NEW BLOG LOCATION

Hello readers!

Thank you for taking the time to take in my articles over the last 5 years.  I have loved sharing what I have learned.  The questions and feedback from all of you have triggered even more learning on my part which has been a massive added bonus.  Let's keep this great relationship going!

My blog, from this point forward, will now be found at www.drdelanghe.com/news

The change is simply to allow for my website and blog to be in one convenient location along with some updated formatting and development options.  This blog, with 5 years of content, will stay live for your reference and reading pleasure for years to come.

Thanks again for reading, and we'll see you at the new site!

Dr. Sean Delanghe

Maybe You Shouldn't Change Your Stride (Part 3)

Throughout the last few months, my articles have been focused on how we ought (or ought not to) alter our stride to enhance running economy.  Last month, for instance, I looked at stride length, and how deviating from a naturally selected length will likely make you slower.

This month, I will address one aspect that I have mentioned in my previous posts: vertical oscillation (i.e. bouncing up and down as we run).

Vertical oscillation has always been one of the features of a stride that I think should be corrected if the vertical translation is excessive.  The research is clear, and logically it makes sense: if you waste energy shooting your body up into the air, you will have less energy to propel you forward.  The idea of a seemingly relaxed and tranquil upper body floating over spinning legs is the image we see amongst the best in the world, and something we should strive for.  BUT, is cutting vertical oscillation out entirely needed, or even beneficial?  Let's see what the research says:

Read the rest on the WRS Blog HERE

Maybe you shouldn't change your stride (Part 2)

Last month I gave an introduction into gait analysis, and a general idea of when one should change their stride.  The take home message was that generally speaking, there are times when extreme form flaw can be identified and should be corrected.  However, it is also apparent that there is a wide range of what is acceptable, a range that is MUCH broader than we have been led to believe.  Altering your natural rhythm to to achieve a narrow view of the perfect stride can decrease running economy and increase injury risk.

Over the next few blog posts, I will be exploring some specific components of form.  Today I will take a look at what the research shows about stride length.

Read the rest HERE on the WRS blog.

Maybe you shouldn't change your stride (Part 1)

Something I get asked a lot about is how to improve running form to enhance performance. I figured the best way too approach this very complicated issue is to do a series of posts over the next 2-3 months. This first post will simply be an introduction into the concept of what exactly a “perfect stride” is and to try to challenge some of the conventional tips that have been engrained into us.

The fact of the matter is that there definitely are key (and somewhat obvious) movement patterns that can have a clear detrimental impact on running performance and/or running economy. For example, we know that excessive arm motion will decrease running economy (for example, read more here). We also know that a crazy amount of vertical oscillation (bouncing too much up and down) will also decrease running economy (as shown, for instance, here).

However, I think in popular running culture, there is definitely an overemphasis on achieving the perfect stride. I also think there is low level of appreciation for how trying to fight your natural rhythm can often do more harm than good. What looks pretty and symmetrical is not always what is best for your individual anatomy.

Read the rest on the WRS blog

GAMING VS RUNNING: WHICH MAKES US SMARTER?

Whenever I get back from a run, I typically feel as though I can think with more clarity and work more efficiently. Not only that, I have sometimes gotten the impression that if I go for a run, my retention of newly learned information skyrockets. That’s why during my days as a nerdy chiro student, I would try my best to separate intense study sessions with run breaks. Is there any truth to what I experienced, or am I actually just finding creative reasons to procrastinate via running when I don’t feel like working?

That’s what I am looking at with today’s article: memory performance in those who go for a run vs. those who play Counter Strike.

CLICK HERE to read the rest on the WRS blog.

Does beetroot juice make you run faster?

A large part of what I focus on in this column is how you can alter your training to enhance performance. Training-schmraining…wouldn’t it be nice if there were ways to enhance performance without putting in any extra effort? Unfortunately, most effortless strategies that make as faster are dangerous and against the rules (EPO, blood doping etc.). There are a few, however, that are allowed and 100% work. One is the use of caffeine as I have written about here. Another ergogenic aid that is coming to the forefront of the literature is beetroot juice. With the more I read, the more it seems that under the right circumstances it actually works.

CLICK HERE to read the rest on the WRS blog. 

HOW DOES YOUR HILL RUNNING TECHNIQUE COMPARE TO ELITES’?

Happy New Year readers! With 2016 finally upon us, it’s time to start laying down base training for a successful year of racing. During this early phase of your year, it’s a good time to think about and train things that you really don’t have time for during the race season. One of these components: our running biomechanics.

I want to preface this article by saying that I think one has to be careful when consciously making an effort to significantly alter form. Firstly, researchers have shown that when you try to significantly alter your gait (i.e. during the barefoot running craze, trying to change to a forefoot strike from a rearfoot strike), not only did many runners become more injury prone, but their running economy went down (at least for a while) when battling their natural biomechanics.

