Many of you reading this will perhaps be contemplating this, or will have actually successfully completed this Ironman triathlon distance many times before.

Relative success in these long distance triathlon races will stem from the ability of the triathlete to oxidise macronutrients at high rates and to transfer this energy to the mechanical energy needed to power the triathlete around the race course.

Ask Yourself…

Do you understand the above statement fully? 

Of all the hours, weeks and months swim, bike and running do you miss one of the aspects that will determine relative success?  

Solving A Common Ironman Problem

I was contacted by triathlete Christian Isakson (@lukeninetwenty) who, having already completed 6 Ironman Triathlon, had never got his nutrition, this fourth discipline of triathlon, right.

Christian is not only an experienced triathlete, he utilizes his sport to raise awareness not only for his own charity The Taxi Initiative and is also involved with Pro Triathlete Chris Lieto with the More than Sport initiative.

Despite having competed the Ironman distance that number of times he was in his own words “still uncertain about the correct nutritional approach”.

As a triathlete, Christian had been “off the bike” and onto the run holding a Kona World Championship slot a number of times, only to find that GI Distress caused his run performance to be sub optimal and he lost the slot.

I worked with Christian to ascertain what practices would assist him to achieve the best performance. The final ingredients towards optimizing Christian’s, and any long distance triathlon performance, will almost certainly come down to an appropriate and trialed nutrition plan, in the form of carbohydrate consumption, and the chosen pacing strategy for nutritional intake.

When working with athletes I like to explain to people what is going on and why, and then we can take determine the appropriate info with regards to training, racing or nutrition. I like to educate from the ground up and not just dictate programmes.

I started by explaining to Christian how the gut functions in terms of blood flow, which is the important aspect.

On IM race day you push everything to the limit: muscles, gut and brain and I think it is important to understand what is going on.   As an experienced athlete we then discussed his current plan, and looked at why it didn’t work and what we could do to change it.  There is a science behind appropriate fuelling and one must ascertain a strategy that works for them. I’d not advise adopting any strategy wholesale, but the principles are the same for all.

Essential Download:
Ironman Nutrition Guidelines

I can not stress enough that testing the strategy, like you would test any piece of race kit, prior to the race and under similar conditions; intensity, pace, effort, temperatures and humidity levels is a must.

So using these evidence based IM nutrition principals, Christian and I worked to ascertain what he could specifically do to achieve an appropriate ingestion of fuel.  We knew what pace he hoped to hold and working within appropriate grams per min of carbohydrates and with the recommended carbohydrate type we could dial in his race nutrition strategy.

How did Christian do?

Christian not only raced a 9:51 Personal Best at IM Texas but went on to race the Epic 5 which is 5 Ironman Triathlons over 5 days on 5 different Hawaiian Islands. Get your nutrition wrong there and you’re in for a long week!

This August will see Christian line up for the 10km swim; 420.2km bike and 84.3km run that is known as Ultraman Canada.  Christian will be utilising the tenets here to ensure success – we wish him well!

]]> http://www.kinetic-revolution.com/ironman-nutrition-overcoming-gi-distress/feed/ 0 http://www.kinetic-revolution.com/asics-gel-noosafast-road-running-shoe-review/ http://www.kinetic-revolution.com/asics-gel-noosafast-road-running-shoe-review/#comments Sat, 18 May 2013 10:48:42 +0000 Matthew Imberman http://www.kinetic-revolution.com/?p=9452 Asics Gel NoosaFast

If you’re a shoe geek, which I most certainly am, then you might be familiar with the following scenario: you buy a new pair of shoes on a whim while at your LRS (local running store, for the uninitiated) bring them home and excitedly install them in your shoe closet (what, you don’t keep a closet of running shoes?) and then promptly forget about them because you have a closet full of running shoes and how can you honestly remember them all.

Such was the fate of the Gel NoosaFast ($100/£95) from Asics, which I purchased after a tipsy brunch one weekend and promptly forgot about until midway through my spring marathon season. Let this be a lesson: don’t buy running shoes under the influence, or if you do at least remember to use the bloody things! In any case, I’m glad I eventually found them, tucked behind a worn-out pair of old racing flats, because they’ve been a real treat to use.

Form

The NoosaFast weighs 6.6 oz (187 gm) in a size 9 and has a stack height of 20mm at the heel and 16mm at the toes (4mm drop). It features a no-sew mesh upper with trippy, Australian-inspired overlays, a structured heel counter, and both conventional and triathlon laces (bungee laces). The sock liner provides a touch of cushioning and ample drainage via small perforations on its underside; and although it’s lightly glued in place, it seems easy to remove if you want to swap in your own or go without.

The midsole is composed of Asics’s proprietary Solyte material with a silicon gel cushioning system in the heel. The midsole is also vented to allow for increased breathability and moisture drainage.

The outsole has high abrasion rubber in a latticed pattern that spans almost the entirety of the shoe. It also features an s-shaped, vertical flex groove running from heel to toe that Asics has dubbed the Guidance Line .

