Saturday, November 29, 2008

Chemin du Buttereau

(Please click on each picture for a better view)

Longevity in the distance running is intertwined with heavy doses of health, luck, and spirit. Longevity is something I have been blessed with in this sport. I have been running for 40 years and have won races overall in 6 different decades

In this post, I will share a source of my spiritual renewal. It is a running course I call Chemin du Buttereau (or just Chemin for short) after the Cape Breton Highland National Park trail that makes up the bulk of the course. The course starts right in front of the modest cottage I own in Petit Etang, Nova Scotia. Within one minute of running along the Cabot Trail you enter the national park running over a bridge crossing the Cheticamp River. A quick swing around the park visitor center and you go through the campground. Back to the Cabot Trail for a 150-200 meter section around a pond. Now you start the well groomed hiking trail called Le Chemin du Buttereau. The trail climbs for a couple hundred meters. It then follows the river in rolling fashion shaded with assorted glimpses of river, emerald colored delta islands,beach and ocean. Once you reach the mouth of the river at the ocean (Gulf of St Lawrence), there is a one kilometer loop that I never tire of, physically or spiritually. The waves thunder majestically against the cliff on the ocean side. I often see whales in the water here.

Eagles glide apparently motionless in the thermals above this spot. The meandering course of the river on the riverside has water that glistens like silver in the daytime sun. Troubles melt away. The only decision that has to be made is how many kilometer loops shall I run today.

It is the only course I have that I get a sense of disappointment when I turn back home rather than add another loop. The course is challenging but not so challenging that you couldn't run it on many consecutive days. The footing is of speed work quality. The trail isn't the only good scenery on the run. Here is the campground road only minutes from home.

When I had cardiac problems a couple of years ago and thought running might become a thing of the past, you get a feeling of loss. It was not the loss of racing skills that hit me the hardest. The thing I mourned most was not being able to run Chemin. This is when I realized the value of priceless intangibles I already had.
The cardiac problems cleared up. I am back to racing and more importantly, back to Chemin. My first run on this course of every trip now starts with a Rocky-like arms in the air exultation when I reach the river ocean junction. This new crazy running ritual will no doubt last as long as I am able to run.

Saturday, November 22, 2008

The Myth and Matter of Achilles Tendonitis

The Achilles tendon is the thickest and strongest tendon in the human body accepting the equivalent of 6 to 8 times body weight with each stride . It is located where the two heads of the gastrocnemius and one head of the Soleus come together to form a cord-like tendon called the triceps surae. This musculo-tendinous unit crosses three joints and exerts meaner force on all three of them than a junkyard Cerberus. The tendon inserts into the middle part of the posterior surface of the calcaneus, a bursa being interposed between the tendon and the upper part of this bone. No other muscle group in the human body exerts such influence, making it the stuff of myths and Homer's Legends. Doh! Not that Homer, but the one of Iliad and Odyssey fame.

Modern day myth starts right with the diagnosis. I feel like Sisyphus when people talk to me about Achilles Tendonitis. Most cases of injury in the back of a runner's heel turn out to be Achilles tendonosis. There is no actual clinical inflammation in the tendon nor are inflammatory cells found in biopsy samples. Hence, tendonitis is a misnomer. Tendonosis is due to chronic degenerative changes in the tendon from repetitive microtrauma and tissue overload.
Achilles Tendonitis does occur; however, I will be making orthotic devices for a Minotaur before the number of "itis" cases overtake the number of "osis" cases.

The etiology of this condition is complex and multi-factorial. It includes:

Gastrocnemius or soleus muscle fiber injury. Muscles fire basically in three ways and hence can be injured in three different ways. The shortening action of muscles is called concentric firing. You fire the Achilles complex concentrically when you raise your foot at the ankle on a step. The breaking action of muscles is called eccentric firing. Many people are 'Zeus lightning bolt shocked' when I tell them that dysfunction/injury of this type is most common. The muscle fires to slow down the lengthening of the muscle. It is a decelerating or braking type action of the complex. The Achilles complex does this shortly after your heel makes contact with the ground during a running stride and does this for only the first half of that split second the foot is on the ground. Postural is the third type of muscle firing. It is the subconscious postural firing of this muscle group that keeps you from falling flat on your face while standing. A muscle can have injured eccentric abilities but not concentrically (or vice versa). The same relationship goes with postural versus the other two.
Structural weakness is common at any tissue change. Tendons are arranged in parallel fibrils. Any knick in the tendon can cause longitudinal tearing along these parallel fibril planes.

Lack of Flexibility can play a role in the early stages of this problem but rarely in the late stage. For this reason, stretching makes a poor universal treatment. Many later stage tendinosis patients are made worse by stretching.
Sometimes tightness is not in the muscle fibers but in the golgi bodies and other parts of the tension monitoring systems within the musculo-tendinous unit. These problems will not respond to traditional stretching and require a different type of exercise.

Bad Shoes: Old shoes, defective shoes, and models that are not a match for your foot type can all put abnormal levels of stress on the tendon.

Bad foot biomechanics: Surprisingly, this is a rare cause of tendinosis in my clinical experience. It occurs when there's too much of a certain motion in a foot joint, or if the right amount of motion occurs but at the wrong time. Fortunately, it is easy to fix when this Pegasus of a different color does occur with use of a custom foot orthotic device.