CLICK HERE to read the rest on the WRS blog

HOW NUCLEAR BOMBS TELL US TO TAKE TIME OFF

The off-season is officially upon us! YA. Time to dial back the volume and intensity, take care of low-grade injuries, get back to other aspects of training you’ve missed, and just generally take it easy and dream up performances to come in 2016.

At our club, Health and Performance, I have seen a number of different approaches to the off-season from our athletes. Some are still hammering, some are decreasing volume and intensity to varying degrees, and others are 100% taking time away from running. Deciding how to manage your off-season is a complicated decision based on a number of factors (injuries, 2016 goals, mental fatigue, level of performance/training in 2015, complicating non-running things) that probably only YOU know all the details of.

However, no matter who you are, I still strongly suggest that some time away from running entirely (1-3 weeks) is a good idea. There are a number of reasons why I say this, but I was once again reminded of the importance of time off when a colleague sent me this study looking at the rate of cellular turnover in different cells in our body...

Read the rest HERE on the WRS Blog.

The Alkaline Diet: Should you be testing your urine?

With the off season approaching, it’s time to start thinking about making small changes that can help you to improve upon your 2015 running performances. One area that’s always good to strive to learn more about: diet.

On this topic, one of my pet peeves revolves around fad diets based on cool sounding pseudoscience that over-simplify what it actually takes to consume a well-rounded, complete, healthy diet. In reality, it’s a challenge to consume a diversity of fruits and vegetables, consume adequate but not excessive calories, jam in enough protein, etc. Even though this is a challenge, and sometimes seemingly impossible, it is not a reason to stop striving to achieve it.

I think that while most of us know this, when the going gets tough, these over simplified fad diets can suck some of us in.

Read more on the WRS Blog HERE

The three keys to fueling your marathon

The fall marathon season is almost upon us! With only a few weeks to go for many of you, it’s time to taper, to let the body recover and to get ready for battle. At this point it’s difficult to make any significant fitness gains, so dial back on that running. It is, however, quite easy to do a number of different things that can sabotage your performance. One of these detrimental decisions is not managing your race day nutrition properly.

Usually I present novel research studies in this column, but today I am going to give you a breakdown/reminder of what to do during your race to optimize performance. It is important to make a nutrition plan and stick to it. Going by hunger or the desire to consume food will leave most runners not consuming enough and therefore not running to the full potential of their current level of fitness.

When it comes to the research there is a lot in sports nutrition that we do not know (i.e. when exactly is beet juice helpful, if at all), and these areas need more time for definite guidelines to be established. Fortunately there is a lot that we do know for sure, and have been proven to make any runner faster. Here are the three most important nutrition rules to following during your marathon:

Click HERE to read more on the WRS blog

The gender gap in running

At the 2015 ENDURrun, we had a number of different spirited challenges within our Health and Performance team. One was a very entertaining and fun challenge between a loving/ ruthlessly competitive couple- Howie and Manny. Howie ended up taking the 160K, week-long challenge by 19 minutes, or just under 2%, after around 16 hours of racing. We also had an all-women’s team who were up against all the boys as they were the only 100% female crew. They posted a 4th place time of 13 hours, 23 minutes. This put them about 2 hours 8 minutes back of the first place team (they would have to be about 16% faster to catch them), and 17 minutes off the podium (they would have to be just over 2% faster to sit in 3rd)

CLICK HERE to read the rest on the WRS blog.

Are you running slow enough?

In the past, I have written about the importance of interval training to improve running performance.  Yes, it is very important to hammer above your lactate threshold a couple of times per week depending on where you are in your training to get the most out of your body.  This is the gold standard of any good performance-oriented running plan.   These are your key workouts, and must not be missed.

That being said, there is still a way to mess up your other runs, and that is by going too fast!  Your recovery runs and long runs, for the most part, need to feel slow.  This is a rule that most runners know, have read about, completely understand, but it still seems to be one of the top challenges that I see competitive people struggling to conquer.  After all, it feels good to run 10-15s/K slower than your 10K race pace for an 8K off-day.  It feels fast, the effort is up but manageable, and seeing a close-to-race effort without struggling excessively always provides a nice mental boost.

In this article, I am going to provide an overview behind the physiology of why the long run and recovery runs should be slow.  It's nice to know the rule, but understanding the physiology will help you stick to that rule and slow things down.

Read the rest on the WRS Blog HERE

Do altitude tents work?

Every runner has heard of altitude training.  The principal is simple: go somewhere high up where the air is thinner and force our bodies to adapt to the decreased oxygen concentration.  These hypoxic conditions stimulate a release of the hormone EPO which causes a spike in the production of red blood cells, increasing the oxygen carrying capacity of our blood. To no surprise, an increased oxygen carrying capacity of our blood enhances performance by improving delivery to our oxygen starved running muscles as we push our limits. It’s legal blood doping!