(Sidebar: I know brands need to differentiate their offerings from their competitors, and I don’t doubt that some of their patented technologies have beneficial effects; however, the amount of seemingly needless acronymization and technical repackaging of common terms is really getting to me. It would be refreshing to see a company describe their shoes in human terms. Do we really need to keep inventing new ways to refer to standard features on shoes? Sidebar over.)

I’ve got to take a second to talk about the looks of these shoes: it’s like the designer had an acid flashback in the Australian Outback. They’re certainly eye catching, but possibly not everyone’s cup of tea. Personally, I like a bit of flash so I don’t mind when strangers comment on my rasta racers; however, it would be welcome to have some simpler colorways to choose from.

Fit

I’ve tried a variety of models from Asics and have yet to find one that fits: either they were too narrow, had too much arch support, or a weird midfoot bump. I was skeptical that the NoosaFast would be comfortable especially since it’s a racing shoe, which often means they are meant to fit more snuggly than an every day trainer. I was pleasantly surprised to find that they felt great on my feet and I didn’t even have to size up from my usual size (12 US).

I have somewhat wide feet with low arches and I’m sensitive to overly supportive shoes. The NoosaFast didn’t bother me at all, despite having a structured heel counter and some arch support. I think despite the conventional fit of these shoes (slightly narrow from toe box to heel) they actually accomodate a range of foot shapes. The seamless mesh upper has just the right amount of give, allowing your foot to feel secure but not pinched. Asics has a real winner with this upper and I hope it translates to some of their other models. I tried Ascis’s Gel Lyte33 2 recently and generally liked how it performed but was turned off by the upper, which seemed bulky and restrictive to me by comparison. In an ideal world I’d widen the toe box to allow my toes to splay.

I don’t think I’ve ever run sockless in my life, but the seamless interior of the NoosaFast was soft enough to tempt me into trying. I took them on a few 6 mile sockless runs and didn’t notice anything on the interior rubbing me the wrong way. I should note that the heel cup extends a little high on the achilles and caused some irritation towards the end of one run, although this was never an issue when I was wearing socks. I aslo noticed some heel slippage with the bungee laces installed, but it didn’t affect my form and this is something I’m particularly sensitive to. Overall I found the fit more secure with the stock laces, but the fact that the bungee ones are included is a nice touch.

Function

Depending on what you read, the NoosaFast is billed either as a replacement to Asics’s HyperSpeed 5 racing flat or a brand new model targeting road runners and triathletes. That they’ve been designed to use sockless, have an extended heel tab to aid in entry, bungee laces, and drainage holes certainly makes a case for the latter. Either way, at 6.6 oz they are sort of in between a traditional racing flat  and some of the new lightweight, low-drop trainers like the Kinvara 4 or Karhu Flow3 Trainer, to name a few. Personally, I prefer the feeling of the NoosaFast to something like the Kinvara, as they are just a little bit firmer, allowing for a quicker turnover and less soreness after long runs.

The NoosaFast felt light and responsive on speed days, but also surprisingly comfortable on long runs. I think Asics really nailed the cushioning, which feels spongy but not sloppy, and I think there’s enough support to use them for marathon distance, assuming you don’t mind the somewhat snug toe box. I have lighter and firmer flats I’d use for shorter races, but I think the NoosaFast would be a good option for half-marathon and longer, where I like a bit of cushioning.

My favorite thing about this shoe is how smoothly it transitions under foot. I don’t know if it’s the  combination of outsole rubber or the lugless/nubless design, but they feel exceedingly smooth and my form feels locked in when I’m wearing them. They also have great traction on wet surfaces, despite the lack of more traditional gripping elements, and I’ve noticed less wear to the lateral part of the midfoot, which is where I usually  wear down my shoes the quickest. I can’t honestly say if Asics’s Guidance Line technology adds anything beneficial. It doesn’t seem to greatly increase torsional flexibility in comparison to other brands that lack a vertical flex groove and it seems like more marketing technology to me, but I don’t notice any deleterious effects either.

So what didn’t I like about the NoosaFast? To start, the drainage holes on the bottom. Maybe this is a necessary feature if you suffer from excessive foot sweating. Personally, I found it a nuisance because it meant my feet were extra soggy on rainy days. In fact, I’ve yet to hear anyone say they love a shoe, but wish it had more holes in the bottom. I think the highly perforated sock liner and airy mesh upper should provide enough cooling that Asics could seal up the outsole ports. I’d also like a wider toe box. I know they’re selling the NoosaFast as a racer, hence the narrower fit, but I think this shoe would have greater success as a lightweight trainer that you can race in, and a wider toe box would make the fit more universal.

Final Thoughts

I’ve greatly enjoyed my time with the Asics Noosa Fast, which for me occupies a sweet spot by being very capable at fast speeds, but with enough cushioning to handle long miles. In the end I can’t help but feel like Asics faces a challenge in marketing the NoosaFast as it’s not really fish nor fowl. The triathlete-specific options could turn off some hardcore runners; and while it’s certainly capable as a racing shoe, I feel like with a few tweaks it would be a great Kinvara of PureFlow competitor. The NoosaFast has only slightly less cushioning than the Kinvara, but is 1.4 oz. lighter and feels more stable to me underfoot, probably because of the lower stack height (20/16mm for the NoosaFast vs. 22/18 mm for the Kinvara 4).