The shape of your heel bone: A prominent bump on the back of the heel bone leads to more wear and tear of the tendon. Poorly shaped subtalar facets lead to the biomechanical stresses mentioned above. The width of your Achilles tendon: Dr. Richard Schuster analyzed the data of over 10,000 of his athlete patients and found a statistical correlation between the width of the tendon and incidence of its injury. He found that thin tendons are more prone to injury.

Nutritional deficiency: Adequate amounts of Vitamin C are critical to tendon healing. Other deficiencies are more individual and open the doors to Hades with any further generalized discussion.

A Loss of ankle proprioception: Proprioception is the ability to know the location and position of a body part without actually looking at it. Loss of this ability has been implicated in all kinds of running injuries. This one is no exception.

Drug side effects: History of steroid injections into the tendon or general use of certain types of oral antibiotics (e.g. fluoroquinolones). It is well known that corticosteriod injections into the tendon may lead to tendon weakness or even rupture. Few people know that certain types of antibiotics can be a chemical Trojan horse for tendon injury.

Age: By the time we hit our mid 30's tendon tissue slowly starts to loose it resiliency. The number of mitochondria found in our cells reduce in number. Training effect and stress adaptation are slower to respond. This is a sad fact of life as to why degenerative conditions become more common in the second half of life. Age just has a way of making Icarus fly too close to the sun.

Illness: Diabetes, gout, and many other chronic diseases can and do play a role in this injury.
Genetics: Tendons mostly contain Type 1 collagen with a small amount of Type 3 collagen. This ratio varies from person to person as a part of genetic variation. Extra Type 3 is also produced during the tendinosis biochemical process. When the ratio of Type 3 to Type is higher be it from genetics or injury, tendinosis is at greater risk.

Improper amount of stress on the body part before adaptation. This has been called Overuse Syndrome. I hate that term as it leads to myths about exercise in general. The Achilles is stressed by running too fast, too soon. However, it would be a myth to think that Hermes-type speed is the only danger. It is also caused by running too slow. Too much hill training (up or down) can also cause adaptation overload.

Low back injury: Sometimes the heel hurts because of injury or function change initiated elsewhere. In my clinical experience, injury to the 5th lumbar, I st and 2nd sacral vertebrae, are the most common sites to trigger the tendinosis cascade.

Treatment is as diverse and varied as the causes of this malady. Each person needs a unique treatment plan. Rest becomes a four letter word to the runner when it comes to injuries ...whoops, it really is a four letter word' Nevertheless, rest does play a role in the healing of these problems in most cases. The length of time depends upon the severity of the injury. Rest can be complete-such as with a below knee splint or it can be done with partial rest. I prefer partial rest in most cases. My favorite method is to off-load the tendon with a carefully applied special type of tape that mimics tendon function. This allows the patient to continue some running, while avoiding muscle atrophy and increasing blood flow and anabolic processes that exercise stimulates so well. Partial rest can be a real win-win situation. Eccentric strengthening exercises come the closest to being a universal conservative treatment for the tendinosis condition. However, at the risk of being a repetitive Sirens' song, no long-term treatment plan will be highly effective unless you address as many underlying cause and risk factors as you can.

Thursday, October 30, 2008

The Old Man and the Sea

Danny, as promised, this essay in in honor of you.

An earlier time and version of me, I often heard phrases like, “runs with the grace of a deer” or “runs like the wind.” Once upon that youthful time, I was running alone on my high school track. A solitary old man was sitting in the stands. He limped slowly up to me after I finished my run, and said that he enjoyed the beauty of my stride. I stammered as I tried to come up with a response, but he interrupted and went on with passion in his voice. “I've seen many people run on this track and some quite fast. You don't run. You're visual poetry with the ground. It is a gift to be cherished. It makes the eyes and spirit of old men young again. It is the essence of life, I say. Never, I say never, give it up.” I really stared blankly now, not knowing what to say. The riddles seemed to shroud the compliments in an overwhelming way for a fragile young boy's psyche. I grabbed my sweats and went on my way.
It was 15 degrees, at best, on blustery February Sunday. Winds were 20 MPH gusting into the 30's slowing the pace of fast legs that have seen better days. It seems that, factors of aging aside and a bout with heart disease, it has become easier to let off the gas pedal of vigor and hide within my own comfort zone with each passing year. It is even easier when I can rest on past laurels. Reminiscing is easier than pushing the human limits of running. I questioned my own sanity for choosing this spot and on this day for a run. However, lunacy ruled for the day, as I headed directly into the wind to start the run. I distracted myself with the blue and green quilted waves with bright whitecaps that boldly crashed upon the beach. The horizon was so clear I felt like I could reach out and touch its delicate but definite boundary. The majestic display of nature helped to occupy the mind while the hamstrings cursed and screamed with every step into the head wind. My face was so cold, the sinuses ached. I broke the monotony and the chill by running one minute down wind before running 4 minutes further up wind. The only pleasure heading up wind for the four minutes was watching the seagulls and piping plovers that were hunkering down on the beach weave a pattern in the sky in front of me as they temporarily fled my approximate path up the beach. Just before the northerly turn-around, I saw a seagull who did not take flight. Instead it sat limp and drained with a stoic but determined stare. I soon realized it was sick, injured, or both. Death could not be but a few hours away. I felt a reverent pity for the poor creature's soul. I could not help but think that we will all be in that bird's situation one day.
I reached the turn-around point and relaxed my effort into the pleasant feel of a tailwind. I slowed my pace as I came back by the dying bird, wishing there was something I could do to make things better. Whatever great my empathy for this creature facing the end of life, I realized my powers over nature and the meaning of life were very limited. I looked back over my shoulder one last time to see the noble posture and courage in the face of death. My mind then flashed back to the old man at the track. The irony then dawned upon me that, if the bird could see how I have treated my gift, it might be having pity upon me. Be it a few hours or a few decades, be it disease or the slow march of the aging process, we do not die from disease, disability, and age. We live with them. Something happened to the embers of old sparks. My sun-faded jacket had an inner glow. I slowly upped my pace from the comfort zone.
It was Mark Twain who said, "Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover."
The trade winds pushed at my back. I concentrated on form. My pace continued to quicken as I explored, dreamt, and discovered.
Yes, you must have your ship boldly take on the wave in order to ride its crest. I want to try my best to get to the top of my own wave and touch the sky even if gravity and physics has lowered its watery mountain-size. The crest is the thrill. It is the essence of life. It is the thrill of the chase. It is Santiago catching his marlin. The prize is in the struggle. Yes, my eyes were starting to see with clarity. What can these old sea legs can do if given the chance? It is time to revisit the gift of stride, for that is how the spirit, once again, becomes young.

