Competitive Edge: Summer 2014

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Injured During Marathon Training? Here’s How to Get Back In Stride

By Laura Goldberg, MD

A long-distance running event such as a marathon is grueling, yet rewarding. Distance runners push the body’s limit to increase their exercise capacity. It is draining and often uncomfortable to challenge your body daily. However, it should not be painful. Recurrent pain or discomfort that lasts after adequate rest should not be ignored.

A common error is to wait until pain prevents training before seeking care. By then, prolonged time off often is necessary to heal. The American College of Sports Medicine reports that 50 to 70 percent of first-time marathoners drop out before their race.

Start From a Base

Marathon training requires a good fitness base so that a gradual mileage increase of 10 percent per week will allow you to be able to run 26 miles. If you currently run 10 miles per week, a gradual increase to 40 miles will take four months. Training errors such as too much too soon are the most common cause of injury. Following a well-recognized program will help you avoid pitfalls. However, injury may still occur. Injury timing and recognition are key factors for race-day readiness.

Begin cross-training as soon as you recognize an injury. If unsure, ask a sports medical professional for advice.

It is important to maintain your strength and endurance as much as you can while recovering. If you temporarily cannot run, low impact cardio exercise such as biking or pool running can continue to improve exercise tolerance.

Once you can walk for 30 minutes without pain during or after, you can begin a slow, strategic return to pain-free running.

Running Following an Injury

Factors to consider when restarting training after injury:

  • Injury severity (Did you cross-train?)
  • Timing from race (Is there time to reach exercise tolerance?)
  • Training errors (Scrutinize running form and training log.)
  • Experience (New runners are more at-risk for recurrent injury due to form and training errors.)

Cross-training allows a speedier return. Still, you must be cautious. If you miss two weeks or more, consider restarting at 30 to 50 percent of your previous weekly mileage. If you missed more than six weeks, start with run/walk intervals. For example, walk 4 minutes and then jog 1 minute. Increase jogging intervals every other day, until you are able to jog for 30 minutes.

If at any point you feel pain, go back to pain-free walking or cross-training.

Do not push through the pain. As you increase your running, consider a biomechanical evaluation of your form. Form is difficult to properly assess until you can run comfortably. Injuries that prevent cross-training for more than two weeks cause the greatest loss, as it is difficult to recover your energy efficiency. You may still finish, but you likely will need to slow down your pace or walk.

Listen and respond to your body throughout training and recovery. Successful marathon training cannot be rushed. Be patient, and your race day will come.

Laura Goldberg, MD, is a Cleveland Clinic Sports Medicine and Exercise physician. She is Medical Director of the Rite Aid Cleveland Marathon and the Rock ‘n’ Roll Cleveland Half Marathon, and has competed in more than 15 marathons. She sees patients at the Richard E. Jacobs Health Center in Avon, 440.695.4000, and the Avon Lake Family Health Center, 440.930.6800.


Losing Weight While Maintaining Athletic Performance

By Kylene Guerra, MS, RD, CSSD, LD

Athletes searching for a performance edge often attempt to lose weight with the hope that their newfound body composition will improve their strength and speed. Unfortunately, many athletes try to achieve this goal in ways that may jeopardize performance and immune function. Consider the suggestions below for safe and effective ways to achieve weight loss while maintaining performance:

Do
Place protein first

Before you drop that pile of pasta onto your plate, make sure it accompanies a portion of lean protein, such as chicken or fish. A balanced diet that includes a slightly higher protein intake at each meal will lead to greater calorie loss by means of digestion. Plus, when protein is paired with healthy fat and fiber-rich fruits and vegetables, blood sugar will stabilize. As a result, you will feel fuller longer.

Remove added sugar

Log your food intake for a week. You may be consuming more added sugar than you think. Are you eating canned fruit, granola bars, sweetened cereal, or drinking fruit juice? Are you using sugary condiments such as ketchup or maple syrup? These foods are not the best choice for the weight conscious athlete, as they contain unnecessary sugar/calories that often result in fat storage. Be sure to eliminate the added sugar in your diet, not the essential nutrients typically consumed at mealtime.

Keep track of when and why

Initially, it is far more important to discover a correlation between when and why you eat each day, not how many calories you’ve consumed. For most athletes, weight loss has more to do with psychology than caloric intake. Emotional eating and improper nutrient timing often make weight loss extremely difficult to accomplish. Together, these habits can lead to poor satiety and a drop in blood sugar each day, not to mention a gradual decrease in metabolism over time. By embracing behavior and habit change, you will be able to experience long-term success without the added stress of calorie counting.

Don’t
Lose weight during the season

Timing is everything. Avoid dramatic changes in weight and body composition during the peak of your season. Depending on your sport, a change in composition could alter your speed, strength, swing and body alignment. Something that is fine-tuned for years is too risky to change in the midst of competition. Gradually alter your nutrition in the off-season or when your training demands are the lowest.

