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The Clinic.

Q. Going the Ultra-Distance

I have been running long distances since the ninth grade and started marathon running in 1979. I have run 18 of them since then with a personal best of 3:31. I would like to try ultra-distance and wonder if you could provide me with a training schedule and nutritional recommendation for a 50-miler. Ten years ago I ran a 40-miler and completed it in six and half-hours with no injury. Of course, I'm ten years older now, 20 pounds heavier, and want to make sure I take a sensible approach. I am 50 years old with healthy blood pressure and cholesterol, and was recently given a treadmill test, which I completed successfully. Thanks for your help.

Roger Palmer

Orange, CA

A. Welcome back to the world of ultra-running. You certainly have the credentials to prepare for a 50-mile race. Just as the long run is the key to marathon training, it is even more important for an ultra event. Gradually increase your long run, adding one to two miles each week until your long run is about 15 miles. Then increase your long run every other week, with a shorter run, 10 to 12 miles in the off week. Work up to a 35-mile training run. Pace is critical. You are just reestablishing your base and you have gained weight. Plan on walking during long runs. You are training your body to keep moving for a prolonged period of time.

Practice eating and drinking on the run. In longer events, sodium intake is important. Electrolyte solutions, such as Gatorade do not have enough sodium for ultra-marathoners. Adding salt to food and drinks is advisable. Try eating a variety of foods during your training runs. Energy bars, fruit, potatoes, sandwiches, cookies and pretzels are some of the ultra-runner's staples. Some fat and protein in the foods is a good idea for ultra long runs.

Your daily diet should be healthy and well-balanced. For the majority of runners, a relatively high carbohydrate diet (about 65%) is fairly typical. Experiment during your training to see what works best for you.

Ultramarathons are often run off-road. Hills, rocks, tree roots, mud and streams are common in many races. Doing some of your training runs on similar terrain will definitely be to your advantage.

Good luck and remember the ultra-runner's motto--start slow and then taper.

Cathy Fieseler, M.D.

Cleveland, OH

Q. Pain in the Gut

I have had pain in my upper right abdominal area, which starts as a dull ache and grows to considerable pain. My doctor has diagnosed it as an abdominal muscle spasm and has prescribed 10 mg of cyclobenzoprin at bedtime. This has helped some but not much. I get relief by pressing my fist firmly in the area.

I am 61 years old and a competitive race walker--5Ks to marathons. I was also doing weight work on a machine, but I have stopped due to this problem. I have also stopped doing crunches, although I'm not sure they worsen the problem. I'm still training 30 to 40 miles a week.

Neal Donahue

West Palm Beach, FL

A. My concern is that you may have a small abdominal hernia, or ventral hernia. Whenever you use your abdominal muscles, especially during forceful bouts of exercise, the pressure of the abdominal muscles occasionally is overwhelmed and leads to a tear in the muscular wall. These tears or openings are avenues for the abdominal organs to creep out or herniate through the wall. This is particularly common during strenuous activities when the abdominal pressure is quite high and the opening in the abdominal musculature is obvious. The risk with a hernia is that it may restrict the herniated loop of bowel and prevent the progress of normal digestion.

More likely, you have a small muscle tear without herniation. This can be handled in a number of ways. If there is pain at rest, you probably have an inflamed muscle that needs to be rested for a period of seven to ten days until the pain at rest goes away. Icing the affected area each day before you go to bed should help, and the use of anti-inflammatory medication would be appropriate.

I would look at your training habits to see whether you are doing forceful ballistic (jerking motion) exercises for the belly, especially during your abdominal crunches and weight lifting. If loaded gradually, most muscles will not tear. But if you are doing your abdominal crunches with a lot of velocity and impact during contraction, or if lifting excessive loads, this may expose you to an increased risk of abdominal muscle tearing. Decrease your race, walk distances, but keep those muscles strong and maintain your cardiovascular fitness gains with cross training while your abdominal muscles heal. Stationary bicycling would be a good choice.

John Schnell, M.D.

Cleveland, OH

A. Another possibility that may have gone undetected is a pelvic dysfunction causing tension on the oblique abdominal muscles that attach to the inferior costal margin. A sports medicine professional could evaluate this possibility and prescribe exercises to correct the problem.

Mitch Goldflies, M.D.

Chicago, IL

Q. Taping for Plantar Fasciitis

I have had plantar fasciitis for over a year--it improved with a cortisone injection seven months ago. I have avoided a really bad recurrence with new shoes, ibuprofen before runs, icing after runs, and orthotics. I'm running 20 to 30 miles per week. I still have some symptoms, but they are not nearly as bad as before I got the injection. I'm wondering if taping would be useful? If so, how do I do it?