Thursday, October 16, 2008

The Pit Bulls of Baskerville

I wrote this piece as a question and answer column in the Tri-Valley Frontrunners club newsletter a few years back. It is a parable for a basic injury prevent concept. So the readers here can understand some inside information, valley girls is the self proclaimed knickname by the female members of the club. Also, Art Doine and Bobby Doyle were names of club members.

Hipper Chick: I have this pain in my hip. It started about six weeks ago and is so bad I cannot run anymore.

First it is Hip Chick. Now it's Hipper Chick. What is is about these valley girls and their fixation on hips. I'm lucky Linda Tripp didn't attend the meeting or I'd be answering Kenneth Starr's questions instead of yours. “Dr. Bob, were you involved with intimate conversation with a valley girl about her hip?” “No, I was not. She was having intimate conversation with me. Define conversation. Define hip!” Well, so much for impeachment. Let's get back to the fruit salad days of impeared hips.From grand jury interrogation of my own, I have deduced that this problem started right after christmas. Santa must have thought you were a naughty girl 'cause he left you a pair of Nike Lumpocoal Max. I also know the pain is located at the origin of the quadriceps muscles, a rare injury for runners. Combine new shoes with odd injury and I'd start my mystery solving with shoes. Here's why. New shoes can perpetrate the crime with unwanted model changes (just when you find a model you like....poof... it disappears), untested gimick features (like the arch cut-out that did my hamstring in last August), assembly line defects, and material variation. Assembly line defects are self explanatory. The untested gimicks subject is longer and juicier than the Starr Report. So for brevity's sake we'll focus upon material variation. To help us find out what is making your quad bay at the moon, we will go way back to another time and across the big pond to another place. I call upon mystery writer of purple past to help us, Sir Arthur Doine-an' (Bobby) Doyle.Enter, Sherlock Shoes! "By jove, Baby Watson, check out this EVA midsole I found in the moors." "It's without sole, sir," replied BW. "That's because I took it off, cheesecake head. What else do you see?" quizzed Sherlock. "It's damp from the moors, more or less," said BW. "No it is the hardness of the midsole. It differs from spot to spot. On the durometer scale it is 40 here and one inch away it is 36 and ... here right next to that spot it is 44!Darn that Dr. Morinjuriarity!" proclaimed Sherlock shoes. "Yeahand darn his dog, too!" hounds Baby Watson as he scrapes pitbull pasture patty off of his waffle trainers. Congratulations Sherlock, you've solved the mystery. We always assume the midsole and its pieces are of the same hardness as the specifications advertise it to be. In fact the industry considers a ten percent variation in EVA durometer to be acceptable. That's quite alot when you consider that midsole gimmicks to change foot function usually differ by no more (moor?) than ten durometer units. Now consider that there is no effective way for the companies to screen out even larger variations in EVA durometer other than random material testing. Therefore, some shoes make it to the market with subtle and invisible defects that interfere with normal foot function.So, now that we have a shoe-in as our suspect, how do we confirm his guilt. As Sherlock would say, elementary, my dear Watson. Switch back to an oldie but goodie. A pair of shoes you used successfully before the injury but not so worn out that it takes Sherlock's magnifying glass to find some tread on your corpse of a shoe. I know it is London rainwater past the dam but it is best to retire a pair of successful shoes half way through its useful life and keep them in your closet. If nefarious Dr Moreinjuriarity crops up, pull your Sherlock shoes out of the closet and wear them a week or two. If there is significant improvement or resolution, then your barking up the right tree. It is one great way to remove one variable from the injury equation.Hopefully, the mystery will be solved. Make sure you put your “Sherlocks” back in the closet where you can find them. For the fog and full moons of mystery will return. With all the shoe problems out there, Dr M and his demonish dog will have many an opportunity to howl in your backyard.