My suggestions to Asics would be to nix the drainage holes, slightly widen the toe box, lower the heel tab, and make the design a little less similar to a Grateful Dead blacklight poster—voilà, instant lightweight daily trainer! I should note that if you’re new to lightweight, low-drop shoes you’re going to want to transition slowly, so don’t go out and buy the NoosaFast (or a similar shoe) and start putting tons of miles on them. If you’ve been comfortably running in a 4-6mm drop shoe and are curious to try something lighter, I think the NoosaFast would be a good option.

I think the NoosaFasts also represent a pretty good bargain. Sure, at $100/£95 they can’t be called cheap, but they only cost marginally more than traditional racing flats, they’re on par with shoes like the PureFlow and Kinvara, and they’re actually quite a bit cheaper than other triathlon-friendly shoes like the Asics Gel Noosa Tri ($125) or Altra 3Sum ($130). Granted, I’ve got less than 100 miles on  my pair, but I’m seeing less wear than on some of my other daily trainers exhibited at this stage and the cushioning still feels great.

In summation, regardless of what the designers were smoking during the aesthetic development phase (woah dude, the colors!), I applaud them on crafting a comfortable, versatile, and lightweight shoe that perfroms admirably and turns heads.

]]> http://www.kinetic-revolution.com/asics-gel-noosafast-road-running-shoe-review/feed/ 1 http://www.kinetic-revolution.com/three-standing-core-exercises/ http://www.kinetic-revolution.com/three-standing-core-exercises/#comments Tue, 14 May 2013 18:35:45 +0000 James Dunne http://www.kinetic-revolution.com/?p=9327 By way of a brief response to a recent article in Triathlete Europe named Ditch The Crunches, I want to share a few ideas about how to train your core muscles in a way more specific to the movement demands of your sport.

Crunches, Plank Holds and other floor-based core exercises make up much of the traditional approach to core training. However, as we all run in a weight bearing posture, surely it makes sense for those engaging in running sports to train and condition the core muscles in a standing environment.

I rather like many of the exercises chosen by Jene Shaw in the article mentioned above. In addition, I’ve added a few examples of some fun and challenging standing core exercises.

Medicine Ball Woodchop

Pallof Press

Medicine Ball Chest Pass

What’s Functional For Your Sport?

Functional Training has become a real buzz-word in the fitness industry over recent years. I remember a few months back having an interesting conversation with a group of Physical Therapists and coaches on Twitter, discussing the definition of the term Functional.

What is functional? Well, my view is this:

With no context (i.e. not knowing what the athlete is training for – their end ‘function‘), the term functional training is completely abstract and useless.

However, if we know that athlete A is a 100m sprinter, and athlete B is a marathon kayaker, we can then observe the different movement, postural and loading demands placed on the two very different athletes in training and competition. With this information, we can then determine what constitutes the true functional demands on each athlete. Subsequently we can come up with two separate functional training regimes – one for each set of needs.

So, functional training for triathlon, functional training for running, functional training for swimming, functional training for football, functional training for hockey, etc… are all valid and important terms in my opinion. But functional training as a stand-alone phrase seems a bit lacking to me!

]]> http://www.kinetic-revolution.com/three-standing-core-exercises/feed/ 0 http://www.kinetic-revolution.com/ironman-nutrition-guidelines/ http://www.kinetic-revolution.com/ironman-nutrition-guidelines/#comments Wed, 08 May 2013 10:42:31 +0000 James Dunne http://www.kinetic-revolution.com/?p=9242 The rise in worldwide popularity of long distance triathlon racing comes with it an increased interest into how to train and prepare optimally for such an event. One important aspect of the physiological demands of long distance triathlon is the energy and fuelling requirements. With this downloadable guide, endurance coach Neil Scholes offers evidence-based Ironman nutrition strategies for maximising race day performance.

The harder you race the more critical Ironman nutrition and fuelling becomes. Intensity is one factor that determines the rate calories are burned and the composition of fuel used. To race Ironman successfully involves balancing that intensity with a tried and trusted nutrition plan to maintain effort throughout the race.

Successful long distance triathlon racing involves balancing intensity and nutrition to maintain effort to the finish. These events require prolonged durations of moderate to high intensity exercise, which mostly use energy from the oxidation of fat and carbohydrate in the range of 4,500 and 11,500kcal. During long distance triathlon racing, athletes should pace themselves by performing at speeds that resemble those practiced in training and by adhering to a pre determined and appropriate Ironman nutrition plan.

Question From Becky

I was wondering if you could recommend a series of warmup/mobility exercises I could add in before I get in the pool and on the bike?

Response From Coach James Dunne

Hi Becky,

Great question. We cover so much on this blog in terms of run specific mobility exercises, it’s of course important fot triathletes in particular to have a set of great exercises for swim and bike workouts too.

Thankfully, the fantastic Aurelie Almeida at TheTriTouch has created this great free download, showing some simple mobility exercises and stretches to try.

I hope these help

Question From Estelle

Hi – I am overweight and now on a new start to change my life.

I only recently started running and was really enjoying it, but developed terrible pain in my shins, so I stopped. That was about two months ago and this week I tried to start gentle running again, but pain came back. Not as bad but it is there.

