The Clinic.

MARATHON TIMES TWO

I am 50 years old, in good shape, and have run several marathons and half marathons. When not training for a race I usually average 30 miles a week, cross train and do strength training for my upper and lower body. My marathon times have been around 3:50. I ran the Marine Corps Marathon last year and much to my surprise I recovered very quickly and was sorry I had not entered the New York City Marathon. I plan on doing both this year, which are about two weeks apart. I assume my training for the first marathon would not change--is this correct? Also what do you recommend for the two weeks in between the two marathons? I know how important rest will be, but I am not sure exactly what to do.

Richard Honig

Plainview, NY

Two weeks is a very short recovery to allow between marathons. There is a rule of thumb that your body needs a day of recovery for each mile raced. In order to run another marathon within two weeks, you'd have to run well below your best effort in order to recover adequately. In a race situation, that is hard to do. It may be important to think about your goals. Do you want to run two marathons, or run your best time and effort? You may not be able to do both without significant risk for injury or overtraining syndrome. I'd recommend that you think about your goals carefully and devise a training and racing schedule based on your decisions.

Roger Moffat

Washington, DC

Running two marathons so close together is a bad idea. You may feel fine after a marathon, but you are not recovered at the cellular level for at least three weeks. If you decide to run both races, in spite of advice to the contrary, your two in between weeks should be one of recovery and one of taper. Make sure to pay particular attention to eating well, including lots of carbohydrates, hydration, and rest.

Lee Fidler, Ed.S.

Stone Mountain, GA

TIMING WORKOUTS FOR PEAK METABOLISM?

I have read that timing your workouts with the natural rhythm of your metabolism (low in the morning, peaking during the day, lower again in the evening) can elevate your metabolism overall. The recommendation I read was to work out at 70% maximum heart rate for 30 to 60 minutes during the morning when metabolism is low. The effect would be to boost your metabolism throughout the day, resulting in an overall higher calorie burn from your workout and from the remainder of the day due to higher metabolism. I've recently put on some weight due to a layoff and would love to know if this is true. If so, how significant is the difference?

Kevin Lamb

Oxford, MI

Research over the past few years has shown that any time you exercise, it is good for the body, with little difference between morning, midday, or evening workouts. However, if you are a competitive athlete, your workouts should be during the same time of day as your competition in order to achieve maximum transfer to race day performance.

Every time you exercise your metabolic rate stays elevated for several hours after stopping the workout. The more intense the workout, the longer the effect lasts. Basal Metabolic Rate decreases as you age. But a fit person's Basal Metabolic Rate tends to decrease at a more gradual pace. One of the best methods to increase Basal Metabolic Rate is to increase muscle mass (strength training), since muscle requires more energy to maintain itself in a resting state than fat tissue does. To lose excess body fat and keep it off, your best bet is to exercise consistently, add strength training to your workout, and eat a healthy diet.

Fritz Huber, Ed.D., C.S. C.S.

Tulsa, OK

BIG TOE JOINT IMPEDES RUNNING

I'm a 59-year-old runner with a chronic big toe joint problem. I believe the diagnosis is hallux rigidus. X-rays taken ten years ago showed cartilage damage, which has reduced the flexibility at the forefoot causing pain, and altering my gait and pace. I don't compete anymore and am reasonably satisfied to run at a slower pace, but even that has been hard lately. The change in my gait, both walking and running, is now causing ankle pain. I'd like to pursue treatment but would really love to avoid surgery. Any suggestions?

Dick Voigt

Middleton, WI

Hallux rigidus is a fairly common problem among runners and other athletes. Repetitive jamming of the big toe joint results in deterioration of cartilage and buildup of bone at the joint. What you now feel as pain is a result of motion causing bone on bone grinding. Although it is very unlikely, the joint may fuse over time without surgical intervention. Fusing of the joint eliminates the motion at the joint, effectively eliminating the pain and resolving your problem.

Sometimes joint replacement is done, but that is not a good alternative for a runner. Another option is surgical fusion of the joint. Although it sounds quite dramatic, the loss in range of motion due to fusing is negligible, especially given that the flexibility of the joint is already restricted. A fused joint does not affect your gait as much as the pain and tenderness you are now experiencing. The procedure would require six to eight weeks for recovery.

There are other procedures in which extra space is created in the joint by removing bone either at the joint or from the metatarsal--this is a surgical cleanup or debridement of osteophytes at the joint. Each procedure would require a significant layoff and may give differing degrees of relief and different amounts of time before your toe might need attention again. Work with your doctor to choose the best treatment for the condition of your toe joint. You can hope that in the meantime the joint will fuse on its own.

Jeffrey L. Moore, D.P.M.

Lancaster; OH

A shoe with a stiff, steel-soled forefoot inserted by an orthotic shop may help you avoid surgery when osteoarthritis of the big toe joint causes pain and a decrease in motion. The shoe should have a "rocker bottom" sole, and lace tightly so that the foot doesn't slide toward the front of the shoe with each step.

Marvin H. Bloom, M.D.

Burlingame, CA

HAMSTRUNG & SIDE-LINED

I've been running the same six-mile loop at about a seven-minute pace, three times a week for years without injury. Last week, about a mile into my usual run, I felt a tightening in the back of my left leg. Before I could even stop and stretch, I felt a sharp pain that stopped me in my tracks. At first, I thought it must be a severe cramp, so I tried to walk it off (although even walking was painful). I sent my running partner for the car and went home for rest and ice. I've been using a stationary bike and doing mild stretches for the last few days. Today I went out for an easy run, but didn't go a block before giving up and hobbling home.

Maybe I've torn my hamstring? What should I do to get myself running again? I'm very discouraged.

Rick Smith

Rexburg ID

Pain in the back of the leg can be caused by a number of problems including bursitis, stress fractures, lumbar referred pain, and piriformis syndrome. Assuming that, in fact, your injury is a hamstring strain, recovery depends on the severity of the injury. This can vary from mild inflammation to an actual rupture of the muscle. If you have pain that persists for more than a week with rest and ice; have any local redness, bruising or swelling; numbness, tingling or weakness, get in touch with a physician for an accurate diagnosis and a good rehab plan. If your injury is a simple hamstring strain, it should heal with conservative treatment, but it is essential that you allow the necessary time for the injury to heal in order to avoid chronic problems and pain.

For the first week of the injury, rest the leg and use ice to reduce pain and swelling. Once the acute pain has subsided, begin gentle stretching every day of the hamstrings, quadriceps, calf muscles, and the hip flexors. As your pain subsides, you can start strengthening exercises including leg curls and leg presses. If your injury is severe or persistent, your doctor can refer you to a physical therapist for additional stretching and strengthening exercises.

Crosstraining activities like stationary biking and deep water running are okay as long as you don't let yourself tolerate pain. Crosstraining shouldn't hurt. If it does, you are prolonging your injury. Reintroduce running when you are pain free during normal activities.

When you start your return to running, you must do it gradually Begin with walking, and add jogging and running as you can, without pain. After starting with a regular walking program, plan to run easy paces and keep distances shorter than your normal loop, with pain as your guide. Continue your strength and flexibility program during your return. Do not rush your return. Hamstring injuries can recur and persist and drive a runner crazy. Although it requires lots of patience, you must give yourself time.

Robert P Wilder; M.D.

Charlottesville, VA

You mention that you have run the same six-mile loop at the same seven-minute pace for years. Varying your routine might reduce the risk of injury and even increase performance. Consider adding crosstraining, strength training, intervals, and longer runs at slower paces--variety is very important for a lifetime running plan.

Doug Lentz, C.S.C.S.

Chambersburg, PA

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 workouts, 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.