Jim Green

Storrs, CT

A. In general, supportive strapping techniques are an integral part of my treatment regimen for plantar fasciltis. Incorporating a supportive strapping technique will definitely ease the strain on the plantar fascia and limit the chance of recurrent discomfort. I recommend taping combined with orthotics to increase support, protect the foot, and limit the chance of re-injury. I usually recommend taping to be performed all day if symptoms are acute, or before running if symptoms are mild. Once the problem has cleared and there are no symptoms for approximately three to four weeks, the taping can be reduced or eliminated. Although a qualified physical therapist or podiatrist is best qualified to do the taping, the following directions can be followed.

The taping technique I recommend is the Lo-Dye strapping technique. Use one-inch adhesive tape for the heel lock and two-inch adhesive tape for the plantar rest strap.

Heel lock--wrap a single strip of one-inch wide adhesive horizontally, starting just behind the little toe joint, continuing the length of the foot, around the heel and back, and stopping just behind the joint of the big toe.

Plantar rest strap--using three pieces of two inch wide adhesive tape, apply across the arch of the foot, extending up the inside and the outside of the foot, and overlapping the heel strap by about a half an inch. The first piece should be applied at the middle part of the arch. The second and third pieces are applied in the same way, but overlapping the first, forward towards the toes, and then behind towards the heel.

Douglas F. Tumen, D.P.M.

Kingston, NY

A. A tight and over-stressed plantar fascia is responsible for pain and inflammation at the heel bone. The plantar fascia extends from the calcaneous (heel bone) to the toe flexors. With each step the plantar fascia is stretched and pulls at the origin. Stretching is the key to treatment in my opinion. Place your toes of one foot on the wall, heel on the floor, and press your knee doser to the wall. This stretches the Achilles tendon and the plantar fascia and should be very effective in treating your trouble.

Marvin Bloom, M.D.

Burlingame, CA

Q. Avoiding Marathon Cramps

I am 49 years old, have run two marathons (3:38 and 3:43), and have suffered the same problem each time. Near mile 20 I begin to get severe cramps in both calves then later in the race, over my entire legs. Cramping occurred every quarter mile at first, then at every step near the finish. The cramps remained a problem for quite a while after the race was over. Stopping and stretching helped only briefly. I tried walking for awhile but that didn't help much either. The weather was humid for both marathons, with temperatures in the 50s and 60s.

After the first marathon, I thought it must be dehydration. So during the second marathon I drank four to six ounces of sport drink at every water stop- nearly 20 stops. I was actually sloshing through most of the race so I know that I was not dehydrated. I also used gels about every 40 minutes.

My pre-race training was about 40 to 45 miles per week, including two or three 20-mile runs for each. I did not develop cramps during my training runs. I am shooting for less than three and a half hours and would like to kick this problem since it really slows me down.

Tom Kirner

Elizabeth, ME

Congratulations on your excellent finishes for both marathons. For your age group you have achieved superior times. I have a few suggestions to help solve your cramping problem.

First, although your long runs are long enough, your total weekly mileage needs to be increased. You probably need to cover 60 to 75 miles per week for marathon training rather than 40 to 45 (which would be good preparation for 10Ks and l5Ks). Second, the humid weather may be a factor given the generally cool, dry conditions prevalent in Maine throughout most of your training. This would compound dehydration problems. Third, even though you were drinking throughout the race, your total consumption was a 1/2 to 3/4 of a gallon. Yet you probably lose up to two gallons of fluid during a marathon. Finally, you need to be more concerued with carbohydrate loading prior to the race than during it. It is dassic for runners to "hit the wall" at about 20 miles at which point your body has depleted its energy stores. Making sure that maximum pre-race carbohydrate loading has been achieved can help offset that problem.

Mark L Ellen, MD.

Philadelphia, PA

A. The most likely cause for cramping during athletic performance is sodium depletion. Make sure you are getting adequate salt through your diet. Also, rehydrate with a sports drink that includes sodium, like Gatorade. In addition, cholesterol-lowering drugs of the "statin" family can cause mild myopathy in about 5% of patients and predispose to cramping.

Randy Eichner MD.

Oklahoma City, OK

Ask the Clinic!

Are you bothered by an injury? Do you have a training or diet question? If so, ask The Clinic, in care of AR&FA, 4405 East West Highway, Suite 405, Bethesda, MD 20814, FAX (301)913-9520, e-mail Free personalized sports medicine, training, and diet advice is an exclusive benefit for AR&FA and AMAA Members only. AR&FA has more than 255 Clinic Advisors representing more than 27 specialities. Include 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 will not be accepted. Include your address and phone number in case the Advisor has additional questions or would like to discuss your case with you. Responses usually take three to four weeks, but can take as long as five.
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Publication:Running & FitNews
Date:May 1, 1999
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