I have had my gait analysis done, have moulded insoles so not sure what else to do as I dearly want to run and have entered a 10k (my first) in July.

Carry on running through it, or lose weight first?

Hope you can help.

Response From Coach James Dunne

Hi Estelle,

Thanks for the great question! Running is of course a fantastic way to lose weight and improve general fitness. It is however, one of the most high impact activities we can partake in. You can work on improving your running form, thus reducing unwanted impact and loading, but when it comes down to it, your body will still have to endure considerable forces step-by-step.

As you progressively lose weight, this will obviously have a positive affect on the loading your body has to withstand. None of us can do anything about gravity.

It’s certainly not uncommon for new runners to experience various aches and pains as their bodies gradually develop the strength in key areas to withstand an increasing frequency and volume of running. The shins, calfs and knees are typical places for such aches and pains… as you are acutely aware, it seems.

Listening to your body is of key importance – one of the most important lessons you’ll ever learn as a runner. A lesson to learn as soon as possible!

So, to answer your question, in short. Please please don’t try to run through the pain. In my experience, shin pain like the pain you describe will only get worse as you try to run through pain!

What Should You Do?

Rest? Well, you’ve already told me that two months rest from running has only resulted in similar (if less) pain when you returned to running recently. So there must be something more you can do…

You’ve had your gait assessed, and now have custom orthotics. Hopefully these are helping your feet move properly, which will hopefully help your shins. I can’t be more specific, as I don’t know the full details of the affected anatomical structures.

Instead - In the relative short-term, I’d suggest putting a great deal of emphasis on high-intensity strength training. There’s evidence to suggest that high-intensity interval training (HIIT) using various whole body strength exercises is a more effective means of fat-burning than steady state cardio, such as running. You’ll get the benefit of workouts that help you lose weight, while also building the strength and resilience your body needs to run in the long term.

The goal is to get fit to run before you can run to get fit.

Perhaps only run once or twice per week (and hold back on milage – work on form) for the next six weeks or so. In this time focus on getting 3-5 HIIT sessions completed per week. From week six, gradually increase your running. You’ll be a stronger runner for it

Example HIIT Session

At the race expo, Matt collected cadence data from over 50 long distance runners, of all levels of ability. He then tracked the performance of each of these runners on race day.

Matt is the first to point out the many flaws when looking at his testing methodology and data from a strictly scientific view point!

However, I personally believe that we need more of  this real-world ”coaching data”, to complement the many great insights provided by the scientific and clinical research community. None of us have all the answers, but this sort of work helps us understand more!

Read Matt’s Full Article

What Does Matt Say About His Data?

As overall race time increases, cadence tends to decrease. The two participants with a cadence of over 190spm both managed sub 3:10 race times.

For runners who exhibited a high cadence but slow race time, maybe this is evidence that they need to focus more on other aspects of running fitness: strength, posture, mobility, etc.

My Thoughts…

Running cadence (stride frequency) is one of the key factors in determining running pace. Another being stride length. As Matt alludes to in his own commentary, there were runners with a high(ish) cadence but slow race time. Perhaps indeed, these runners need to address their stride length, amongst other technique-based factors.

One common bit of feedback I hear from runners new to increasing cadence is that they feel like they’re “cutting their strides short” to accomodate the new rhythm.

This is how I see it… If a runner is accustomed to achieving the required stride length to run at a given pace, by reaching the foot out ahead of the body (over striding). As soon as we tell him/her to increase cadence and stop “reaching out” , they feel like they don’t know where to find the stride length. This creates the stride-chopped-short feeling many report with increased cadence, and the subsequent inability to increase pace comfortably. Often they get frustrated and give up working on cadence.

Thus it’s important when working on cadence to also learn where to find the stride length needed for a given pace. Learn not to reach the foot out forwards, instead try picking your feet up a little more to speed up.

It wasn’t within the remit of Matt’s testing to look at stride length, posture, landing position (relative to center of mass), body type (limb length) or any other element of running form. Nor was it possible to look at each individual running outdoors.

All ideas for future in the field research perhaps?

Question From Anna

I can qualify for next year’s London marathon if I run a sub 3h30m before 1st July this year (it might actually only be 3h50m, I need to check after this year’s race is run).  Next year may be my last year in London, and I’d quite like to do the London Marathon before I leave town for good.

There is a flat marathon in on 1st June (one month from now) that I could enter. Based on online race predictor calculations from my 10mile race yesterday (1h15m), I am currently on track to run a marathon in about 3h32m, in theory.

I have two questions…

• My ‘A’ race this year is a sprint tri in September (5k run), so if I enter the marathon I’m planning on doing 3x weekly runs: 1 x intervals  & 1 x tempo (focusing on improving my 5k time) and then 1 x long run (focusing on the marathon)… after 1st June I’ll revert back to 100% focused on the sprint tri / 5k run.  Does this sound feasible?
• If I achieve a time around 3h30m in the marathon on 1st June, how realistic would it be to get this to around 3h00m for next year’s London Marathon?

