photo by Cole Burston

iRun to clear my head. Running helps me burn off steam, recharge and refocus. I think it helps make me a better husband, father, colleague and friend.

In the September 2014 issue of iRun, Josh Greenberg — runner, cyclist, family man and a university professor in Ottawa shares part 1 of his journey to break out of a vicious cycle of running injury and finish his next race pain-free. In part 2 of this series, he speaks to the steps it takes—and the ones he’s taken—to get him running injury-free.

The Road to Recovery

By Josh Greenberg
It seems almost everyone in my running network is dealing with one ache and injury or another these days: shin splints, achilles tendinitis, plantar fasciitis, metatarsalgia, ITBS – the list goes on. We’re all juggling families and careers, trying to squeeze in a workout between rushing from a meeting to a kid’s hockey practice or daycare pickup. In my case, this too frequently leads to shortcuts in warm-ups. And forget about stretching to aid in recovery and repair. 90 per cent of the time, I have a small window of opportunity for a run, head out the door, and try to just log as many kilometres as possible.

In the first part of this series I talked about my struggle with chronic injury and pain, and how in the winter of 2010-11, I tore my right calf and achilles during a very sloppy build-up to my first Ottawa Race Weekend Half Marathon. That race wasn’t a total bust: I finished with a limp and walked more than I’d have liked, but my time was respectable, all things considered, and the experience of completing the event was exhilarating. Aside from running longer than I’d ever run before, I was drawn in by the atmosphere of the race, both on and off the course. Cresting the Alexandria Bridge and running onto Colonel By Drive into what I can only describe as a tidal wave of applause and support is an amazing feeling.

I’ve competed in about a dozen races of varying distances ever since, and in almost every case I’ve either started or finished my race injured. After a perfectly normal start, a sharp, stabbing pain comes seemingly from nowhere (there are never trigger warnings), typically seizing in the gastrocnemius, and radiating intense pain into my soleus and achilles tendon.

If I were smart, I would stop, stretch, massage at the point of injury, and then gently walk home. But I’m not smart. Instead, I do what I think many other runners do: push through the pain and finish my run.

THE COST OF INJURY
This repetitive cycle of injury is frustrating and has become tediously predictable. It’s also expensive. Although I have a decent health plan that is better than many, I spent the equivalent of our annual family ski pass on paramedical services last year. The situation has become so discouraging that I’ve considered giving up on running altogether. I no longer have a witty answer to my neighbour who jokingly asks, “Isn’t this supposed to be making you healthy?”

• Are these chronic injuries related to the aging process? I’m now in my 40s and I know that I used to recover from injury far more quickly than I do now.
• Is the problem related to how I’m training? I know that a proper warmup and cool down, including stretching and regular strength and conditioning training, are important. But is the fact that I too often take shortcuts to blame?
• Is there something wrong with my gait? Am I pronating, supinating or otherwise biomechanically flawed? Is orthotics or new shoes the best solution?

I wanted answers to these and other questions so that I can get on the road to running pain free as soon as possible. I can’t continue run in pain all the time, and, besides, physiotherapy, massage and chiropractics should be services I use occasionally, not all the time. And my family shouldn’t have to put up with all the melancholy and sadness that accompanies these periods of re-injury.

GET HELP FROM AN EXPERT
One of my running partners recommended a gait analysis at Solefit in Ottawa to see if the problem was biomechanical in nature, and whether I was using the right type of footwear. Solefit’s mission is to “help identify the root cause of biomechanical issues or injuries and to make recommendations on how to resolve them.” Their team of Certified Pedorthists uses a number of diagnostic procedures, including a thorough running and injury history, and video analysis that includes anterior, sagittal, and posterior views of an athlete’s running gait. The purpose is to identify any problems with running technique, efficiency and force distribution, to assess footwear choice and to see whether orthotics, braces or other aids may be required permanently or just in the short term to get back on the road to running injury free.

I met with Ryan Grant, one of Solefit’s co-owners, on August 25. Ryan is also a competitive runner and has a great reputation for getting weekend warriors and serious athletes back on their feet. We talked a lot about my history of injury, my frustrations with recovery, the types of shoes I’ve used, and my short and long term running goals and objectives. I explained to Ryan that my main goal is to get to a point where I can run regularly without pain. But I’m also a competitive (recreational) runner, and would like to compete at the inaugural MEC Fall Classic Half Marathon in Gatineau Park on November 1. My first priority is to come out of that race healthy and ready for a solid winter of training. After a disappointing 2014 Ottawa Half Marathon, I’m intent on running a PB next May.

I spent about an hour and a half with Ryan in Solefit’s Ottawa clinic discussing my injury history; he examined my feet, watched me walk barefoot, did some basic joint and range of motion testing, and then had me run on the treadmill both with and without my shoes. Here are some clips of the video analysis, along with summaries of Ryan’s assessment.

“From this view, we are looking for excessive movement of the foot ankle. The foot strikes on the outside border of mid-foot and pronates to neutral. Based on this shot, I would not recommend footwear change but to continue with using a lower drop shoe with reasonable stack height.”

