Friday, January 20, 2006

Medical Observations for Across the Years race

Medical Observations for Across the Years

By Andrew Lovy

The race conditions at Across the Years offers some unique challenges medically that I feel every runner and crew person should be aware of to plan for their best performance.
The race director Mr. Bonnet made it clear at the outset that dehydration and blisters are the most common reasons why individuals drop out or have less than optimal performance.

Having said that at the outset the predictions were still quite accurate. The track itself is crushed gravel. This makes for a rather soft surface initially but as the runners trample the gravel down it becomes slightly harder. However, recovery is much quicker than when running on concrete or asphalt or even artificial turf. However, there will always be micro variations in the surface, since each footfall can be on a peak or a valley of the hard surface causing the foot to land ever so slightly differently each time. This can create more hot spots and problems for the runner as the race goes on. My first suggestion for the runners is to bring at least two pairs of shoes that have slightly different lasts, so that when the foot tires in one and the hot spots develop another shoe either of a different make or a different model will result in slight footfall differences and help compensate somewhat for this.

My next suggestion is that aside from some elite runners training is essential for maximum performance as is entering the race relatively injury free for the past two to three months. Even the slightest injury at a different race may result in a cumulative effect of stress or strain on various body parts, again leading to musculoskeletal problems. There are many blister formulas out there now and I would suggest trying several until you find at least one or maybe two that work best for you under these conditions. Most blisters can be prevented if the shoe fits properly and blister control elements are utilized. I have a formula that I have used for over ten years that has been of great benefit for friction points resulting in far fewer blisters in most individuals who use it. All the ingredients can be purchased in a dollar store so literally a lifetime supply can be had for fewer than ten to twelve dollars. The basic ingredient is Vaseline, any manufacture, and generic works well. Desitin ointment, not cream is another major ingredient. It can also be found generically as Zinc Oxide ointment. The third major ingredient is A&D ointment, be careful when you shop since  A&D is a trade name and is on many tubes that actually are Zinc Oxide. What you want is the vitamin A and vitamin D ointment, which usually comes in tubes or tubs and is yellow and this is the only somewhat costly element. Mix equal parts of these three to a smooth consistence. Then add aloe vera ointment or cream vitamin E ointment or cream to this mix using less than a third of these two ingredients than the original two. Again mix these to a consistent paste. If you suspect rainy conditions slightly more Desitin and A&D will help made your foot more waterproof. If there are lots of rocks and the opportunity for many scratches, abrasions due to a surface add slightly more aloe vera and vitamin E. Vaseline is an excellent lubricant that does wear out fairly quickly. Desitin is healing and a water block as well as a lubricant as is A&D. The other two ingredients promote healing as one runs.

My next suggestion is to run with a double sock. These are commercially available, I would try different brands. What I use is a nylon socket, which is very inexpensive, and a thin cotton sock. Lubricate the foot, the heal, between the toes and anywhere there may be friction and put the nylon sock on removing all wrinkles and then the cotton sock again, being careful to remove all of the wrinkles. The two socks rub against each other dissipating the heat and friction into the shoe and not into the foot. Also, if conditions are wet, such as running through puddles or in the rain the combination sock acts as a wick and pulls the moisture away from the foot and into the shoe. The shoe may feel soaked but the feet remain dry. I have uses one application of this, which was sufficient for six days, however, if grit, sand, dirt gets between the socks or on the foot it is wise to wipe that off and then reapply. It is also advisable to have at least one pair of shoes that is a half to one size larger for later in the race since feet have a tendency to swell in time. Loosening the shoe with differential lacing has always worked for me but sometimes half way through the race another larger shoe with a different last may feel more comfortable for the second part of the race.

Conditions in Arizona are quite dry. Dehydration occurs much more rapidly and with greater devastation than with moderate or high humidity. I usually drink every mile and a half to two miles but at ATY frequently it is every second or third loop. Water is a mainstay, however, it is very necessary to include electrolytes to keep the mineral content up and the sodium and potassium levels adequate. With a decrease in sodium, potassium and water the muscles do not respond as well and the likely hood of injury to the muscles and/or dehydration is great. It is almost impossible to over hydrate during a twenty-four to seventy-two hour race. A standard and reasonable guideline is urinating clear. If one does not urinate within five to six hours it may be necessary to super hydrate ever loop until one not only urinates but also urinates clear.