Many of us have dreamed of getting this extra boost to our performance, but simply do not have the resources or opportunity to disappear to a high altitude location.

Enter the altitude tent.

CLICK to read the rest on the WRS blog.

Why the sit-ups must stop!

There are many uncertainties in healthcare, but this isn’t one of them: sit-ups are not good for your back.

Understanding that sit-ups are bad for the lumbar spine is not a new development. Yet, for some reason, we still do them. I see it all the time in practice– leg and back pain triggered (or at least aggravated) directly by flexion dominant core routines that include the sit-up.

Why? I think sometimes it’s because if we can’t visualize why something is bad for us, it’s harder to stick to the habit. Blindly following a rule is tough, but understanding why the rule is there makes it much easier to abide by. Hopefully this article helps to give method to the no sit-up madness.

CLICK to read the rest on the WRS blog.

Is pain slowing you down?

As you read this (as long as you are reading it in the first full week of May, 2015), a local runner named Charlotte Vasarhelyi is trying to conquer a 6-day running event.  The premise of the event is simple: ignore your brain and its valiant efforts to slow you down and keep running.  Do this for 144 hours straight.

While many of us will never pursue the 6 days of pain that Charlotte seems to thrive under, we all could still learn a lot from her ability to psychologically conquer the impulse to slow down.  Back in 2013, I wrote an article for Canadian Running taking a closer look at Charlotte along with general coping mechanisms runners possess and can develop to beat pain and its maniacal quest to slow us down.  The following is one of the drafts from the article...

READ THE REST ON THE WRS BLOG HERE

FIX YOUR CHRONIC TENDON PAIN BY LOADING IT

Chronic tendon pain is something most runners face at one point or another.  When the injury is acute, there is obvious inflammation and tears in the tissue.  Time, relative rest, ice and a gradual return to running usually does the trick.  These are cases of tendinITIS.

However, once pain persists beyond 6 months, the origin of that pain completely changes.  I have written about the subject before here.  In summary, the tears and inflammation are gone.  The pain persists from a not entirely known mechanism which includes lingering pain neurotransmitters that no longer belong in the tissue, and new blood vessels penetrating into the tissue and bringing pain sensing nerve fibers with them.  The tissue is hypersensitive.  It has healed after 6 months, but it has not “learned” to be normal again.  These are cases of tendinOSIS.

The reason I am bringing this up because I just came across a review study that puts into question a commonly recommended treatment protocol: eccentric loading.  Eccentric loading involves putting force through the tissue you are wanting to rehab as you take it from its short to long position.  Almost 4 years ago I wrote about the importance of using eccentric loading, and it is something that the research has supported.  However, eccentric loading, as I have seen in practice and have long suspected, may not be the magical movement we once thought.

READ THE REST ON THE WRS BLOG

HOW COMMON IS A REARFOOT STRIKE?

What’s better, a forefoot or a rearfoot stike?

This is a complicated question and one that I get asked quite frequently.  It’s a topic I have avoided writing about on this blog until now because it is impossible to tackle and do the debate justice with just one post.  Sometimes topics area easy to summarize with clear conclusive statements, such as “toning shoes are bad.”   Rearfoot vs. forefoot strike is a little more complex.

Gradually, overtime, with multiple posts, I hope that I will be able to answer many of these questions.  With today’s post, all I want to do address the prevalence of each strike type and the associated importance.

READ THE REST on the WRS BLOG

Why does strength training make us faster?

Last month, I wrote an article looking at the impact strength training can have on our running performance.  In essence, the studies I presented showed that weight training, specifically high weight low rep, is great for boosting running economy.

Why does strength training impact our running economy?  There are a few mechanisms of action that experts suspect are at play.  For me, understanding these mechanisms really helps to solidify the importance of strength work as part of a training plan.  Getting to the gym is tough- picturing what you’re doing to your muscles makes it a little more palatable!

READ THE REST on the WRS blog.  

STRENGTH TRAINING OR PLYOMETRICS TO IMPROVE YOUR RUNNING ECONOMY?

It’s the off-season!  Does your training look exactly the same as how it does during your competitive months?  If your goal is to be as fast as possible, it shouldn’t!  One of the best training tools that runners should use during the off-season (that is a little more risky/costly to use during your competitive season) is strength training.

I am not going to waste your time preaching about how strength work is better than no strength work.  It think all runners know that whether you are doing high rep low weight, low rep high weight, or explosive/plyometric/jump training, adding some sort of strength training will make you run faster.

CLICK HERE to read the rest on the WRS blog.  

How well to compression socks work?

