The Clinic.

I'm 47 years old and have been running since I was 19. Meanwhile I've had two children and after four surgeries for colon cancer, I am cancer-free. Training for and running the marathon distance is my way of celebrating the fact that each day is a gift. My goal is to qualify for Boston and I need a 3:55 time for my age. I recently ran a marathon and had some unexpected problems-my goal time for the race was 4:00 to 4:10, but at mile 18 my legs started cramping so badly, I ended up walk/jogging much of the last eight miles and finished 4:32.

Leading up to the race, I trained conservatively-four days a week, alternating with strength training three times a week My total weekly mileage was 35 to 38 on weeks that included a long run of 16 to 21 miles (four long runs leading up to the race), and 28 to 30 miles a week on the alternate weeks. Each week included speedwork, tempo runs, hills and eight to ten miles at marathon pace. During the marathon I was well-hydrated, ate a gel every 40 minutes, and the race temperature was perfect-about 40 degrees and no wind. My splits went from under nine minutes to well over 16 minutes for mile 25. Cramps hit my quadriceps and hamstrings at mile 18. With stretching, walking, and jogging I was able to finish the race. How can I avoid the agony of those cramps and achieve the under four-hour time I need for Boston?

Molly McCammon

Anchorage, AK

Congratulations on your incredible accomplishments, not the least of which was finishing the marathon despite your terrible leg cramps. Trimming 32 to 37 minutes will require greater intensity and more volume. Run as much as you can without getting sick or hurt. It is a fine balance to achieve the necessary training gains without overtraining. Better safe than sorry-you may need to stage your goals in order not to overtrain. First, aim for a 4:15 marathon, and then try to break four hours.

Muscle cramping may have been the result of inadequate training for your marathon effort. You will probably need more long runs and longer, long runs. Try to have two to three long runs each month. A longer build up with long runs may enable you to gain more experience at 21 or more miles. Taper to your last three long runs, which should not exceed ten miles. Allow three weeks for recovery after your last long run. Run increasing portions of these runs at marathon goal pace (9:09 for 4:00).

Once a week work on improving your speed, since you have a time goal. Base your speedwork on current 5K pace. Running at 5K effort or slightly faster, building up to three miles of work. If your 5K is 8:00, try this schedule: warm-up minimum one mile; 6x800 at 3:56 or 4:00; rest intervals at 2:00 or jog 200 for cool-down at least one mile. Or try 4x1, 200 at 5:55 to 6:00 with 2:00 rest intervals.

A third hard workout per week could be an anaerobic threshold run. This run would be about three miles at 25 to 30 seconds slower than your 5K pace. Be very conscientious with diet, rest, and recovery to avoid over-training. Good luck!

Lee Fidler, Ed.S.

Stone Mountain, GA

Muscle cramps during long distance running are often the result of sodium depletion. Anyone exercising in excess of three hours is at risk for running low on sodium and the result can range from muscle cramping to more serious problems (see Running & FitNews, September 1999). You say you are well-hydrated, but if you are drinking mostly water, your cramps may be the result of salt depletion. It is a good idea to increase your intake of sodium. Use more table salt leading up to any runs over three hours, use beverages with electrolytes (like sport drinks) to rehydrate during races, and The American Running Association's Editorial Board Member, Randy Eichner, M.D. suggests carrying a salty snack like pretzels to eat about every half hour during a race. While salt will not guarantee an under four hour finishing time, it is very good insurance against muscle cramps.

-Ed.

POSTPARTUM EXERCISE

I delivered a healthy baby boy about five weeks ago. How long should I wait to resume running and mountain biking? I understand my hormones and ligaments are gradually returning to their pre-pregnancy levels. How long does this generally take? I have continued to walk a lot and do some biking. I have tried to run a couple of times but have noticed some knee pain both with biking and running. I am very anxious to really get moving again but I fear injury if I push it too soon.

Jane Bies

La Vista, NE

If you are breast-feeding, it may take a bit longer to return to pre-pregnancy hormone levels. During pregnancy, there are changes in both the ligaments and the bone structure due to a hormone called relaxin, which is produced in the latter part of the pregnancy to allow the pelvis to accommodate labor and delivery. The single most important factor in determining postpartum activity is the level of fitness you maintained during pregnancy.

If you maintained your fitness level during pregnancy with walking, running, swimming, or other activities, six to eight weeks should be an adequate recovery to resume your running and mountain biking. If you had extra weight gain during pregnancy, that will add to the stress on your joints and should be taken into consideration. My guess is that you tapered your activity considerably during your last trimester and that, combined with normal postpartum recovery, this adds up to a period of about five months of relative inactivity, compared to your activity before your pregnancy.

Returning to your pre-pregnancy exercise level needs to be gradual, taking into consideration de-conditioning more than your hormonal status at this point. Begin very gradually and work up to a regimen you are comfortable with. Do not try to begin running the same distances or speeds you ran before your pregnancy until your conditioning matches pre-pregnancy levels. A gradual return will allow your musculoskeletal system to become accustomed again to the impact of running and mountain biking.

Congratulations on both your new baby and your motivation to remain fit and active.

J. Ron Eaker, MD.

Augusta, GA

HILL RUNNING & KNEE PROBLEMS

I know that running downhill can potentially cause knee problems, if done excessively. Can uphill running also be trouble for knees? There are some really nice hills where I live, and I like to run them. I get a great workout and it is really satisfying. I run these hills about three to four days a week, for 35 to 45 minutes with a weekly total of about 15 miles. Although I haven't had any knee problems yet I don't want to press my luck.

Ken Salman

Knoxville, TN

There is nothing intrinsically wrong with running hills, either up or down. However, like any other stressful or more intense training, the risk of injury is higher than with easy running on level ground. Just as a sudden increase in training increases the risk of tendonitis or stress fractures, running hills increases the risk of injury. It is always prudent to ease into running hills gradually, just as you would gradually change any other element of your running program.

It sounds as if you may be running over more or less "hilly," rolling terrain, which is different from "running hills." Hill running is usually considered a separate training tool in which you locate a relatively steep hill and run up, walk down, and repeat for a designated period. If you enjoy the hills you're running now, this is something you might like and it is a great tool to increase power and speed.

I would recommend running your normal workout first, cutting back a portion of the time to allow for hill work. At the end of your regular run spend three to five minutes running up and jogging down a small, steep hill. You will be less likely to overdo it since you'll be relatively tired from your usual run. Every three to five days you can increase your time by a minute or so until you your reach your goal. At the first sign of trouble, you should back off in order to avoid an overuse injury.

G. Klaud Miller, MD.

Chicago, IL

I've seen runners actually recover from some impact injuries when uphill running became a major part of their program. The assumption is that running uphill is less traumatic, in terms of impact anyway. Therefore, high aerobic stress can be sustained while impact is reduced.

Jack Daniels, Ph.D.

Cortland, NY

RELATED ARTICLE: ARE YOU BOTHERED BY AN INJURY? DO YOU HAVE A TRAINING OR DIET QUESTION?

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