Forget to refuel

Recovery nutrition is one of the most important meals of the day for an athlete. Refueling within 30 to 60 minutes after exercise is critical. Proper refueling can reduce body fat and yet maintain lean mass while speeding recovery. Within that brief period post-exercise, your cells are able to use nutrients as fuel instead of storing them — not to mention that it will be much easier to control consumption at your next meal if you aren’t famished after a tough workout.

Weigh yourself daily

Stepping on the scale each day is the least effective way for an athlete to track weight loss while training. Changes in hydration status, glycogen storage, menstrual cycle patterns and bowel movements can result in drastically different numbers on the scale from day to day. This inaccurate reflection of weight may cause you to experience a false sense of failure and disappointment.

Kylene Guerra, MS, RD, CSSD, LD, is a Certified Specialist in Sports Dietetics for Cleveland Clinic. For more information or to schedule an appointment, call 216.444.3046.


Bicycling for Wellness

By Michael Schaefer, MD

Bicycling offers so many health benefits. Find out more about this healthy activity and how to be safe and comfortable while you ride.

As the weather gets warmer, many of us turn to an old love for exercise— the bicycle! When we were children, we rode our bikes all over the neighborhood and we remember the feeling of speed and freedom it gave us. Now, as adults, bicycling offers an excellent form of exercise, especially for those of us who suffer with long-term joint problems.

It’s a nonimpact activity, meaning it lessens stress through the hips, knees and feet. It also can be done in a wide range of intensities — that is, if you tend to go a little slower, you can coast once in a while, or use lower gears to ease the burden on your legs. Finally, bicycling allows us to generate our own breeze, so we often can venture outdoors on days when it is too hot to walk or jog.

Leg muscles benefit the most from bicycling. Pedaling works most of the major leg muscle groups — the quadriceps, glutes and hamstrings. It also exercises the calf and ankle muscles.

Most important, bicycling uses the heart and lungs. Increasing the pedaling speed or adding hills can give an excellent cardiovascular workout. To some extent, the spine, arms, shoulders and core muscles also are strengthened. For some patients with spinal stenosis, the bent-forward posture of bicycling actually relieves pain. Those with neck or arm problems, however, should consider using a recumbent (sit-down-style) bicycle.

Before you venture out on your bicycle, remember a few important considerations:

  • First, check with your primary care provider or musculoskeletal specialist to make sure that bicycling is appropriate for you. If you have known heart trouble or neurological issues, you should seek the opinion of specialists in these areas.
  • Always wear a bicycle helmet. Modern helmets are lightweight and have excellent ventilation. A helmet must fit properly to protect you, so it should be purchased and sized at a bicycle shop.
  • Take other safety precautions. You should wear eye protection — sunglasses probably are good enough. Always wear brightly colored, visible clothing, and only ride during daylight hours. Consider using bicycling gloves to protect your hands from vibration or from injury in the event of a fall. For longer rides, don’t forget sunscreen.
  • Bicycle fit is important. Even if using a bicycle you’ve owned for years, you should visit a bike shop to have the seat and handlebar heights properly fit for you. Most shops have employees who are trained in bicycle fitting. Many have knowledge of common orthopaedic conditions and can make adjustments to help accommodate you. For instance, bicyclists with knee pain usually feel more comfortable with their seats elevated. Neck pain often can be relieved by using raised handlebars. And a good pair of padded bicycling shorts goes a long way toward preventing skin sores.
  • Finally, where to ride? When selecting your route, safety should be the most important consideration. Many towns have dedicated bike trails to keep you separated from traffic. Many local governments also have maps showing recommended bike routes. Bicycling may take some getting used to, so don’t get disheartened if your first ride is more challenging than you expected. Start with a short ride, maybe just five or 10 minutes. Give your body time to adjust to the new position and exercise. Before long, you’ll be whizzing along like a kid again!

Michael Schaefer, MD, is Director of Musculoskeletal Rehabilitation at Cleveland Clinic. He is board-certified in physical medicine and rehabilitation and sports medicine, and is a competitive bicyclist, triathlete and cross-country skier. To make an appointment with Dr. Schaefer or another musculoskeletal specialist, call 877.440.TEAM (8326).


Keeping Dancers Healthy: There’s Help to Prevent, Treat and Rehabilitate Injuries

By Kim Gladden, MD

Dancers, like all athletes, are susceptible to sprains, strains, fractures and overuse injuries.

These injuries can range from mildly annoying to career-altering. The types of injuries sustained vary by the type of dance studied. Foot problems may occur more often in those studying ballet, while neck pain is more prevalent in a style that involves sharp body movements, or “popping,” such as jazz or hip-hop.