Sunday, September 28, 2008

All that glitters

I think everyone who partakes in an amateur sport, at some time or another, entertains the dream of running in an Olympic or world championship. I often did on days when I felt extra spunky on a run. It is just that I happen to also be a realist, even when I have my head above the clouds. Therefore, I rarely won, even in my dreams. Cracking the top ten was a fine and dandy doer even for a dreamer.

The idea to revisit cross-country in a big way started when Coach Bill Squires asked some of my workout friends and me if we wanted to run on a team for him in the cross-country Nationals to be soon held in Boston. Bill was between jobs and looking to showcase himself. He had been providing free coaching during the past two years for us, so it was the least we could do for him. He registered us with the USATF as Team SISU and gave us singlets with the team name. Sisu is a Finnish word which roughly translates to courage or toughness.....OK a closer translation would be balls! While waiting for my race, I watched Rodgers and few other people I know in the 1990 Masters XC championship race, thinking, I could do that. I could stay up with those guys (not yet realizing that age 36 is very different from 40+). So the seeds were sewn for a goal. Oh yes, I was about 200th place in the open championship.

Over the next three years, I trained hard but my heart really wasn't into it. I blamed it on the new duties of fatherhood rather than the physiology of aging. My times were getting slower and it was getting more difficult by the year to compete in the open division. As I approached age 39, I read that the National Masters XC champ would be returning to Boston but that the open division race would now be held at a separate time and location. This didn't bother me because I would be a master. I slowly started “ramping” up training. There was a lot of grass running leading to repeat miles on a boring, flat, devoid of shade course I laid out around the outside of the track on the school grounds. This was the best I could do in park-bare Weymouth to get a necessary pillar of cross country training. One can transition from grass to roads but you cannot go from road training and expect to do well on grass. I trained through a 5k developmental XC race to get the first feel of running in spikes since college. Then after a couple of weeks where many of my repeat miles dipped under 5 minutes per mile, I ran the New England XC champs. I finished 3rd, just barely loosing out in a last minute battle for second with Jack Fultz (two time winner of the Boston Marathon). Then, I fully backed off on the training and did my goal race. I was 7th in the Nationals and exacted my revenge on Fultz, who finished a couple of places back.

So, my goal was complete.....or so I thought until the invitation to the Worlds came in the mail. USA was the host country for the first time in 20 or 30 years and Buffalo was the host city. Hmmmmm. Doable! Very Doable. The race would be July 12 which was at the end of my hard to change, already scheduled vacation. The wife and son did not want to give up our Nova Scotia trip so the compromise was a slightly shortened Nova Scotia trip, then shuffle off to Buffalo. My first thoughts when opening the invitation: July 12th in upstate New will probably be 90 degrees and humid. So bring on the encore presentation of repeat grass miles and Sunday fartlek workouts. Add some weight lifting type workouts to boot. Then resist the urge to remove that extra clothing layer in the spring all the way into the summer. By the time we transition into summer, I'm still doing my workouts when it is 80 degrees with a rain suit on. This culminates in my last full length workout 5 days before the big race. I ran an easy paced 11 miles on a 90 degree day in a full rain suit. Since 90 days are rare in Aylesford, Nova Scotia and most locals were suffering in the heat, I was quite a sight to the locals in my heavy running gear.

Sunday- There is heavy bumper to bumper traffic through Maine that afternoon. We decide to drive an extra 50 miles and sleep at home in our own beds in Massachusetts.

Monday- Then, go west, young (errr old) man. We make it as far as Syracuse and stay in a motel. Tuesday- Next morning I wake up and I cannot put any weight on my left leg. It is two days before race day. First thought, panic! The next thought: okay, what did I do that was unusual 1-2 days ago? Ah, heavy clutch activity in our standard transmission car in Maine. I hobble out to the car and continue a gimpy shuffle off to Buffalo.

Wednesday- I wake up in Buffalo and the leg has made quite a recovery. A short run confirms my opinion. I go to a team meeting /athlete orientation. WAVA (World Amateur Veterans Association- the arm of IAAF that handles us geezers) and IAAF(the organization that runs the Olympics) officials “lay down the law” about conduct, random drug testing, etc. I rest in the motel for the afternoon and watch my son. My wife goes and tours around Niagra Falls.

Thursday- It's race day! Out to Akron Falls, the site of the cross-country venue. We reserve a spot in a campground only a couple of miles away for afterwards, then off to the race. I was wrong about the knee jerk temperature prediction. It wasn't 90 and humid. It was 99 and humid! My race was last as they started with the older age groups of both men and women. Half hour before race time, warming up. The course is 10,000 meters (6.21 miles), has a lot of up hill in the first half (my forte) and is flat or downhill in the second half. The last mile culminates in a lot of downhill (my weakness). 10 minutes before race time, there is an announcement. 24 people treated by medics on the scene today and 10 of those requiring hospitalization. The event has been postponed until further notice. Shock and disbelief set in. A meeting was scheduled at the Games headquarters tomorrow. It was only announced in English. A Runner from Portugal standing next to me is lost in concept due to the language gap. I don't know the language but I do know a little Spanish. I successfully get the concept across in the third party language. Back to the campground. We see groups of teens heading into the campground with cases of beer, possible impending bad weather, and a race possibly still to be run. There are broken beer bottles on our tent site. We decide to leave. Buffalo is out of the question for accommodations with the Worlds now in full swing. Severe weather alerts are starting to come across the radio. We pull into a motel in Akron Falls. I forget the name. I think it was the Bates Motel or something like that (psycho violins sound effects scream in the background). The manager, who has a strange resemblance to a young Anthony Hopkins shows us to a room. My 5 year old son goes to sit on the bed and it collapses <>psycho violins. Mr. Hopkins shows us another room and the bed is fine. We take it. Later, I check the bathroom and see an old porcelain tub style shower with a white vinyl shower curtain. The light in the shower is a bare bulb hanging from two wires. There is no cover plate protecting the electrical outlet. <>more shrieking violins Now there are violent thunderstorm warnings and a tornado warning for this area. I have the urge to shut the TV off for fear of a Hitchcock film festival being the feature presentation.