At the beginning of November, I was lucky enough to have the opportunity to run the 2014 NYC marathon.  I had a blast racing the event, but as I write this article, my legs are yet to functionally bend at the knee thus rendering stair walking a hilariously debilitating act (hilarious for those around me anyway).  Time to speed up the recovery process…but how?  Today I am going to take a quick look at using compression socks.

How compression works

Researchers now understand that compression socks help with recovery, to a small degree, when used after a hard effort.  The mechanism of action is simple: it helps to prevent pooling of blood and facilitates better venous return (aka enhanced blood transportation from the legs back to the heart).  The reason why this works is because veins (the blood vessels that feed blood back to the heart) do not have muscular walls like the arteries that bring blood away from the heart.  So, while arteries actively help to pump blood away, veins rely on that momentum generated by the heart and arteries, and simply act as passive channels to bring the blood back.

CLICK HERE to read the rest on the WRS blog.  

CAN YOU LISTEN TO THIRST ON RACE DAY?

The fall marathon season is finally upon us!  With a massive summer of training in the books, it would be a shame to put that hard work to waste with improper nutrition on race day.  One very important component of this, without a doubt, is fluid intake.  But just how much should you you consume?

General guidelines

The American College of Sports Medicine makes the following recommendation: 5-8 ounces of fluid every 15 minute for events lasting over 40 minutes.  This is a good, general, safe guideline (I guess).  If you don’t want to give your fluid intake any thought, this is a reasonable plan to follow, but I personally don’t like it.

CLICK HERE to read more on the WRS blog.  

Running beyond the limits of pain

For anybody to run at their best, regardless of ability, that means pushing through pain.  I am here to tell you that ALL of us runners, while we feel we push at or above our limits, are still likely not reaching our physiological limits of performance.

It would be nice to finish a race knowing that we got the most out of bodies as we possibly could, however, this just isn’t the way we are built.  When we run, distress signals build up in the body (lactic acid, heat etc.).  As these distress signals ramp up, our central nervous system slows us down.  Many researchers argue that this stimulus to slow down is so powerful that the brain makes it impossible to push our bodies to their physiological limit.

CLICK HERE to read the rest on the WRS blog.

Is there value in active recovery?

Picture this: You beat yourself up with a massive interval session yesterday, your legs are thrashed, stairs seem like an impossible feat, you wake up with a deep insatiable hunger, and your energy levels are low.  What is it time for?  One of the best parts of every runner’s week: the active recovery day.  Yesterday was 90 minutes of agony, today is a 30 minute shuffle.

The active recovery is something firmly implanted in almost all complete running plans.  But what is the true benefit to these sessions?  Do they actually help us to recover faster, or is it just a case of carrying on a running tradition?

CLICK HERE to read the rest on the WRS blog.  

How useful is cross-training?

Running is a funny thing.  Often times our desire to lace-up is inversely correlated with how much running we are actually able to do.  When we’re feeling great, sometimes finding the motivation to train can be difficult. On the other hand, when we’re injured, often ALL we want to do is run.

When I see injured runners, often I am asked about the efficacy of cross training.  Is it time well spent, or should an injury just be seen as a time totally away from training?

CLICK to read the rest on the WRS blog.  

THE BENEFITS OF TRAINING IN THE HEAT

This is a topic I have written about in the past, but is something that all runners should have a good understanding of.  With temperatures starting to rise, so do the questions of if it is beneficial to train in the heat, or if it should be avoided.

Some runners argue that any challenge is a beneficial challenge, so training in the heat is a positive stimulus.  Other runners argue that the heat takes away from their ability to push themselves, increases the risk of dehydration, and as a result has a detrimental impact on training.  Both of these points of view intuitively make sense, so we’ll have to go to the science behind heat training for our answer.

While this answer is complicated, what researchers DO know is that training in the heat has a unique impact on your physiology and makes you faster in a way that training at colder temperatures cannot.

CLICK HERE to read the rest on the WRS BLOG.  

Strap on a weighted vest to boost your running economy

Are you striving to become a faster runner?  Maybe you should try strapping on a weighted vest when you warm up!

Some new research is showing that by warming up with a weighted vest (similar to how a baseball player will swing a bat with a weighted doughnut before they step up to the plate), runners are showing an acute increase in leg stiffness.  This stiffness leads to an improved running economy, which could potentially lead to running faster.  Skeptical?  Let’s take a look at the science of why this happens.

CLICK to read the rest on the WRS blog.  

Why your antioxidant supplements are making you slower

Some popular buzzwords in the world of nutrition in athletics include “antioxidants” and “decreasing inflammation.”  These words sound like good things, don’t they?  Well, they might be at times, but in just as many other scenarios, they are likely having a detrimental impact on performance.