In terms of my marathoning background, I’ve run 5 before… 3 as part of Ironman races (all around 5 hours) and 2 as stand-alone races but with injuries / snow and slow finish times.  My quickest half-marathon is 1h42m six months ago. I’m on the way back from a chronic Achilles injury, but this seems to be successfully healing.

Response From Coach Neil Scholes

Hi Anna,

Thanks for the great question. I’ll try and keep my answer succinct although I suspect there may be a few ifs, buts, maybes and possibly a potential definitely possibly

Let’s start with qualification. If you are under 49 then you have to run sub 3:50 to get a Good for Age slot at London. This time then increases through the age groups in batches of 5 years maxing out at 70+ where you need to run a 6:30.  In fact as a woman if you can run sub 3:15 I think you can get an Elite start.

I wrote a piece on predicting your marathon time (here) that maybe of interest to you, but if we stick with one of my preferred resources, that being the work carried out by Professor Jack Daniels and looking at your times specifically we can potentially make some observations.

You ran your recent 10 miler in a great time of 1:15 which is 7:30 per mile pace. IF you could have continued that pace on for another 16 miles you would have run a marathon in 3:16:38. The “if” is deliberately in capital letters. I read between the lines however that you may have been nursing your achilles to ensure no flare up and potentially you could have run the 10 miler faster. So the correlation between this time and how fast you could run a marathon may not be accurate.  However it is unlikely on this performance alone that currently that you could go faster than 3:16.  I say currently deliberately.

Six months ago you ran a half marathon PB in 1:42, this is 7:47 per mile pace which is considerably slower than your recent 10 miler of 7:30 pace. Keeping your 10 miler pace (7:30) would have given you a half of 1:38 so between the half and the 10 miler, your running has improved, you have lost weight, you have improved your lactate threshold, become mentally stronger or all of the above or something else.  What ever it is, there is a difference – and a good difference.

Having completed a number of Ironman distance races and a few marathons outside of this your endurance should be good although I note a significant (in the scientific use of the word) drop off in your Ironman run times. With appropriate training I expect my athletes to run approximately 30 mins slower in an Ironman that they would do in a stand alone marathon. Your first attempt at Ironman is the exception – until you do one you have no idea what it is like and all bets are off. Just finish, stay out of the medical tent, smile and want to do another are the only goals for 99% of athletes. So for you if you can run 3:30 you should look at 4:00 for an Ironman! So I suspect that pure endurance is not an issue for you; specific muscular endurance and speed endurance may be an issue and we’ll come on to that…!

If we take a half marathon PB (your current proven time) of 1:42, then Daniels predicts that with the right training that you are physiologically capable of a 3:32 marathon. If we take you 10 miler time and keep this pace to give a half marathon time of 1:38 then Daniels predicts a marathon time of 3:24. These tie in with your own online calculator. Both times would give you a London Marathon good for age slot, also allowing for some drop off in the last few miles to comfortably come in under 3:50.

So London Marathon 2014 is extremely likely to be achieved and I’d be very surprised if you did not achieve this.

Before we leave marathons and look at your training let’s look at the target of 3:00. Firstly no one wants to run 3:00. If I ran 3:00:00 you’d find me hanging from a tree – 2:59:59 is the goal!

So, what does it take? Well these goals are the absolute simplest ones to aim for; ALL you have to do is run 6:51 pace for 26 miles if you run 6:52 then you fail. Can you run that fast? I don’t know. What does it take? It will take 1 to potentially 2 years of run training for you to get to your best. That means running 6 times a week over 5 days with 2 rest days. Will your swim and cycle ability drop? Yes. Can you still cycle and swim on top of this? Yes – as long as it doesn’t stop you hitting the run numbers and detailed paces and as long as you are recovering. Running as you well know causes the most impact on the body compared to cycling/swimming so the potential of injury is higher.

Your marathon on 1st June is less than one month away. Regardless of that, you are physiologically capable of running a London Marathon qualifying time. But as I don’t know what training you have done I don’t know how much this will take out of you!

Training for the short distance does not necessarily equate to being able to hold specific speed endurance or having the muscular endurance over the longer distances. Iwan Thomas who is still the GB 400m record holder used to train at our track and subsequently has run the London Marathon a number of times. As an Olympic Silver Medallist and still a very fit man you might expect him to perform relatively wel. However I do often remind him that even me, a very soon to be 50 year old, can beat him by about an hour in the marathon! You can see that short course performance does not necessarily equate to long course performance.

Looking at your training you 3 runs look a reasonable balance. If we start with the assumption that you are looking to achieve around 3:30 for the marathon (8:00 per mile pace) then your “long run” should be carried out at no SLOWER than 8:30-8:45 per mile pace. As Emil Zatopek said “I don’t need to run slowly I already know how to do that“.

Your tempo run I would suggest something like 10 mins easy, 45 mins @ 8:00 per mile pace, 5 mins easy. If you were much further out from the race a longer tempo of say 20 miles with first 5 miles at 8:45 pace and the middle 10 miles @ 8:00 pace.  In terms of an interval session then something like 10 mins easy, 7 x 1 mile @ 7:30 per mile pace, 10 mins easy.