There is a product out called E-Caps which has been found to be very useful to maintain sodium, potassium balance and I would suggest using them as directed unless you are going faster than anticipated, in which case I would increase the dosage moderately. The race has potassium pills, which are also very useful for muscle fatigue and do not adequately “twitch”. There may be a drastic temperature change at night, do not be fooled into thinking that because it is cooler and you are not sweating as much that you do not need as much hydration. If anything you may need more in order to keep the core body temperature at its optimal. It really doesn’t matter whether it is cold or hot liquids since the core body temperature will neutralize. Warm liquids, such as hot chocolate, coffee, soups, etc., may taste better warm so you will hydrate more, but you can survive on cooler drinks as well. It is also necessary to maintain sufficient levels of carbohydrates to fuel the muscles as well as some protein to prevent tissue breakdown. I would suggest experimenting on long distance training runs or other races as to what feels optimal for you. It is not unusual for runners to do quit well for a period of time and then apparently completely crash. Re establishing carbohydrates, simple such as honey, fructose as found in fruits and complex carbohydrates such as found in breads, pastas, etc., are optimal. It is also advisable to have a certain amount of fat since that helps to metabolize the carbohydrates. Peanut butter seems to be an almost ideal fuel for this as are any of the soft cheeses with a high fat content. The high fat content cheeses are not really advisable at all times under all conditions, but as part of a race regime can be very very helpful.

Another danger at night is the muscles will cool. Some people run well under those circumstances but once you stop and you feel chilled it is better to stay slightly warmer and compensate with increased hydration than to chill and have a muscle spasm. When one takes a break of more than a few minutes it is reasonable to attempt to stretch the muscles using any protocol available with repeated contractions going around the track the muscles will tend to shorten and want to stay short and stretching them out can revive them considerably. Once again, it is much easier to prevent any form of depletion type injury than to attempt to treat it once the damage has been done. Blisters are not fatal they are the bodies defense against friction. However, if not appropriately treated it can cause the individual to shift their balance utilizing muscles differently to compensate so that there is no pain ultimately leading to more tissue breakdown in other muscles. It is best to address hot spots as quickly as possible, after all a three to five minute break to prevent an injury is time well spent.

Chris McLaughlin is one of the best blister treatment people I know. Once he has worked on a blister early they seldom return to cause further damage. There are also massage individuals available at different times during the race and if you feel fatigued the muscles don’t appear to be functioning as well as you would like these individuals can do quite a bit to work the lactic acid out, stretch you and to bring those muscles back to full function. Massage therapist can do a considerable amount of damage if not done appropriately during an event, however, the massage therapists at ATY are specifically and specially trained and sensitive to the needs of ultra runners and can change your thinking from there is no way to go on, I can never again get into a decent stride to a I am feeling pretty good and then can go on. For runners who are naves to the longer distances keep in mind that your marathon times are not indicative of how well you can do in a twenty-four aor forty-eight, if you attempt a forty-eight or seventy-two hour race be forewarned that it is not X number of marathons or three twenty-four hour races but one continuous race and one needs to go at a speed that will ensure the ability to complete the race unless one has entered a twenty-four hour forty-eight seventy-two with a more limited goal in mind such as one hundred miles, fifty miles APR at a distance etc.

A beauty of a twenty-four hour race is that one can set a pace finish rest and come back and put on more miles or chose not to. It is also an advantage that one is never more than two hundred and fifty meters from assistance. The medical team can work with you and assist you in many ways during the race but are quite limited in scope when you enter the race with a pre injury status. Again for the more naves runners it is not unusual to feel tired, have pain, discomfort, etc., and a good general rule is to list to your body and then attempt to compensate if the pain discomfort and drive cannot come back to the level you want keep in mind this is a race, it is a test of your capabilities and potential and there is no shame in either slowing down or stopping all together and re evaluating the situation and possible even terminating your participation in the race.

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