The Clinic.

YOUR SHOES CAN INJURE THE ACHILLES TENDON 

Several months ago my Achilles tendon started bothering me. I noticed that the soreness was where the upper part of my shoe rubbed on the tendon. So I cut the shoes to try to prevent further rubbing and put heel lifts in. But I am still having trouble. Now there is a little bump there. Is there anything else I should do?

Cindy Sweezy

Rocky Hill, CT

Most running shoes are made with an Achilles notch to prevent irritation to the tendon. The irritation, which may be minor at first, can escalate into a major problem. First, stop running and see a sports physician familiar with runners. If there is a bump or thickening in the tendon, there may be chronic inflammation with scar tissue, degeneration, or even a partial tear, with real risk for an Achilles tendon rupture. An MRI should help with diagnosis and treatment, which will necessitate rest and may include physical therapy. If the injury is severe, surgery may be required. This is not something to ignore.

Patrick J. Nunan, D.P.M.

West Chester, OH

Pistoning of the foot in the shoe--this is the back and forth sliding motion of the foot inside the shoe--can exacerbate Achilles tendon irritation. Try a tongue pad glued onto the back of the shoe tongue (available at specialty shoe stores). When glued to the foot side surface of the shoe tongue, along with tight lacing, the back and forth movement of the foot can be reduced.

Marvin Bloom, M.D.

Burlingame, CA

COUMADIN AND DISTANCE RUNNING

I am 63 years old and have been running for over 22 years with 25 marathons under my belt. I am currently running 22 to 25 miles a week at a 10- to 11-minute pace. Because of blockages in my right leg and resulting bypass surgery. I need to take Coumadin, a blood thinner, for the rest of my life. Will this affect my running? My doctor tells me that I should avoid long distances, but I'd like to try a half marathon in a few months.

John Robbins

Stuart, FL

Coumadin should not have a direct effect on your running. However, Coumadin does increase your risk of bleeding. If you were to injure yourself while running, such as a muscle tear, for example, you could experience excessive bleeding at the site of the injury resulting in a very large bruise or possibly other complications.

Beyond the risk of bleeding, I don't see any major problem with running long distances. The effects of exercise on blood clotting are not entirely clear, but several studies suggest an increased risk of clotting around the time of an exercise session. Whatever risk this might pose is probably more than counteracted by the Coumadin. Whether running long distances might in some way result in mechanical trauma to your graft is not known.

There is an association between hardening of the arteries in one part of the body and the arteries elsewhere in your body. If the cause of your right leg blockage was due to hardening of the arteries (atherosclerosis), your risk for developing coronary artery disease is increased. If you ever develop chest discomfort or excessive shortness of breath while exercising, stop what you are doing and contact your doctor right away. Although the value of a screening exercise test in people who don't have symptoms is controversial, in your situation I think that it would be a reasonable thing to do. Discuss this issue further with your doctor.

Todd Miller, M.D.

Rochester, MN

I also advise a stress test. Although it may not be as predictive of future events as we'd like, a stress test can help to diagnose a current problem.

Charles L. Schulman, M.D.

Boston, MA

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 send e-mail to [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.

RACE PACE HEART RATES

I have frequently used a heart rate monitor for training and have referred to The American Running Association's publication "Max Heart Rate Training" for guidance. I have a question about race pace heart rates. Why are the heart rates based on race distances instead of times? If two individuals run the same distance at the same heart rate, one at a five-minute per mile pace and the other at a ten-minute mile pace, the 10-minute runner runs twice as long as the five-minute runner. It seems to me that being able to sustain a level of effort should be based on how long (time) not how far (distance) the effort can be sustained.

Clair Billet

Stewart town, PA

Whether you look at distance or time in thinking about your running effort and the corresponding heart rates is a matter of convention and logic. But in either case, it is always surprising to realize that whether you cover a mile in five minutes or in ten, it is the same amount of work measured by the calorie expenditure or work the body has performed. A mile is a mile regardless. The difference between race times reflects variables including age, sex, weight, race terrain, weather conditions, and primarily training status.

Regardless of any individual runner's fitness and speed, the percentage of maximum heart rate that can be sustained over a given distance is lower the longer the distance. Imagine the near maximum effort that you could sustain over a sprint distance. In order to cover a longer distance, such as a 10K, you would have to find a pace and a heart rate that was slower than the sprint effort. And further, as your fitness improves, you will be able to run faster and faster at a given heart rate. Another way to look at it is that you will have to work harder (that is run faster) to achieve a particular heart rate than your less fit self.

You might find more satisfaction in racing and training by using ratings of perceived exertion; that is, how you feel rather than heart rate. Heart rate training for the most part comes down to that-it assigns a number (your heart rate) to what it feels like to run with a certain degree of effort.

TREADMILL ADVICE

I am looking for a good treadmill to use at home for winter training. Can you give me some guidelines for shopping? Also, why do I get the sensation of continuous movement after a treadmill workout?

Lisa Raw!

Annandale, NJ

Treadmills can be an excellent source of both winter and summer training during weather extremes. However, treadmill training is a little different from running or racewalking. Obviously, the treadmill carries the leading foot backward and requires less push-off and therefore less energy. But, more energy is spent keeping the body upright and maintaining balance as the ground moves beneath you. In addition, the unrelenting pace can fatigue muscles and the lack of a cool breeze can raise the body core temperature. It helps to use a fan when using the treadmill.

When buying a treadmill, look for several features. The treadmill should have a running belt that is at least 20 to 24 inches wide, a motor of at least two horsepower, particularly if anyone over 175 pounds might use the machine, and a length of at least 48 inches. Look for a machine that will reach a top speed of at least nine miles per hour. Even if you don't usually run at this speed, higher speeds are useful for interval training. Don't buy without trying it out in your regular running shoes. You need to make sure it doesn't rattle and shake, that your knuckles don't hit the safety rails, and that the running surface has a little give but not so much that you dip with each step.

The continuous motion that you describe is related to motion in the inner ear semi-circular canals. They control motion and balance sensation, and have an amazing ability to adapt to changing conditions. The symptom will likely lessen with time.

Douglas J. Johnson, MD.

Morganfield, KY

Get all the information on the warranty for both parts and labor, and find out who will service the treadmill, because it will need service. This can make or break a great experience with a treadmill and there are major differences among manufacturers.

Doug Lentz, C.S.C.S.

Chambersburg, PA