It is difficult to be very specific as I only have limited information but based on my assumptions above these would be a good mix. It is the ability to hold a specific pace for a length of time that you require; so pace endurance (ie the ability to hold that pace for 26 miles) and muscular endurance are what you require.

Lastly, and I apologize for the length of the response, but I didn’t want to give you you half an answer – it’s not my style! I want to come back to the question of running 3:00. The truth is I don’t know and neither do you.

I do however know what it takes and that is progressive development over a period of time. We have just under one year until London Marathon 2014; is that enough to see a significant MARATHON improvement – yes.  Is it enough time to get close to sub 3:00 – possibly not – that may take a couple of years.  Potentially you would go 3:10ish after a year and close to 3:00 the year after given the right course (incidentally I do not think the LondonMarathon is the right course – I’d go Berlin, Rotterdam, Amsterdam, even smaller races like Aylesbury) and of course you need luck and the right conditions.

Hope this helps. Please don’t hesitate to give me a shout if you need any more coaching advice.

]]> http://www.kinetic-revolution.com/qa-training-for-sprint-triathlon-marathon/feed/ 5 http://www.kinetic-revolution.com/patella-tendinopathy-what-runners-need-to-know/ http://www.kinetic-revolution.com/patella-tendinopathy-what-runners-need-to-know/#comments Tue, 30 Apr 2013 18:25:12 +0000 Brad Neal http://www.kinetic-revolution.com/?p=9040 One sub-group of Patellafemoral pain that I did not discuss in my previous article about knee pain in runners is Patella Tendinopathy. That is because we felt that it is a broad enough topic to warrant a full article, which is presented here.  One slight difference to my previous posts, this is designed purely to demystify this complex area for suffers/patients, but comments from other clinicians are obviously welcome at the bottom of the blog.

Terminology

The term Tendinopathy came about in the early 2000’s as a replacement for the historic Tendinitis, as the examination of problematic tendons consistently showed minimal to no inflammatory markers. Remember that it is just a diagnostic term and that you do not need to get caught up in medical semantics. In fact, the topic of inflammation is currently back on the research agenda, with this very recently published paper proving very popular (Rees et al, 2013).

Get an Accurate Diagnosis

A true diagnosis is obviously prudent for all areas of medicine, but especially so in a Tendinopathy. In an ideal world, this will be done with a real-time ultrasound scan, as this will allow us to apply the diagnostic criteria put forward by Cook & Purdham in 2009, which for me is still the best way to then decide upon any subsequent treatment modalities.

What I like to do is give my patients a diagnosis of either ‘Reactive’ or ‘Degenerative’ Tendinopathy, the treatment for which will differ significantly. An ultrasound scan also allows us to screen for any differential diagnoses; such as a full/partial tear, a Paratendinitis or a Calcific Tendinopathy being common examples.

Select the Right Loading Method

There are many methods of loading suggested in the literature – eccentric, concentric, isometric; which one is right for you?

I must advocate that a Physiotherapist direct your tendon loading because (as an example) a degenerative patella tendon should respond well to eccentric loading but it will usually significantly worsen a reactive tendon. However, optimal loading can be a very powerful tool in rehabilitating patella tendinopathy, the long-term mechanism of which is attributed to a phenomenon known as ‘mechanotransduction’ (Repair through Loading) (Khan & Scott, 2009).

Exercise Caution with Injections

There are a plethora of injections on the market to treat tendinopathy but beware – systematic review level evidence (the best we have) usually finds minimal difference between all of them (Van Ark et al, 2011). This suggests to me a mechanism that is not consistent with what substance is injected, but that is a separate topic.

The only injection that I currently advocate in my clinical practice is ‘Polidocanil’, a sclerosing agent designed to destroy the rouge blood vessels (neovessels) encountered with most degenerative tendons. Please avoid any injection involving corticosteroid, as this can increase your chances of tendon rupture significantly.

Surgical Intervention

Any orthopaedic surgeon worth his salt should be very reticent to get involved with any tendinopathy. This is not something you should even contemplate unless your symptoms are recalcitrant and have failed to respond to adequate conservative management for a minimum of six months.

My close colleague Professor Hakan Alfredson (a world renowned tendon specialist from Sweden), has developed a revolutionary minimalist ‘scraping’ technique for the patella tendon which is showing excellent follow up data when applied to degenerative tendons and this is what I would advocate if conservative management fails.

Optimise Your Training & Biomechanics

As with any musculoskeletal injury, how often and with what quality you move is paramount in your recovery. Tendons rarely respond well to total rest, but ensure that your clinician and coach communicate regularly to get your training levels correct. Seek the advice of a Physiotherapist or Biomechanics Coach to ensure that your running form is strong and that you are structurally balanced and robust.

Tendon Experts in Social Media

Consider following this list of expert clinicians for further information relating to all aspects of Tendinopathy:

1. @HakanAlfredson (Professor Hakan Alfredson, Umea Sweden)
2. @DrPeteMalliaras (Dr Peter Malliaras, Melbourne Australia)
3. @BJSM_BMJ  (Karim Khan, Vancouver Canada)
4. @ProfJillCook (Professor Jill Cook, Victoria Australia)
5. @drjrees (Dr Jonathan Rees, Cambridge England)

Final Messages

I hope that you’ve found this information useful. I’ll happily answer any further questions in the comments section below.

