The Clinic.

GLUCOSAMINE AND BLOOD THINNING

I have heard that glucosamine and chondroitin sulfate can have a blood-thinning effect. I am currently taking an aspirin a day and wonder if taking both together could cause a problem.

Willard Creekmore

California, KY

The risk for bleeding with these products is extremely low when used at their recommended dosages such as those found in currently available over-the-counter preparations. Since you are already taking a dose of aspirin to prevent stroke, your risk is very slightly higher than average.

William M Simpson, Jr., M.D.

Charleston, SC

For runners using coumadin, discuss taking glucosamine and chondroitin sulfate with your doctor. Your physician may want to monitor your blood clotting factors.

LTC Francis G. O'Connor, M.D.

Fairfax Station, VA

REHAB FROM BROKEN FIBULA 

I am 60 years old and have been running for 21 years. I am coming back from a broken fibula three months ago. Can you give me advice on a safe return to running?

Carter Jones

Littleton, CO

I am assuming your injury is fully healed and your doctor has advised you to begin exercising again. After a trauma such as a break, the time you spend immobilized helps the bone heal, but weakens the ligaments and tendons. The break may be fully healed but it will take some time for the tendons and ligaments to regain their elasticity and strength. Establish pain-free walking, before adding running intervals. Gradually increase the time spent running and decrease the walk breaks. Once you are able to run continuously, begin your progression gradually by choosing to increase the intensity or volume of your workouts, not both. Also, do 95% of your training on a smooth level surface (like a track or a treadmill) running only on the straightaways. Lateral stability is the last to recover, so taking the turns should wait. To increase both range of motion and lateral stability of your ankle, trace the alphabet in the air with your foot. Try both upper case and lower case letters. After several weeks, gradually wor k the turns back into your workouts.

Don't forget to give ample attention to stretching, especially the lower legs. Tightness in those muscles and tendons can put added stress on the bone. Always include rest and recovery between workouts to avoid overuse injury as you return to your previous level of running. Make use of crosstraining venues like cycling and swimming to help strengthen muscles without leading to re-injury or new overuse injuries. Deep water workouts can help you maintain fitness and strength without, impact.

Greg Tymon

East Stroudsburg, PA

Based on your age and history, consider having a bone density test to make sure you don't have osteoporosis.

Marvin Bloom, M.D.

Burlingame, CA

RUNNING WITH GRAVES' DISEASE 

I have been diagnosed with Graves' disease, or hyperthyroidism, and would like to get information about the effects of the disease and the treatment on running. I have been running for 20 years and would like to train for a marathon.

Smithson Roberts

Ridgewood, NJ

Graves' disease is an autoimmune disease (the immune system directs itself against the body's own tissues) of the thyroid gland, which results in an overactive thyroid gland. Since the thyroid controls many organ systems, such as the heart, muscles, and brain, dysfunction of this gland can have adverse consequences. Symptoms of hyperthyroidism include loss of energy in particular with exercise, increased heart rate, sweating, weight loss despite increased appetite, and muscle weakness. Treatment can include beta-blockers, antithyroid drugs that lower thyroid hormone concentrations, and radioactive iodine treatment that destroys the thyroid gland. Surgical removal of the thyroid gland is occasionally performed in unusual cases. It can take months of medical treatment to lower thyroid hormone concentrations in severe cases.

Hyperthyroidism can slow your running down tremendously since it causes muscle weakness, easy fatigue, and increased heart rate. Since medications should improve the hyperthyroidism, your running performance should improve as well. However, some of the medications, in particular beta-blockers, will slow the heart rate and prevent an exercise-induced increase in heart rate. Therefore, you may not be able to run as hard as you usually do.

Many athletes, however, have suffered from this disorder, including Gail Devers who recovered from a severe case of Graves' disease and won a gold medal in the Olympic games, and Olympic marathoner Margaret Gross. Take heart that this is a completely curable disease with appropriate treatment. You can find more information at the following Web sites: www.glandcentral.com and www.thyroid-info.com.

Theresa A. Guise, MD.

San Antonio, TX

SHOOTING FOR A BETTER 10K

I am 50 years old and have been running and racing most of my life. I would like to get under 40:00 minutes for a 10K. My recent races include a personal record 5K in 18:01, 1,500 meter in 4:56, a mile in 5:12, and 10Ks in 40:53 and 41:09. My usual training includes running 30 to 40 miles a week, including track work and speed drills, and swimming two or three times a week. I'm planning to add strength training to my routine and increase my base mileage to 50 to 55 miles per week. Can you give me some suggestions that may help me achieve my under-40:00 minute 10K goal?

Jerry Rephan

Hot Springs, AR

Your training seems to be going very well. To me, your mile, 1,500, and 5K times are superior to your 10K. Usually you can double 5K time and add one minute to get a predicted 10K time. Your 10K should be 37:01 using this formula. Your increased base training should help you extend your speed over the additional 5K. However, be sure to increase that mileage gradually. Staying healthy is your primary concern. As you age, your recovery needs increase and adding mileage too fast without adequate recovery can lead to overuse injury.

Once your base is established, try to incorporate hill repeats into your program. Run at a 5K effort, build the number of repetitions, and run downhill as well as up.

After about a month, add interval training. Run tempo runs at a 5K pace plus 25 to 30 seconds per mile. Their length should be three to four miles.

Your interval workouts should be at 5K pace or slightly faster. Run intervals that take three minutes or so, that is 800 to 1,200. Begin with equal time for recovery and gradually try to reduce rest volume to half work time. Two and a half to three miles is a good volume for speedwork.

As you approach racing season, reduce your pace to 1,500 or mile pace and shorten your long runs to nine to 10 miles. As you are moving towards the mile, begin to reduce your intervals to 400s, or even 100s. Time trials at 400, 800, 1,200 may also be helpful.

To maximize performance, take serious tapers prior to the significant events. Cut volume 50% to 75%, leaving some goal-pace work in the mix.

Don't forget stretching. While the benefits of flexibility training may not have been proven clinically, I believe stretching is helpful.

Expand your strength training and continue it through the racing season, decreasing sets and repetitions. Make sure your program is running specific. Some suggestions are: dips, chin ups, push ups, feet-elevated push ups, overhead and bench press with dumbbells, back extension, lunges, 10-second hops on one leg, squats, step-ups, and crunches.

You seem to be on track for good performances--on the verge of running new personal records. But don't overdo it. Think train, recover, train, recover...so that you don't end up injured.

Lee Fidler, Ed.S.

Stone Mountain, GA

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. Handwritten 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.