The Clinic.

FASTER MARATHON

I have completed two marathons in the past two years at 4:28 and 4:23. I was using the Galloway run/walk method and in the past nine months have dropped the walk breaks. I would like to shoot for a four-hour marathon, or even a 3:59! Can you recommend a training schedule that builds on my current schedule? Each week I usually do one long run of 10 to 15 miles with a rest day before and after and three other runs from six to eight miles each. My pace is from eight to nine minutes per mile for the shorter runs.

Betty Weinkle

Miami, FL

I assume you'd like to stick to your four times a week plan. If you decide to add another day, a four to six mile run midweek would be a good choice. Use the schedule below as a guide. Try to stay true to the spirit of the schedule rather than to the letter. Adapt it to your circumstances. Good luck with your goal.

Lee Fidler, Ed.S.

Stone Mountain, GA

 Sunday     Monday               Tuesday               Wednesday

0-5 Miles   6 Miles   8 Miles                            Rest


0-5 Miles   6 Miles   8 Miles with 3-4 hill repeats      Rest
                      lasting 3 minutes each

0-5 Miles   4 Miles   8 Miles with 3-4 hill repeats      Rest
                      lasting 3 minutes each

0-5 Miles   6 Miles   9 Miles with 3-4 hill repeats      Rest
                      lasting 3 minutes each

0-5 Miles   4 Miles   8 Miles with 3-4 hill repeats      Rest
                      lasting 3 minutes each

0-5 Miles   6 Miles   2 Mile Warm-Up, 2-4 x 800 @ 5K     Rest
                      pace with interval rest/jog for
                      200m, cool down with 3-5 miles

0-5 Miles   5 Miles   2 Mile Warm-Up, 5 x 800 @ 5K       Rest
                      pace with interval rest/jog for
                      200m, cool down with 3-5 miles

0-5 Miles   6 Miles   2 Mile Warm-Up, 6 x 800 @ 5K       Rest
                      pace with interval rest/jog for
                      200m, cool down with 3-5 miles

0-5 Miles   5 Miles   2 Mile Warm-Up, 4 x 1200 @ 5K      Rest
                      pace with interval rest/jog for
                      200m, cool down with 3-5 miles

0-5 Miles   3 Miles   2 Mile Warm-Up, 6 x 400 @ 5K       Rest
                      pace with interval rest/jog for
                      200m, cool down with 3-5 miles

0-5 Miles  0-3 Miles  0-3 Miles                          Rest

Marathon!    Rest     Rest                               Rest

 Sunday        Thursday        Friday     Saturday

0-5 Miles  8 Miles with 3       Rest   10-12 Miles
           Miles at 8:45 Pace

0-5 Miles  9 Miles with 4       Rest   18-20 Miles
           Miles @ 8:45

0-5 Miles  8 Miles with 4       Rest   10-12 Miles
           Miles at 8:45 Pace

0-5 Miles  10 Miles with 4      Rest   20-22 Miles
           Miles at 8:45 Pace

0-5 Miles  9 Miles with 4       Rest   10-12 Miles
           Miles @ 8:40

0-5 Miles  10-11 Miles with 4   Rest   22-24 Miles,
           Miles @ 8:35                Last Long Run


0-5 Miles  9-10 Miles with 4    Rest   9-10 @ 9:00
           Miles @ 8:35                pace


0-5 Miles  9-10 Miles @ 9:00    Rest   9-10 @ 9:00
                                       pace


0-5 Miles  9-10 Miles @ 9:00    Rest   9-10 @ 9:00
                                       pace


0-5 Miles  1 Mile @10:00, 1     Rest   0-3
           Mile @ 9:00, 1
           Mile @ 10:00

0-5 Miles  Rest                 Rest   Rest

Marathon!  Rest                 Rest   Rest

NAGGING FOOT-ANKLE INJURY

I am 42 years old and a regular, casual runner. I enjoy running a half marathon each year if I can. I had a recent layoff due to hamstring problems and have just started training again. I run three miles two to three times per week on a treadmill and recently kicked it up to four miles. I have a new pair of running shoes that I'm breaking in. I have been getting a nagging little pain on the top of my foot where the foot and the ankle meet and am wondering what could be causing this. Maybe I tied my shoes too tightly? The problem isn't bad when I'm running, but soon afterwards I feel it. I've been using ice and anti-inflammatory medicine and within a couple of days it's gone. I'd like to train for a 15K in a few months and hopefully a half marathon a few months later, but clearly I need to nip this problem before it gets out of control.