The Basics

When we workout, or are exposed to other sources of stress (like UV radiation), charged particles called Reactive Oxygen Species (ROS) are produced in our body.  These charged particles then can react with cells in our body, creating inflammation.  This has been advertised to us as a bad thing, linking ROS and inflammation to injury, decreased recovery time, and even causing a number of diseases (such as cancer) with chronic and prolonged exposure.

Antioxidants, such as vitamin C or glutathione, work to help to take the charge away from these ROS.  With no charge, the ROS are no longer reactive, and the risk of creating cellular damage and inflammation goes down.

So decreased cell damage, decreased inflammation, faster recovery- how can this be bad?

READ THE REST on the WRS BLOG

Do toning shoes work?

To become a better, faster, fitter athlete, there are some sure-fire ways to succeed.  Generally speaking, if you run more, mix in more intensity, do some strength work and maintain consistency, you will improve very predictably.  The one downside to these guaranteed methods? They require time and effort.

I truly believe that most people are not against putting in time and effort…that is, until a day becomes absolutely filled with work, kids, traffic, house work, homework and shovelling the driveway AGAIN.  It quickly can become tough to put in the time and effort required to see the results we want, and sometimes we reach for shortcuts.

One great example of a widely used shortcut: toning shoes.

CLICK HERE TO READ MORE.

Stretching and its impact on muscle sorness

Last month for the WRS blog, I wrote an article that took a look at how stretching makes us slower.  There were some good follow up questions to that article.  I think after reading it, most runners understand how stretching has a detrimental impact on running economy.

However, many wondered: Is that enough reason to stop stretching?  What about all the benefits?  For example, what about stretching and its role in preventing muscle soreness?

Well with today’s article I want to clear up a very common misconception.  It is a topic that I have written about before in my blog.  Here it is:

Stretching does NOT help to prevent muscle soreness.

CLICK HERE TO READ MORE

One reason to stop stretching

I am going to preface this article by saying I am not anti-stretching.  If you know me, have seen me at a H+P

practice, or have seen me as a patient, you will know that there are times where I recommend stretching.

That being said, this whole idea of “stretching is good” – an idea we were taught in elementary school and has now self-perpetuated to the exercise groups we attend in adulthood – is definitely misleading.  Stretching is good in some situations and stretching has no impact in other situations; I will deal with these scenarios in a future article.  This article will deal with a third situation: how stretching has a detrimental impact on us.

How can stretching be bad you ask?  Well, there are a few reason, but since this is on a running series website, I’m going to stick to this: static stretching makes you slower.

 CLICK HERE to read the rest of the article on the WRS Blog.

The benefits of interval training

We have all heard of interval training before.  There is a plethora of combinations and permutations to set up interval workouts with, and each has its advantage depending on what you are training for. That being said, they all involve the same basic concept: run really hard, recover, repeat.

If you’ve heard of interval training, you also have probably heard that it is a good use of your
training time.  The downside is that it is a little more painful than a normal run.  Because of the added discomfort, runners will often avoid interval training, or not push themselves to a high-end pace during the workout.  If your goal is to see results, this is a mistake.  Interval training is not only a good use of your time, but it is the best use of your time.

Just how good are intervals?

Take for instance this 2011 study.  In the study, subjects were divided into 2 groups that did 6 weeks of training.

CLICK HERE to read the rest on the WRS blog.

Improve runners' knee by decreasing variability of motion

Last weekend I went to a "Run Faster" conference put on by the Royal College of Chiropractic Sports Science.  Topics ranging from running technique and coaching to nutrition and injury management were discussed.

One presentation that was exceptionally interesting to me was put on by Dr. Reed Ferber from the University of Calgary.  He also has a website that is an amazing, evidence-based, resource for any runner- click here to check it out.

Patella femoral pain (PFP)

While Ferber researches an array of topics, one focus of his talk involved a new look at how to not only manage PFP, but how to THINK about PFP.

As many of you know, PFP is a condition that involves pain at the front of the knee, directly under the knee cap.  It typically kicks in early into runs, and progressively gets worse as we keep running.  It also often hurts to keep the knee in sustained flexion (i.e. sitting for long periods of time), and can be quite stiff when it comes time to straighten the knee out again.

The cause of this pain is thought to be an irritation to the soft tissues underneath the knee cap as we move.  If things are moving smoothly, the tissues don't become irritated, and pain does not occur.  However, if things are not moving well, then friction, tears, inflammation and irritation to those tissues can occur, and pain follows.

Why does this irritation occur?  It is suspected that, in many cases, this is happening because of a knee position known as genu valgum, or being knock kneed (see right).

If you imagine the knee cap normally sitting within two grooves when the knee is straight, it only make sense that genu valgum would cause issues.  Rather then the knee cap being centered every time we take a step, having genu valgum will cause the knee cap to be forced up against one side of those grooves, resulting in a pinching of the tissues underneath with every step.