“As the camera angle shoes, there is a mild hip drop that will need to be corrected with additional core training. I recommend gluteus medius strengthening exercises and will do a comparison in 2-3 months to see whether this has improved.”

“I’m seeing a tight gastroc/soleus (right more than left) limiting the calf muscle from storing maximal elastic energy and limiting the stretch reflex on toe off. This, along with tight hip flexors, leads to early toe off and increased vertical displacement. There is no quick fix to this problem, so recommend a combination of active release therapy (ART), massage, regular foam rolling, and the use of tune up balls to help release these areas.”

“If we compare the shots with and without shoes, we can see immediately that running barefoot promotes increased cadence and foot landing closer to centre of mass along with a decrease in vertical displacement. Once the period of pain has passed, I recommend small amounts of barefoot running and cadence work to help change a ‘hard wired’ pattern that will encourage more efficient running that can reduce the likelihood of re-injury.”

To my great relief, Ryan recommended that I not “rest” my injury but run regularly and slowly for no more than 10 minutes per day for approximately 2 weeks. As he explained, the idea of a short and slow daily run is to apply “gentle stress” to the injured area to accelerate healing and recovery. To complement a new routine of short and slow running, he advised:

• Heat, local friction massage and foam rolling, at least once daily
• Regular stretching and calf-raises to promote strengthening
• Core exercises, such as power lunges, planking, and the monster walk, to address the “hip drop” problem

As the injury heals and the pain subsides, Ryan suggested I gradually increase the distance of my runs while following the same basic principles described above to help correct the biomechanical problems identified in the gait analysis.

SO FAR, SO GOOD
I’ve been following this new injury recovery ritual for a little more than a month now. I started with a “reset” massage to flush out all of the major knots and kinks in my calves, IT band, and hip flexors. For the first 10 days, I ran only for 10-15 minutes at a painstakingly slow pace (plus a 20 minute walk warmup and cool down), and have been very gradually building on this distance ever since. With very few exceptions, I’m still running every day and my “long runs” are now at 12k at a pace roughly 1:15-1:30 per/km slower than I would have run in the past. I’m doing a pretty good job of consistently following the recommended daily core strengthening activities, but I know I could do better.

The key so far has been to establish and maintain new rituals. This means being deliberate and disciplined about scheduling my workouts in and around a very tight schedule. With 3 young kids and a busy day job, this often involves very early alarms and occasional late evening runs – while it’s hard to change into my gear at 10pm when I’d rather be drinking a glass of wine and watching TV, I know that I need to stick with the program.

The upshot of my new routine is that I haven’t felt the familiar anxiety of worrying about whether or when my injury will resurface. But I also haven’t tested myself with a speed or tempo workout either. Success in anything, particularly sport, takes discipline. I’m doing my best to stay focused on the short-term goal of avoiding re-injury, and with an eye on the longer-term goal of having a successful, healthy winter and a strong spring campaign.

PART 3: WHAT’S NEXT?
The third and final part of this series will be a race report from the inaugural sold-out MEC Fall Classic on November 1. Stay tuned and please keep your fingers crossed for me that I’ll start and finish the race injury free!

An odd thing happened to us last week at EachCoach, the running page of the National Post. A celebrated American runner had promised to answer our reader’s questions but, when faced with the deluge, he pulled a DNF and left us in a bind. Enter the Canadian marathon heroes. Rather than see the questions go unanswered, we turned to our country’s greatest runners: Reid Coolsaet, Krista DuChene, Lanni Marchant, Rob Watson and Dylan Wykes. In fine form, and not afraid of hard work, each of the champion’s gave their response, and all this week, we’ll feature their expertise. Yesterday, Reid Coolsaet, Olympian, rock star, and second fastest marathon runner in Canadian history, took the questions. Today, Krista DuChene, dietician, mother of three, iRun columnist, and second fastest female marathoner in Canadian history,  gets down. Krista is pretty amazing—she once ran a half marathon on a broken leg. Here’s what she had to say:

June asks: Do you think Boston will be able to accommodate all qualifying runners in 2015?


Krista responds: Yes, Boston has an excellent reputation and is a high-class event. I do believe they will find a way to accommodate the runners in a fair and equitable way.

Terrie asks: I am planning to run a half marathon on October 12. I have been training. I ran 18 today.  What should I be practicing my long runs at? How should I practice my tempo runs?  I would like to finish the half marathon at 1:50. This will be my 3rd half marathon. But I’ve never finished less than 1:52.

Krista responds: Typically, each week I do intervals (i.e. speed work), a long run that is slower than race pace, and a tempo run that is faster than race pace with a 12-16 week training block.

Dean asks: During a marathon, how much and what do you typically drink and how many gels do you eat?

Krista responds: I mix Eload and Eload “Fly” with water, which I consume in combination with gels during a marathon. The volume of fluids varies, depending on the weather, but the amount of carbohydrates remains the same. Aim for approximately 55-75 g carbohydrate/hr and 400-800 mL fluid/hr. Practise in advance to know what works best for you and your digestive system!