Tendon pain is common presentation amongst athletes, especially runners. It’s an injury we believe we treat with great success with our combined approach at Pure Sports Medicine and Kinetic Revolution. If you are struggling and need our assistance then please don’t hesitate to get in touch.

References

Cook, J & Purdham, C. Is tendon pathology a continuum: a pathology based model to explain the clinical presentation of load induced tendinopathy. Br J Sports Med 2009; 43: 409-16.

Khan, K & Scott, A. Mechanotherapy: how physical therapists prescription of exercise promotes tissue repair. Br J Sports Med 2009; 43: 247-251.

Rees, J et al. Tendons – time to revisit inflammation. Br J Sports Med 2013; Article in Press.

Van Ark, M et al. Injection treatments for patella tendinopathy. Br J Sports Med 2011; 45: 1068-76.

The plantar fascia is made up of 3 bands of tough fibrous tissue extending from heel bone to multiple attachments in the metatarsals (bones at the base of the toes). Of these 3 bands the central band is considered most important in plantar fasciitis, the lateral band is very variable and not fully formed in many people while the medial band is very thin at its attachment to the heel bone.

PF is said to affect more than 1 million people per year (Goff and Crawford 2011) and while it does tend to be self limiting and resolve in 6-18 months (Wearing 2006) it can be a long and frustrating process, especially for an athlete. Understanding the pathology is key to managing the condition but can be complex and challenging to understand (by ‘pathology’ we mean what is actually going on with the tissues). Wearing (2006) describes common tissue changes in PF:

“Collagen degeneration with fibre disorientation, increased mucoid ground substance, angiofibroblastic hyperplasia and calcification are the most frequently reported findings.”

Unless you study histology I doubt that clarifies much! A simplification would be to say there are changes where the plantar fascia attaches to the heel bone (an area known as the enthesis). These changes involve thickening of the tissue and disruption of the fibres which make up the fascia (collagen). In degenerative cases this can involve the development of blood vessels within the fascia in areas that usually have limited blood supply, this is called neovascularisation or angiofibroblastic hyperplasia. Calcification refers to parts of the tissue changing to become more bone like in nature, this can happen in PF with the development of a bony ‘heel spur’ – a small bony projection on the heel bone. However heel spurs can be present in patients without PF so they may not be relevant to the pathology.

These changes share a lot in common with another group of conditions – tendinopathy. In fact the plantar fascia shares a lot of similar features to tendon – both thicken in response to excess load and both show a non-inflammatory reaction that can progress to degenerative change. They also have similar structures and display ‘viscoelastic’ properties during loading.

In recent years the work of Cook, Purdam, Magnusson and co. has advanced our understanding of tendon pathology. This progress has resulted in fundamental changes to how we manage tendinopathy. Plantar Fasciopathy hasn’t enjoyed as much of the lime light and as a result there are still many questions about how best to manage it.

There are certainly many overlaps between tendinopathy and fasciopathy, this begs the question, should we approach PF in a similar way to tendinopathy?

At present I think there can be a ‘one size fits all’ approach to PF. Standard advice and stretches are given, sometimes regardless to the stage of the condition. In fact in an NHS Trust I previously worked in PF was managed with telephone advice and a standardised exercise sheet! I’m hoping that following a similar reasoning process as tendinopathy might improve our management of PF.

So how do we go about dong this? Key features in tendinopathy are determining the stage of the tendinopathy, modifying both tensile and compressive load and promoting tendon adaptation through appropriate loading exercises. Can we apply these to PF?

Identifying PF Stage

Cook and Purdam (2009) highlighted the importance of determining the ‘stage’ of a tendinopathy in determining management. They suggested that clinically 2 broad stages could be used – reactive/ early dysrepair and degenerative/ later dysrepair. In the reactive stage the tendon responds to excessive load by thickening and stiffening which helps act as a stress shield to decrease load. Unfortunately this process usually results in pain but is reversible and settles when the excessive load is removed. In degeneration the tendon structure changes and there is change in the collagen which makes up the tendon. For more on this read staging of tendinopathy.

Scott Wearing is widely published in PF research. He suggests in his excellent 2006 paper that there is similarity between the response of plantar fascia and tendon. This could mean that PF also goes through stages along a similar continuum. All that jargon aside where does it leave us with managing PF?

Well I would suggest it may be helpful to stage PF in a similar way – determine if it is in an acute ‘reactive’ stage or a more chronic ‘degenerative’ stage and vary your management accordingly.

The reactive response usually occurs after a fairly rapid increase in loading so if you’ve not had PF before and it’s developed as you’ve increased your running distance or introduced new training it’s more likely to be reactive.

Degenerative change usually happens after prolonged overloading. If you’ve had grumbly heel pain for a while which has gradually worsened and you’re an older athlete it is more likely a more degenerate picture.

Treatment of different stages

In the reactive stage treatment will largely centre around reducing load on the plantar fascia. This can be achieved by reducing activities that increase pain such as walking barefoot and running. Taping the fascia can also help. Stretching the Achilles is widely recommended for PF but it might be best avoided in the reactive stage as it places greater stress on the fascia. In tendinopathy ‘load management’ is key in the reactive stage and the same is true of PF.

