped me when I run in the morning....

(4) Carry a wad of toilet paper with you!

I suspect that if you monitor your diet closely, you'll probably find
something that makes the problem worse than at other times and you can
avoid that food...

Some other advice: (Sanjay Manandhar 1.
Less fiber in the diet 2. Run repeats on small loops.
3. Note all the washrooms along the route. 4. Time of day. For me, mornings
are bad. In the evening runs the problem is infrequent. 5. A primer run. If
I have to run in the mornings, I run 1 mile of primer run so that the
bowels can be taken care of. Then I start my real run.

----- Diabetes & Running (Timothy Law Snyder

Oops, here is what makes virutually every person with diabetes bristle:
MYTHS of diabetes!

Not to flame Jay, but diabetics can (and do) eat as much sugar, drink as
much booze, and run as many marathons as anybody else. The challenge is
that they must manage the delicate balance between insulin (which lowers
blood sugar), food (which raises it), and exercise (which, because it
stokes up the metabolism and makes the insulin "rage") lowers blood sugar.
Timing is important, and sometimes, due to the millions of factors that are
at play (and _not_ due to negligence), the blood sugar will go too high or
too low.

Before a run, a person with diabetes (nobody in the know calls them
"diabetics" any more) must make sure that the blood sugar is somewhat
higher than normal. This gives a "pad" so that exercise does not result in
a low-sugar crisis. Often the runner will take less insulin the day of the
run. Before (and for long runs, during) the run some food must be eaten.
For short runs, carbos will do, but proteins and fats are also necessary
for the longer hauls.

For a marathon, one must take some sort of food during the run. A high-
carbo source like a soda works well, for the sugar is taken up immediately
and, since the beverage is concentrated, it is easily digested (relative
to, say, the caloric equivalent in whole wheat : ).

Sugar does absolutely _no_ harm to the person with diabetes (provided, they
do not ignore insulin requirements). That's right: The person could knock
off twelve sodas, an entire chocolate cake, and a bag of M&Ms, and be as
"fine" as anybody else (quotes intended---yuk!).

While I am at it, here are a couple of other myth corrections: There is no
clear evidence that diabetes is hereditary. Diabetes has _nothing_ to do
with how much sugar the person ate before acquiring the condition. People
with diabetes can (and do) drink as much alcohol as anybody else. (Alcohol
lowers the blood sugar a tiny bit, so one must be careful to not forget to
eat [and too many cocktails tend to...].)

Hope this helps. Oh, by the way, NO, the taste of something sweet does not
cause the release of insulin (save a possible [and rare] placebo effect).


Nutrition and Food (Bruce Hildenbrand bhilden@unix386.Convergent.COM) [Ed.
note: Originally appeared in rec.bicycles]

Oh well, I have been promising to do this for a while and given the present
discussions on nutrition, it is about the right time. This article was
written in 1980 for Bicycling Magazine. It has been reprinted in over 30
publications, been the basis for a chapter in a book and cited numerous
other times. I guess somebody besides me thinks its OK. If you disagree
with any points, that's fine, I just don't want to see people take
exception based on their own personal experiences because everyone is
different and psychological factors play a big role(much bigger than you
would think) on how one perceives his/her own nutritional requirements.
Remember that good nutrition is a LONG TERM process that is not really
affected by short term events(drinking poison would be an exception). If it
works for you then do it!!! Don't preach!!!!

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