How to Prevent Dance-Related Injuries
  • Master the basic movements. Incorrect posture and technique, repeated in practice, can lead to overuse injuries. If repetitive movements or activities cause pain, see your doctor.
  • Don’t advance too quickly. After mastering basic technique, ease into more sophisticated routines to reduce your chance of injury.
  • Adequate core strength — in your abdominal and back muscles — is vital to protect your lower back, knees and hips.
  • Get enough rest. Most injuries don’t need surgical repair, but they do require rest. While complete rest may not be realistic for a professional dancer, “relative rest” — modified exercise that protects the injured area while conditioning the rest of the body — may be a reasonable strategy. Adequate sleep and nutrition also are important.
  • Pick the right dance type. Some body types are more suited to one style of dance than another, just as some runners are better at sprinting than distance running. Find a dance form that works for you.

The requirement in classical dance that the dancer “turn out from the hip” may contribute to many of the issues occurring in other body parts affected by this motion — the knee, ankle, foot and lower back.

Some of these injuries can be prevented by proper technique and early detection. Since the movements a dancer practices and performs are repeated thousands of times, errors in technique are compounded. These compounded errors result in the dancer developing “motor memory” to continue the faulty execution, turning seemingly small lapses in technique into an overuse injury and possibly chronic problems.

When a dancer suspects an overuse injury, the first thing to do is rest, if possible, and undergoes a detailed evaluation of technique and alignment. An experienced instructor who knows the dancer’s training history can provide feedback on proper technique and problem areas. For injuries such as muscle strain or ligament sprain, the time-honored approach of RICE (rest, ice, compression and elevation) may offer some relief. If the pain doesn’t resolve after treatment with RICE for a week or two, evaluation by a physician may be warranted.

Many dancers fear seeing a doctor because they think the physician won’t understand the demands of their sport and that they will be told to stop dancing. This is where practitioners familiar with dance terminology and training demands can be of benefit.

Cleveland Clinic’s new Dance Medicine Clinic uses a multidisciplinary approach that involves practitioners interested in the care of both amateur and professional dancers. The staff includes physicians, physical therapists and athletic trainers well-versed in dance movement, training, injury prevention and rehabilitation.

Dance is a demanding activity that keeps its practitioners limber and young at heart, regardless of age, skill level or career goals. Practicing this art form with body awareness and education is key to sustaining involvement in dance throughout the dancer’s lifetime.

Kim Gladden, MD, is a Sports and Exercise Medicine physician who formerly worked as a dance performer and instructor. She is part of the Dance Medicine Clinic team, which holds clinics on the second and fourth Tuesdays of the month at Cleveland Clinic’s Sports Health Center in Garfield Heights. For more information, or to make an appointment, call 216.518.3475.


Meet Our Newest Team Member

Kurt Spindler, MD, is an orthopaedic surgeon who joined Cleveland Clinic’s Department of Orthopaedic Surgery and Cleveland Clinic Sports Health in January 2014. Dr. Spindler previously was Medical Director of the Vanderbilt University Sports Medicine Center, professor and Vice Chair of Orthopaedics and Rehabilitation, and head team physician for Vanderbilt’s athletic teams. He received his medical degree from the University of Pennsylvania School of Medicine. He completed an orthopaedic surgery residency at the University of Pennsylvania and a sports medicine fellowship at Cleveland Clinic. Dr. Spindler’s specialty interests are sports medicine, knee ligament reconstruction, arthroscopic surgery of the knee, and the evaluation and treatment of sports musculoskeletal injuries.

Q: How did you get interested in sports medicine?

As a high school football player, I suffered a season-ending injury. An orthopaedic surgeon and a physical therapist treated my injury, and I recovered to play my senior season. I knew I wasn’t good enough to play athletics outside of college. But the injury and treatment helped me realize that I could keep a connection with sports, even if it wasn’t as a player. I could treat athletes for the rest of my life.

Q: You specialize in knee injuries. As sports become more extreme, are you seeing more complex injuries?

Yes. In extreme sports, the knee injuries more often involve multiple ligaments. Today’s treatments, including surgery y and rehabilitation, are more evidence based. This means we have very strong scientific clinical studies that guide our treatment strategies for athletes. For example, we have a large database that tracks how patients fare after surgical repair of the anterior cruciate ligament (ACL) in the knee.

Q: Any advice for athletes who want to avoid knee injuries?

We have investigated ACL tear prevention strategies that are effective in reducing injuries by about 40 percent. All athletes, especially women, who are at highest risk, should perform core and hip balance and strength training as part of their normal workout regimen.

Q: What do you do to stay fit and active?

My wife, Mary, and I enjoy running, biking, hiking and skiing. My weekly fitness routine consists of rowing, biking and inclined treadmill walking. My friend is a hot air balloon pilot, and I enjoy riding and helping crew the balloon.

Kurt Spindler, M.D., is also the Vice Chairman of Research in the Orthopaedic & Rheumatologic Institute, the Director of Orthopaedic Clinical Outcomes, and the Academic Director of Cleveland Clinic Sports Health. To make an appointment with Dr. Spindler or another sports health orthopaedic surgeon call 877.440.TEAM (8326).

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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