So why does genu valgum happen?  There are a few causes.  Sometimes it is due to the shape of our bony anatomy, other times it may be due to a muscular deficiency.  One common area that therapists link PFP to is weakness of one of the main pelvic stabilizers: glut med (see right).

Glut med's job is hip abduction if you are lying on your side, but it functions to keep your hips from dropping as you run or walk.  Somebody with good glut med strength will be able to maintain level hips, while somebody who has a weaker glut med will tend to sway and drop their hips as they run.


For instance, look at the picture on the right.  Picture (a) shows a runner with good glut med strength and good pelvic stability.  Then, picture (b) shows somebody with weak glut med strength, which as a result, is causing the hip to swing out to the side.  You can see that as the hip swings out to the side, this is going to put a force on the knee that encourages genu valgum.

So, our injury sequence: weak glut med...hip drop...genu valgum...then PFP.

Correct the genu valgum, correct the PFP, RIGHT?  Maybe not...


Ferber's new look on PFP

In one of Ferber's studies, he took a group of runners with PFP to test the above.  He had them do exercises to strengthen their hip abduction (glut med) for 15 minutes/day.  The exercise was simple: attach a resistance band to your ankle, and move your leg to the side for 10 reps, 3 sets, daily, for 3 weeks.

Here are the results:

The great news:

• Pain (red bar) went down by over 40% 
• Strength of hip addiction (blue bar) went up almost 40%

The "bad" news:

• Knee position/ peak knee angle (black bar) didn't really change AT ALL.

So these athletes had PFP, they had weak hip abduction, they corrected that weakness, their pain got better...but their knee position did not change.  This is where it gets interesting.  

Ferber's study also looked at another component of motion: variability.  In other words, when we take a step, our legs move around in subtle ranges of motion (i.e side to side, rotation) that we don't really realize.  So if a runner is settling into a genu valgum position at foot strike, there is a number of different ways the knee can get there.  

Ferber thinks is that if that variability in motion is reduced, this is what MAY explain the change in PFP they saw without changing the knee position/ peak angle.  This is what they found:

Each line on this graph represents a foot strike.  So as you can see, on the pre-rehab graph on the left, the lines are random, and going all over the place.  By comparison, the post-rehab lines are very consistent.  YES, the subjects' peak knee angles are the same, but the movement to get there is no longer variable and unpredictable.  The researchers believe that this drop in variability is what gives tissues the type of load during running they need to heal.

Practical Applications

The practical applications, in mind, are quite significant.  There are three major reasons I say this.

• If you suffer from an anatomical genu valgum that just does not seem to be reversible, this research shows it just might not matter.  If you have genu valgum, and PFP, correcting your genu valgum does not necessarily need to be your focus.  If you work on pelvic stability in general, and your variability of motion goes down, it is quite possible to get ride of the pain without changing the angle of your knee.
• This research does not change what therapists should prescribe from a rehab standpoint.  Even if you think you are correcting genu valgum, hip abduction strength work would be prescribed.  So it's the same intervention, just expectations and outcome measures must be changed.  Decreased pain, hip abduction strength and variability of motion (if you have the fancy equipment), must be valued over knee position since knee position seems like it CAN be independent of those who suffer from PFP.    
• Finally, it also puts into question the specificity of exercise prescription.  If you are not correcting genu valgum with hip abduction strength worth, then why is it better than something else?  Couldn't other exercises and interventions decrease variability of motion just as much?  Well, that is something the Ferber lab is looking into (and already has with looking at quad exercises which achieved similar results).  More to come on this!

That's it for now, thanks for reading, and thanks to Dr. Ferber for presenting such interesting work.  

Conquering exercise associated muscle cramping

Good news readers: I have recently started writing for the Waterloo Running Series blog with a regular column: The Science of Training and Performance.  The column will look at what the latest research is showing you can do to make yourself a better athlete.  There is a lot of misinformation out there, and hopefully this will act as a good, evidence based, honest information source.  If you have any requests for the column, do not hesitate to contact me:

seandelanghe@gmail.com

@DrSeanDelanghe

CONQUERING EXERCISE ASSOCIATED MUSCLE CRAMPING

Well my running friends, the fall racing season has come and gone. Congratulations on your season of hard work and dedication! Now it is time to recover, start planning the 2014 schedule, and initiate some good-old base training.

If you did not reach your target time in 2013, one of the reasons may have been related to a strong muscle spasm that just would not let up; something we like to call ‘exercise associated muscle cramping’ (EAMC). EAMC is a frustrating and ridiculously painful experience. They are frustrating because often athletes feel as though they got cheated out of a good result. These spasms can happen without being at the limit of your cardiovascular fitness- the energy and desire to compete can be there but the legs just won’t respond. Why does this happen?