With more chronic degenerate PF load management is still key but can involve a gradual increase in load on the plantar fascia. This will probably involve stretching of the plantar fascia itself as well as the Achilles’ tendon. Strengthening calf muscles and Tibialis Posterior may also help these muscles to manage load associated with impact during running to prevent recurrence. Again if we take the lead from tendinopathy management we have some guidance in terms of pain and exercise. Research on achilles tendinopathy by Silbernagel (2007) found that people could continue sport as long as they aimed to keep their pain below 5 out of 10 (where 0 is no pain and 10 is worst possible pain) and pain had reduced by the next morning. You could apply this idea to plantar fasciopathy, indeed many runners continue to run with their symptoms. However I would urge caution with this – running with pain hasn’t been widely studied in patients with PF.

Types of load

When we consider the stress on a tendon or the plantar fascia with often think of tensile load which places a stretching force on the tissue. Until fairly recently compression has been overlooked but Cook and Purdam (2012) highlight the importance of compressive load.

Tensile load on the plantar fascia is thought to be created by something described as the ‘windlass mechanism’ and can be increased by achilles tendon tightness. However according to Wearing (2006) compressive load has not been fully examined in PF. Perhaps future research will shed light on this.

A number of factors will play a part in loading – your training type, volume and intensity will have a role as will footwear and training surface. There can be a connection between barefoot running and PF as this promotes forefoot striking and increases load on the calf complex. Harder surfaces like road may have a larger ‘ground reaction force’ than grass or off-road training placing more load on the fascia. Try to spot patterns between changes you’ve made and changes in symptoms. This can help you identify a cause to your PF and potential solutions.

Risk factors

Several risk factors have been identified in PF and generally these link to increase load on the fascia;

• Obesity – BMI over 30
• Achilles tendon tightness
• Reduced ankle dorsiflexion (the upward movement)
• Foot posture? High arches and excessive pronation have both been linked to PF and are listed as risk factors by Goff and Crawford (2011). However there is some debate in the literature as few empirical studies have demonstrated a clear connection between plantar fasciopathy and shape of the arch of the foot.
• Excessive load through sport or occupation – especially prolonged standing or distance walking/ running.

Addressing these factors will likely reduce load on the PF allowing it to heal.

Role of stretching

Stretching the calf muscles has been a cornerstone of managing PF for years. Many articles in the literature recommend it alongside traditional exercises like rolling your foot over a frozen bottle of water. Despite its popularity there is a sparsity of quality evidence supporting calf stretches for PF. The theory is that a tight achilles increases load on the fascia so we stretch it to reduce load. The problem is there is some debate whether stretching will actually achieve this. A big question too is why stretch a condition that is usually aggravated by tensile load? Cole et al. (2005) reviewed the evidence base for treatment of PF and reported “the benefits of stretching both the plantar fascia and achilles tendon are unknown”.

That said I do feel achilles stretches have a role in more chronic cases where you are aiming to gradually increase load on the fascia. There is some evidence that stretching the plantar fascia itself may be more effective - DiGiovanni et al. (2003) found fascia specific stretches were superior to achilles stretching in treating chronic PF. Their follow up study (DiGiovanni et al. 2006) revealed marked long term improvement with specific plantar fascia stretching. Whether you can actually ‘stretch’ the fascia remains a subject of debate but this intervention does seem to help symptoms.

Limitations

Many aspects of plantar fasciopathy have not been extensively studied. My thoughts here come from the perspective of a reasoned way of managing a condition heavily linked to overload with many similarities to tendinopathy. It’s based on general theories on how tissues respond to load and how treatment often involves ‘optimal loading’ of the tissue to stimulate recovery. However without a sound evidence base this can only really be theory and opinion in relation to plantar fasciopathy. Indeed while there are similarities to tendinopathy (which has been used as a framework to guide some of these ideas) there are differences too. The use of isometric and eccentric exercise has become a key factor in managing tendinopathy, this is difficult to achieve with plantar fascia. The pathology of tendinopathy and fasciopathy differ too so questions remain on how much of what we’ve learned from tendon studies can be applied to PF.

Summary

It can be helpful to think of plantar fasciopathy as a response to excess load. This can be an acute response that will settle with temporary reduction in load or a more chronic response that requires a gradual re-introduction to loading. Modifying sporting activities to find a level that doesn’t aggravate symptoms is key to management. There are similarities with tendinopathy that might help guide us in some respects but this approach is not evidence based. In 2003 the Cochrane Collaboration did a systematic review of interventions for treating plantar heel pain. The work, by Crawford and Thompson reported,

“At the moment there is limited evidence upon which to base clinical practice”

They updated the review in 2010 but it was later withdrawn as it was substantially out of date! This highlights a big gap in the research for this common and complex condition.

And finally…

Plantar Fasciopathy is not the only potential cause of heel pain and is frequently misdiagnosed. With any lingering injury it is sensible to seeking a professional opinion to clarify diagnosis and management. As ever with injury management if in doubt get it checked out!

More from me here managing plantar fasciitis and PF in an ultra marathon runner.