Jim Hamerstadt

Cincinnati, OH

You may well be correct that you are tying your shoes too tightly. This can cause compression and friction against the underlying tendons, resulting in tendon inflammation and pain. It could also compress underlying skin nerves, which might cause numbness, tingling or burning pain over the top of your foot. If your pain is not the tingling, burning type of pain, it is more likely tendinitis. However, another possibility would be a stress fracture of one of the tarsal bones (the long foot bones that extend from the toe joints or metatarsals) called the navicular bone. Typically pain from stress fractures worsen the longer you run, which is not what you describe. Nevertheless, given that a navicular stress fracture is a possible cause for your symptoms, you should see a physician specializing in sports medicine as soon as possible since that injury is potentially a serious one that may require surgery to heal properly.

Meanwhile, try tying your shoes more loosely, skipping the last hole, and making sure to catch the tongue loop to keep it from bunching up. Also try a different pair of running shoes. Continue icing and using anti-inflammatory medication. Limit your mileage and consider crosstraining rather than increasing your mileage or intensity until you have this problem resolved.

Brian L. Bowyer, M.D.

Columbus, OH

Try getting off the treadmill. This may sound like an odd recommendation, but it doesn't permit a completely natural gait as running on a flat area or track does. Modify your training by reducing speed and mileage until your problem corrects itself.

Marvin Bloom, M.D.

Burlingame, CA

ELEVATED BILIRUBIN IN A MARATHONER

As a 20-year veteran of marathon training and racing, at 42 years old I feel great and thought I was the picture of health. A recent insurance physical detected an elevated bilirubin. Should I do anything about it? Should I be worried?

Samuel Ellison

New York, NY

Bilirubin is a yellow fluid found in the bile as a result of red blood cell destruction. As red blood cells break down, bilirubin enters the liver and collects in the gallbladder. There are two types of bilirubin tests. The total bilirubin level increases in liver disease and in anemia caused by red blood cells being destroyed faster than they should (a process called hemolysis). The normal range for total bilirubin is zero to 1.0 mg/dl. The direct bilirubin test is usually increased when the gallbladder is blocked, hampering the flow of bile fluid. The normal range for that test is zero to 0.2 mg/dl.

Common causes of a high bilirubin level include gallbladder disease, liver disease, blood disease with rapid red blood cell breakdown (hemolytic anemia), and most commonly, a benign hereditary disorder that causes a trend to high bilirubin levels, which get worse when you are tired or fasting, as after a long run. Some of the above conditions may be transient (they come and go), chronic (stay around for a long time), symptomatic (you feel sick), asymptomatic (you feel normal), and vary in severity from very mild to severe.

In addition to those medical conditions, distance runners can suffer footstrike hemolysis in which the constant pounding of long distance running destroys some red blood cells and elevates the bilirubin. In that case laboratory findings are usually mild and intermittent. An elevated bilirubin may indicate something to worry about or it may be a benign finding. My recommendation is that you see an internist to rule out a problem. Maybe your blood was drawn after a hard, long training run and footstrike hemolysis caused your high bilirubin, but you should find out for sure.

Carlos Jimenez, MD.

Guaynabo, Puerto Rico

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

Ask The Clinic, in care of The American Running Association, 4405 East West Highway, Suite 405, Bethesda, MD 20814, FAX [phone], or e-mail at [e-mail]. Write a letter including as much relevant information as possible about you (age, weight, etc.) and your Injury (type and location of pain), training schedule (typical weekly workout, pace, surface), athletic and medical history, sole wear, recent changes in training, etc. Type or print your letters. Hand-written FAXed letters cannot be accepted. All letters, even e-mail, must include your name, address and phone number. Responses usually take three to four weeks, but can take as long as five.