The Cause

So what causes these spasms, and how do we get rid of them? Often it is assumed that it is a result of an electrolyte/hydration issue. Is this true?

CLICK HERE to read the rest on the Waterloo Running Series blog.

Naturally enhancing sleep

When we were kids, our biggest enemy was sleep.  I, for one, saw afternoon naps as a complete waste of time, and bedtime was typically too early by 3-4 hours.

We should have enjoyed it while it lasted...

Now, sleep seems to be the one thing we can't get enough of.  Often we're limited by time, but the most frustrating thing is when we lose sleep simply because of a complete inability to fall asleep.

Recently, I wrote an article for Canadian Running looking at the impact of sleep deprivation on weight gain.  While writing this article, I came across a number of studies on what you can do from a nutritional/natural standpoint to help you to fully take advantage of whatever amount of time you have to sleep.  Here are some of the best-researched, natural ways you can enhance your shut-eye:

Tryptophan

Tryptophan is an amino acid (a building block of proteins) we all know the effects of (aka the post-thanksgiving dinner nap).  Exploiting tryptophan's sleep inducing influences was one of the strategies Jerry Seinfeld used when trying to play with a friend's classic toy collection- and all he did was feed her excessive amounts of turkey!

The reason why tryptophan helps improve sleep onset latency (makes us fall asleep faster) is because it is a precursor to the hormone melatonin.  As many of you know, an increase in melatonin is what causes us to fall asleep.

Take a look at the above diagram.  Ignore everything on the left.  The oval labeled "Pinealocyte," represents a cell in our pineal gland- a part of our brain where melatonin is produced.  As you can see, tryptophan (at the top of the oval) comes in from the blood stream, goes through a few steps, and produces the melatonin we need to fall asleep.

An interesting side note- this diagram also explains the importance of sleeping in a dark environment.  Without getting into to the details, light that reaches our retina actually signals a stop in production of melatonin.  By contrast, a dark environment will allow tryptophan to be converted to melatonin.  So if you're sitting in bed reading this on your computer, and you can't fall asleep- it makes sense because the light emitted from the monitor is inhibiting melatonin production.

Back to tryptophan: we know from experience that this amino acid makes us feel tired- but does it actually work as a treatment?  Well, in short, the research says yes.  This 2010 review study showed that even taking as little as 1g of the amino acid can enhance sleep latency, making it easier for us to fall asleep.  As always, it's better to get this from dietary sources.  Try turkey, or, perfect for this time of year, pumpkin seeds 1 hour before bed.

Melatonin

So if tryptophan, a precursor to melatonin, improves sleep latency, then why not just take melatonin itself?  Researchers think that melatonin works, but not that well (and not conclusively).  This nice 2012 review of insomnia discusses how more research is needed.  They reference a 2005 study which showed that melatonin allowed for subjects to fall asleep 7.2 minutes sooner- so it should do something to help you sleep, just not that much!

If you don't want to supplement, try cherry juice.  A few studies, like this one, have shown that it helps to raise melatonin levels, and improve sleep.

Valerian Root Extract

Another common supplement that is often suggested for aiding with sleep is valerian root extract.  It is not fully understood why valerian helps, but it is thought to be involved with impacting the part of our nervous system that helps us to calm down- the GABA neurotransmitter receptor system.  Long story short, when GABA binds to its receptor, it has an inhibitory effect, and our excited nervous system calms down.  It is thought that something in valerian root helps to enhance the inhibitory effect of GABA.

So does it work?  There is some good research out there showing that valerian does help us to improve how much time you spend in the deepest phase of sleep.  This is a little different than melatonin and tryptophan because they help us to actually fall asleep in the first place, while valerian simply improves the quality of sleep.  Once again, more research is needed to know exactly how well valerian works, and what type of dose is optimal.  

Dietary Manipulation

This topic is a little tricky because they way dietary interventions are studied is not always easily applied (or practical when considering other factors like weight loss).  For instance, researchers know that consuming carbohydrates 1 hour before bed will improve sleep onset latency.  Good for falling asleep, bad for weight loss.

Researchers also know that a regular diet that is high in protein will result in subjects spending more time in the deepest, most restorative phase of sleep.  

What should I do?

So there you have it- a few ideas to help you take advantage of the time in your schedule allotted to sleep.  It is important to keep in mind that these are only some of the many natural ideas that can help.  It does not even begin to address the importance of good sleep habits that should be mastered first (i.e. sleeping in dark, quite environments and sticking to a regular schedule).  But if you are running out of ideas, and you want to try some natural, nutritional strategies, use this as a guideline:

I am having a hard time falling asleep

• Try tryptophan (starting with dietary sources like turkey and pumpkin seeds)
• Try melatonin
• Try consuming a healthy carbohydrate snack 1 hour before bed

I am having trouble staying asleep, or feeling restored

• Is your diet low in protein?  Try increasing the percentage of your caloric intake that comes from lean protein sources (chicken breast, fish)
• Try valerian root extract

*I also should mention that everybody has unique needs, and risk factors.  Make sure to talk to a professional before trying any of these interventions!