Friday (the 13th )- Well, we made it through the night. No conversations with a long dead mother or daggers in the dark. It's off to a meeting that hopefully will not be run by a fellow in a hockey mask named Jason. An official looking person comes in and reads a brief statement. The gist is that the race will be run Monday morning at 9:00. This looks grim for me. My wife must be back to work Monday and Horror Hotel is out of the question for even another night. I see the Portuguese runner I met yesterday and tell him that it is unlikely that I will be able to run. He tells me in Spanish, “Hay uno o dos cuartos vacĂ­os en mi edificio en la aldea del atleta (There are one or two empty rooms in my building in the Athlete village).” This is confirmed with a WAVA official so the wheels of Instride's scheming gears start to turn. My wife and son head home. I stay and eat in the Athlete village and take a flight from Buffalo to Boston. I miss my scheduled work in a nursing home on Monday, but they were already in the process of giving my work to a multi-health service corporation. So a delay till the following weekend shouldn't ruffle any feathers. So it's settled. I continue the quest. Take that, Jason!

I was on the tenth floor of a building without air conditioning. The only people who spoke English on my floor were those from New Zealand and they generally kept to themselves. I wasn't going to go to Opening ceremonies tonight (sounded too pomp and circumstance for me) but changed my mind to get some human contact after many hours of solitude. It was clearly my best decision of this adventure. I had never experienced the full roar of tens of thousands of people cheering on the home team when we entered the stadium in our USA uniforms. I was placed in the front row for the procession because someone decided I looked good in my uniform (somebody better give that official a drug test). There were fireworks, Elvis impersonators parachuting to a target on the 50 yard line, a Chubby Checkers concert, acrobats and dancers. All in all, it was quite entertaining. Ingrained in my mind was that Ruth Anderson as the torch person to light the “Olympic flame.” She dropped the torch after lighting the flame and the flammable material from the torch must have spilled and caught fire. The platform was engulfed in flames but a quick acting fire fighter whisked her out of there with only suffering minor burns rather than doing a Joan of Arc imitation.

Saturday- It is still hotter than Hingham House of Pizza Buffalo wings. Rod Dixon wins the 800 meters in that furnace. I remembered him medalling at the Montreal Olympics in the black uniform of New Zealand.

My travels lead me to discover an air conditioned room in a place housing mostly Australian athletes. The “cool room” was one of the few comfortable places around. They quickly adopt me as one of their own on the basis of his wit and story telling. One of the Aussie women I spoke with makes it through the prelims and semis in the 100 meters. Her physical rehab between races is thorough and her demeanor is incredibly focused. I now have some new found respect for sprinters. I told her that maybe I'll watch her race Sunday night to offer moral support. She says if I do anything other than rest for my race, she would personally beat me up. Considering the size of here biceps and the speed in her legs, I have no doubt that she could keep her word. I followed her advice.

Sunday- I don't know if it is hot enough to fry an egg or humid enough to poach that egg. Maybe I could tell if I could figure out which came first, the roasted chicken or these hard boiled attempts at wit.

It's tough getting to bed. The heat is bad but the temperature in my subconscious is starting to rise. I'm starting to doubt whether I belong in this caliper of competition. I wake up in the middle of the night. I head out to the John. An empty bladder makes for better sleep. I notice that I'm rubbing elbows with Rod Dixon who is draining his dragon in the adjacent urinal. If piss and vinegar count, maybe I do belong here.

Monday- Race day for real! I make my way to a shuttle bus at some ungodly hour for a nearly one hour ride. Even though it was early, the weather was more reminiscent of fire and brimstone than a heavenly dream. We line up on a course that starts right up a hill. Bang! The gun goes off 4 days late and a whole bunch of dollars short. Feeling the adrenalin and a gift of good hill climbing, I'm in the lead pack as the hill levels and then transforms into a gradual downhill. I ease into a rhythm as others up their tempo. People pass me by in droves. The situation reminded me of that childhood nightmare where you are trying to run away from something or someone and going in slow motion. It seemed like everyone in the race must have passed me by the mile mark. I was waiting for the Laugh-In man in a yellow raincoat on a tricycle to come scooting by. Still, this is no time to panic. There are many uphill sections over the next two miles for me to use my strength. I gain on no one over the next mile and a half. On the most challenging uphill on the course at about 2.5 miles, I catch no one. Someone even goes by me. Maybe it is time to panic. However, the little over-achiever voice in my head says I'm out here to do my represent myself, my team, and my country. Have pride and do your best. I retrench and refocus on my race effort, whatever that may turn out to be. Then, a funny thing happened after we hit the halfway mark. The course opened up onto a huge grassy field. It reminded me of the conditions where I did my repeat miles: flat, groomed grass, and hotter than blazes! The tide turned. I started passing people. Only one person went by me in the next 2 miles. He said something in an Eastern European language. I could not understand the words but the tone of his voice was encouraging. He could have been saying that my mother eats kitty litter and I wouldn't have known it. I tend to lean towards kind words because of the tone. Ah! I know. He must have said, “Slovac and steady wins the race.” Well, so much for oxygen debt humor. I start the downhill last mile and I'm still getting by competitors. I pass three more in the final 200 meters. I didn't have the slightest idea as to my place in the race. I was just happy that I gave my all and had done my best on this given day. The race was won by Grenville Wood of Australia. I hope he is as nice as the Aussies who shared their cool room with me. Joaquim Pereira was second, and Francisco Ribiero took the bronze (both from Portugal). The slots started to fill in on a top ten board. Then low and behold, the tenth slot is filled and says Robert Chasen USA. A wry but satisfying smile came to my face. Dream-Mission Impossible is accomplished. Then, as they say on a Ronco commercial, “wait there's more...” The team scores were then posted and the USA won the silver medal (Portugal won the gold).

It may be a team medal I was awarded. However, no piece of hardware on my awards shelf has such a rich individual story to tell. Yes, all that glitters isn't always gold. Sometimes it is the silver lining to a dream fulfilled.

Wednesday, September 24, 2008

Breaking the tape

I have been asked too many times over the last month about the tape Olympic beach volleyball athletes, Kerri Walsh and Misty May-Treanor wore during the Beijing Olympics. Does it do anything or is it a promotional gimmick?

I cannot answer whether money changed hands. Only their manager and hairdresser know for sure. However, I can tell you this. The tape on their legs and shoulders is a useful tool in the arsenal on the war against injuries. It is a Japanese product called Kinesio Tex® Tape. It is a very thin (about the same thickness as skin), porous cotton fabric with a medical grade acrylic adhesive. A special method of adhesive application and porous nature of the fabric allows the skin to breathe and showering cleans part of the skin under the tape. The tape is designed for a 30 to 40% longitudinal only stretch and when applied lifts the skin and provides support for surrounding soft tissue. This support occurs by reducing the eccentric muscle firing needed to decelerate the muscle group forces it is taped over yet allowing the athlete to still function in his or her sport. I use this tape in my office myself for certain types of injuries (usually those with eccentric overload causes).
So is it marketing? Maybe. The Olympics is big business and who wouldn’t want product with bikini clad healthy women. Is it useful? Definitely

Thursday, August 14, 2008

Plantar Fasciitis

Plantar Fasciitis is an injury caused by excessive stretching of a broad band of fibrous tissue which runs along the bottom surface of the foot, attaching at the bottom of the heel bone and extending to the forefoot. The band stores energy from heel contact in a windlass mechanism and returns most of it to push the foot off the ground. The term is often used to include the layer of muscles which adhere to it. A chronic plantar fasciitis eventually becomes a heel spur in most cases. My treatment will typically begin by determining and addressing the cause or causes of the injury. No injury can have a set cookie cutter treatment. Each patient's treatment plan varies according to the contributing causes.

The common causes and aggravating factors are:

  • Over-pronation (flat feet)

  • But also a foot with a high arch

  • A sudden increase in length and intensity of workouts

  • Excessive weight change

  • Pregnancy

  • Improperly fitting footwear

  • Tightness of the foot and calf (gastocnemius and solues are most common culprits)

  • Training errors

  • Old running shoes

  • Improperly fitting running shoes (especially too wide)

  • Improperly designed running shoes

  • Rheumatoid variant types of arthritis (HLAB27 antigen positive) and disorders of connective tissue healing

  • Running on surfaces too soft

  • fixated or subluxation at calcaneal cuboid and talo-crural joints

The use of medical grade silicone gel heel cushions, and compression socks used as first aid is as close as I come to a universal thing to do. This is rarely curative but is meant to reduce symptoms . Some people like to tape the foot. This is okay for short time intervals as a taping lasts 3-5 days. Socks with spandex woven into them when the need is likely to be more long term. Nonsteroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen, etc.) have significant benefits only in arthritis induced cases. Arthitis induced cases are rare. Most cases of plantar fasciitis lack inflammation. Hence, such drugs often misused for this condition. Deep tissue massage is helpful in some cases. Night splints (which immobilize the ankle during sleep) are well hyped. They have been used with mixed results, at best over the last decade. Stretching and strengthening programs are good for those people who have a tightness of a weakness. Orthotic devices are considered only for those people with a biomechanical fault. A Cortisone injection into the scarred attachment has a success rate of about 50%. Healing modulators, such as injectable preparations containing Arnica Montana have been shown to speed the healing course. Manual mobilization of the calcaneal-cuboid and/or talo-crural joint help those people with subluxations or fixations. The final option, surgery to release the tight fascial bands has a 70-90% success rate. Shockwave therapy fits is as an alternative to surgery. Shockwave or more formally known as Extracorporeal Shockwave Treatment is a relatively new delivery of high energy sound waves to affected areas of the body. It is very similar to the units used in certain cases to brake up kidney stones. It works theoretically by creating controlled injury of the plantar fascia insertion. Proponents are claiming to have success similar to percutaneaous (small incision) surgery. It requires anesthesia and has a timetable similar to small incision surgery. Shockwave theapy is contraindicated in people with diabetes, concurrent nerve-related problems, vascular, pregnancy, clotting disorders (or taking any drug which thins the blood) or various types of arthritis.The present studies I have read on the effectiveness of this therapy are mixed and controversial. Because of this, it is not covered by many insurance companies. The positive studies so far have all been funded by companies who make the unit. I would like to see one by a source with no vested interest before I start to forge my own opinion of the therapy. Only time will tell how good this alternative will be. You have heard the phrase "time heals all wounds? Well time also wounds all heels.