Well, that was a longer article than normal.  If the tryptophan didn't put you to sleep, maybe the article did.  Happy napping!

Gastrointestinal upset when we excercise

There really is no debate- in order to perform at your best during endurance exercise, you need to fuel properly.  For events lasting 45 minutes or more, that means taking in some carbs throughout the event (usually 30-60g/hour).

While most people know this, in practice it's not always possible to take in enough sugar because of GI upset.  Do not fret- hope is not lost!  There are measures that can be taken to try to decrease the odds of experiencing stomach problems.

Causes:

First, it is important to understand that not all causes of GI upset are related to dietary issues.  Some common reasons athletes have issues that are NOT related to diet include: decreased blood flow to the organs (aka splanchnic hypoperfusion), a decreased ability of our intestines to move food through our system, and even pure mechanical damage to the intestines.  For instance, the jarring and pounding motion of running can directly cause damage to the epithelium that lines our intestines.  

Nutrition:

The above causes of GI upset are a little harder to manipulate, but nutrition is definitely something that can be changed and influenced to decrease the odds of GI upset.

There is no doubt that some athletes respond better than others to eating while exercising   That being said, researchers know that EVERYBODY has the ability to adapt and improve.  The key concept in reducing GI upset is this:

Reduce the amount of time whatever you are taking in stays in the intestines.  

The longer the food we ingest stays in our intestines, the more likely water will travel into our intestines.  As these guys discuss, if we can absorb our food quickly, the probability of GI upset goes down.  So how do we do that?

Rule #1: Avoid foods that do not absorb quickly.

Fats, proteins and fibres are important components to a complete and healthy diet.  But, there is just no reason to be ingesting them during competition.  They are difficult to absorb and digest (or in the case of fibre, not digestible at all).  This results in increased time spent in the intestines, which accelerates water loss, and predisposes us to GI problems.  More importantly, they provide no additional benefit to performance over simple carbs- it's just a more challenging way to fuel your activity.  So get rid of the gels, powerbars and everything else with protein and fat- it's not helping (I seriously hope there isn't a gel out there with fibre).

In addition to fats, protein and fibre, it is also crucial to avoid the wrong types carbohydrates.  While complex carbohydrates (i.e. the type of carbs found in our multi-grain bread, pastas etc) are good for daily use, they are harder to absorb.  Even fructose, the sugar found in fruit, is a different shape then glucose, and is more difficult to absorb.  While you race, this is the one time in your life where simple glucose is best.  There is some research pointing to the combination of fructose and glucose being an effective strategy, but when in doubt, stick to glucose.

Rule #2: Practice 

It seems like common sense, but not everybody does it.  If you plan on racing while ingesting carbohydrates, then you better practice.  Studies show that the more you train with carbohydrates, the more efficiently your body will adapt to utilizing them.  

For instance, this 2010 study looked at 16 cyclists and how they adapted to two nutritional regimes; a low carb and high carb protocol.  After getting used to their nutritional plan, the athletes were put through a 100 minute steady ride.  The researchers found that the high-carb fueled athletes showed an increase from 54.6g of glucose use during the earlier trials, to up to 63.6g by the end.  By contrast, the low-carb fueled group showed no increase in glucose use when comparing their initial and final 100 minute ride.  What this indicates is that with practice, your ability to utilize carbs during exercise improves, and thus the risk of GI upset should decrease along with it.

Rule #3: Stop taking NSAIDs

It's something that most athletes know- NSAIDs (non-steroidal anti-inflammatories) such as Ibuprofen, significantly increase the odds of GI upset and intestinal bleeding, as this study shows.

Heck, Ibuprofen can even cause more serious consequences, like it did for this UK gentleman.  The man died, in part because of the NSAIDs he was taking.

The death part is unlikely, but the GI upset is common.  The answer is simple: don't use NSAIDs, especially during your race.

Rule #4: Stay hydrated

This is an obvious one- but at the same time you don't want to consume too much.  How much are you supposed to drink?  I wrote about that HERE.

So what to do?

Some are lucky and don't suffer GI issues, while others constantly struggle with it.  That being said, we all can improve, and here's how:

• Avoid fats, proteins and fibres during
• Avoid complex carbs during
• Practice with your simple carbs DURING
• Stay away form NSAIDs
• Drink enough water

Follow these tips, and you will be thinking: "Gee, I think my GI issues have never felt better."