There are also other treatments used in plantar fasciitis by me in cases of an atypical cause of the problem. For example, I remember one athlete on a college scholarship who had seen just about every sports medicine doctor in the Boston area. Both the athlete and her coach were very frustrated after over 3 years of inability to run. The only thing I could find was a wart on the ball of her foot. A wart does not hurt with direct pressure but it usually very painful with side to side pressure. To make a long story short, I removed the lesion and all pain went miraculously away. Not all heel pain is plantar fasciitis. Spinal impingement (at the 5th lumbar or 1st sacral vertebra), tarsal tunnel syndrome, nerve entrapment, Sever's Disease (calcaneal apophysitis), bone cysts and benign tumors can all mimic plantar fasciitis symptoms.

Hopefully this information will enlighten readers of this blog about their McFeet. For we all need help from the sign of the golden arches one time or another.

Sunday, August 10, 2008


I lie curled up on a cot, shivering under a military blanket. I started to cry first as a whimper. But as the dam gave way, the trickle became a deluge. An EMT came over to quickly access the situation, “anything wrong? Are you in pain?” I turned and replied, “No it is just the pain going away.” A perplexed worker stood and stared, then finally walked away. Had I lost my sanity? Here is my story. It was a full blown New England Nor'easter as I waited inside the school for the start of the Ocean State Marathon. Huge thunder claps reverberated the room and lightning flashed in the gym skylights as I stretched on the floor. I overheard a passer-by say, “It sounds like a hogs heaven rally in the air going on out there.”

I said I would run another marathon when pigs fly. That was 1982 in the Foxboro Marathon. I was invited as the guest lecturer for their sport medicine seminar the night before. Running the race would be a good follow through for me. I prepared with long runs and a variety quality workouts. I trained and planned to be prepared. But somehow, even the best plans of mice and men can go awry. That is especially so at about the 21 mile mark when glycogen supplies of the muscles have a tendency to ebb. My brisk pace slowed to what seemed like a crawl. Less than 100 yards from the finish both hamstrings seized up. You've seen it before on the news. A runner doing an imitation of a telephone pole right before the finish. No matter how I tried to take even the smallest of baby steps, my legs would paralyze in spasm. I had come this far. The cameras, finish line spectators, and the clock were in front of me, creating a surreal nightmare. I reached down for something physical and nothing was there. When the flesh is weak, it is time to explore the spirit. I searched the recesses of my mind for an answer. An image then appears of my cat who loved to play with me by challenging me to catch her. She did so by staring me down while making her eyes look big and round, arching her back, escaping me while running backward. I never caught her. If I got too close, she would give a four legged leap 6 to 7 feet in the air all the while twisting and gyrating in ways that would make a gymnast jealous. Okay, idea strikes. If the hamstrings are out to lunch, why not pivot myself around and go backward to use the quads instead. Sure enough, I could move a little. I finished walking slowly backwards, much to the delight of spectators and film crews.

The loudspeaker breaks my reflections, “10 minutes till the start of the race. Please make your way to the starting line. Make sure your number and team tag if you are on one is on the front of your jersey.”

My team was one man short for scoring in this grand prix championship event. I had dedicated my performances in the grand prix to my cat, Windy, who lost her battle with cancer several months earlier. Some people are musicians and can write a song. Others are artists and paint or sculpt a masterpiece. I only have a reasonably fast pair of legs to define who I am. I raced wearing a tea shirt bearing her picture. I had run superbly in those earlier races but figured I would end my season before the marathon. Here was my chance to put an exclamation point on that tribute.

“We'd like to give tribute to the Mayor of West Warwick...” the starters bullhorn droned on. The rain, thunder and lightning had ceased. The weather was finally starting to cooperate as they ended the V.I.P. introductions.

Our introduction was awkward at best. This cream and blue calico cat came out of a side alley begging for food. She was a full grown cat that was emaciated down to just 4 pounds. My wife asked someone on the porch of a nearby apartment if she knew who the cat belonged to. The person replied that the cat was one of many strays that fend for themselves in the alley behind the building. Faster than you spell hooked, she brought the cat home to our no pets allowed apartment and raided our $10 a week food supply for something a cat would eat. I not only lost part of my week's sustenance, but she came right in and ate a spider in the corner of the apartment. I coexisted with this arachnid because it worked better than any can of poison to get rid of biting red ants in the apartment. Now I have a type of animal I never have had any previous contact with eating my precious few morsels of food returning me to a life of ant bites. The cat just stood there and blinked here eyes at me.

I blinked into a stray droplet of rain as the starters gun fired and the race went off. I settled into a comfortable 5:55 pace for the first two miles. Then the course takes a left turn once you reach the Atlantic coast to head northeast for the next 23 miles or so. This normally would not be a problem, except the start weather was just a lull in a powerful Nor'easter. A Nor'easter is October to April precipitation event named for the winds that blow in from the northeast and drive the storm up the east coast along the Gulf Stream. This a band of warm water that lies off the Atlantic coast fuels the storm to make it even more powerful. The winds took any spunk right out of your stride. I worked extra hard to catch up to 3 runners running side by side about 100 yards ahead. Even with the extra effort the pace slowed to 6:10 for the next mile. I already know that the marathon is a long and humbling race. It was time to tuck in behind them and “dog it” for awhile.

I was in a small park near my apartment with Windy on a warm spring day. She enjoyed the outdoors but we tried to do it in a supervised fashion. Suddenly a huge unleashed German Shepherd had her cornered. I rushed into the fray and quickly swooped here up. Windy immediately became calm once in my arms. “You mean she didn't claw you trying to get away,” my wife said, “I never heard of a cat doing that. There's some kind of a special bond between you two.” Windy always considered my lap a safe place to be.

I stayed with that group as if their was a rope around my lap attached to them. Two of them fell off the pace at 9 miles. The other runner took off ahead of me at 10 miles as we passed through in 61:20. I was happy to keep pace and let him go. The rain was really starting to intensify, again. The wind didn't seem quite as bad but still had a bite to it.

I was on the porch of our apartment in Massachusetts. Another cat came across the lawn and became friendly with me. Windy she sat on the other side of me while I pet the cat. She scrunched her eyelids in an disapproving manner. Suddenly the cat bit me on the hand for no apparent reason. Windy growled and leaped over me chasing the cat right off the property. She stopped at the property line whipping her tail back and forth staring down this fleeing feline.

The rain was starting to pick back up as I passed that same runner between mile 14 and 15. At about mile 17 there was a stream coming down a street across my path. It feels more like a steeplechase rather than a marathon. Someone once said that I was so thin that I could run around in a shower and not get wet. However this was no ordinary rain. By mile 18, I was so cold and drenched that I was numb below mid calf on both feet. It was a very strange sensation when running, indeed. At least my feet did not hurt.

There was a wet matted area on the fur of her neck. I found this to be odd for an immaculately clean cat. I brought her in for her 5 month overdue annual check-up. The veternarian found a growth on the underside of her tongue and thought the possible diagnosis was bad. I had him perform an excisional biopsy. The diagnosis was squamous cell carcinoma, an extremely aggressive and deadly cancer in cats. Windy was unusually good for a cat. She took all the pills I gave here without much fuss and even let me give her subcutaneous fluids with a needle to take the stress off of her now straining kidneys. She would give me adoring soulful eye contact even after this painful treatment. It was as if you understood the whole situation.

I hit the 20 mile mark in 2:01:40. I became leery of the dreaded marathon wall that was the start of my undoing 15 years ago.

Sometimes I wondered how she escaped my room to greet patients in my office attached to my home. Then one day I had her in the room with me while I was resting in bed with the flu. I heard a sound and rolled over in bed to see Windy on a chair next to the door. She was “standing” on her hind legs using her two front paws to jiggle the door knob. The door opened and out she went.

Instead I felt better than I had all race. It was as if someone had opened a door in the marathon wall. I picked up my effort through a small village. I felt invincible but knew better than to keep the hammer that far down as the legs started to fatigue at about mile 24.

One day early in June, she felt well enough to issue me the arched back catch me if you can game. I caught her for the first time ever. Rather than gloat about my victory, I fell into a tearful embrace of her. She in turn, looked at me and rubbed her cheek onto side of my face.

Shortly thereafter, we turned out of the wind, but the slowly mounting fatigue made the loss of the wind handicap, unnoticeable. The flooding roads were camouflaging potholes in the road construction as the rain continued to fall. I stepped into one of those potholes with my right foot. It was about 2 feet deep. I went down onto the flooded road face first.

I had a lousy Father's Day. First I was lead off course while running what would have been a nationally ranked masters 10K time. Then I come home to the real bomb. For the first time, Windy won't let me give her the daily medications. At the local animal hospital, they take some tests. The advancing cancer had ulcerated right through the lining of her mouth and could not be repaired. This was causing massive infection which could be controlled by antibiotics but not stopped. The cancer had also spread to hear lungs. I should have known something was up. Usually she sleeps on or next to my legs. That morning, I woke to her on my chest with both front paws in full embrace of my neck. Windy took the journey to the rainbow bridge that following Monday morning. She sat on my lap, the safe place, as the series of three injections were administered to finish the lethal process. It was the most difficult thing I have ever had to do.

Picking myself up out of a 2 foot pot hole in a storm during a marathon was a small hurdle on the steeplechase course of life after black Monday. I got up and made my way up to the finish line. The clock said 2:42 as this weary 43 year old body crossed the line a full 17 or 18 minutes behind the young Kenyan winner. It was not a day for times and records. It was a day for courage and commitments. That was fine by me for I had kept mine to a special fury friend.

The EMT tried to take my wet shirt away from me. “No!” I yelled, “it's source of warmth as I clutched it even closer to me. He completely gave up to attending me after that. But, the pain was leaving and the shirt with her image was warm. The sampling of the memories I have shared of here are tightly woven into my adventures like a strong but beautiful tapestry. Such fabrics resist the fraying stresses that life brings along its journey.