Khavita asks: How does your diet differ from the start of training to a few weeks prior to your big run? 

Krista responds: With about six weeks left to go before a marathon, I really tighten up my already balanced and healthy diet. Less snacking and smaller quantities help get me lean for race day. Of course, I consume more carbohydrates in the week leading up to the event so as to maximize my glycogen stores.

Vanessa asks: What is the beat piece of advice for getting to Boston? How did you tailor your training to get faster and stronger?

Krista responds: Consistency is key to getting faster and stronger for any marathon. Set goals with a coach or mentor and work your way backwards to determine what you must do now to succeed.

Wendy asks: My concern is a solid race nutrition and hydration plan. For my age and weight (130), I am having a hard time understanding the carb loading before a race, and what my plan should be during my race. I was told to try different things during my long runs. I have tried gels, fig newtons, dried fruit, nuun in my water bottles. Nothing has clicked. The last couple of weeks I have been using Hammer Perpetuem. I like the idea of just one item (and water). Is this enough?

Krista responds: While food is perhaps more appealing than gels as a way to consume carbohydrates, gels are more practical. Try various brands and flavours, and rather than gulp one all at once, sip it slowly. Consuming an electrolyte drink is also important during the race. Practice using the drink provided by the race, ahead of time.

Sylvain asks: Energy gels help me when I run long distances. Those with caffeine are particularly effective but may cause gastrointestinal hyperactivity (not a good timing…). How can I reduce this side effect?

Krista responds: Perhaps if the caffeine ones cause GI distress for you, they should be avoided. Otherwise, drink appropriate amounts of fluids prior to and after consuming the gel. And sip rather than gulp the gel.

Paul asks: I’m a runner who’s been running for 22 years.  In 2010 I switched to running barefoot do decrease the severity of chronic injuries.  What do think of barefoot running?

Krista responds: There are mixed reviews and the pendulum has gone both ways from the necessity of a “full support” shoe to “barefoot”. Carefully find what works for you, slowly easing your way into any new change. And of course, consult with your treatment team (e.g. physio, etc.).

Theresa asks: I’ve been running for a year now (I am 45), my biggest challenge is not listening to the voice in my head that tells me I should stop and I can’t do it. I’m running my first 10km this month and would like to work up to a half in the spring. Any advice on how to beat the voice in my head?

Krista responds: Practice in your training runs, to ignore and fight off that voice in your head, particularly at the end when you are hurting and vulnerable. Remember, “What will be your story when you are finished?”. No regrets!

Chantal asks: I am training for the Toronto waterfall  this upcoming October. I am doing a half. I also qualified for the boston marathon of 2015 and will know soon enough if I will be attending. Meanwhile I am trying to get myself a better runner and faster. I do speed work and hills. Any suggestion to pass from 3:37 to 3:30 for a full marathon? Nutrition what should I add. I eat very healthy fruits, vegetables and lean meat?

 Should I run the Boston to compete or have fun with the amount of runner attending?

Any suggestion would be greatly appreciate.


Krista responds: Weekly speed work (intervals), tempo, and long runs are part of my training plan. Consistency in a healthy diet and improved training by gradually increasing mileage with faster workouts, will allow you to succeed over time. As for Boston, have fun being the best you can be!

Sandra asks: I’m an older female runner (50+), but I just started running seriously in the last 2.5 years.  So the good thing is I think I still have young legs. LOL  But, the problem is that I’m not sure what I am really capable of running.  In Boston, I ran a 3:55 marathon.  I would like to run faster and have been reading the literature on how to improve my times. However, I find the philosophy is all over the place. It is clear, you have to run faster to get faster, but I’m wondering what type of speed work you would recommend in my case at my age? Is it best to concentrate on longer tempos and/or Marathon Pace runs, or 800 meter repeats, or longer repeats or should I be doing all of this?   I am currently trying to peak at approx 130 kms per week and am training for a Dec Marathon.  

Krista responds: I hate to do this but it’s the same advice as the earlier question—in a nutshell: typically, each week I do intervals (i.e. speed work), a long run that is slower than race pace, and a tempo run that is faster than race pace with a 12-16 week training block.

Akii asks: This past week I’ve been ill and unable to run, missing a planned 15k race last Saturday and leaving me very frustrated.  How do you bounce back from a setback that interrupts your training?  Do you go right back on schedule in terms of distance, intensity, etc., or do you ease back into it with some shorter, slower runs?

Krista responds: Sometimes we get sick/injured because we are over-training.  Look at the time off as a chance to rest and recover. Do not attempt to make up for the lost training. Ease your way back into it and you will soon find that you didn’t lose any or much fitness.

An odd thing happened to us last week at EachCoach, the running page of the National Post. A celebrated American runner had promised to answer our reader’s questions but, when faced with the deluge, he pulled a DNF and left us in a bind. Enter the Canadian marathon heroes. Rather than see the questions go unanswered, we turned to our country’s greatest runners: Reid Coolsaet, Krista Duchene, Lanni Marchant, Rob Watson and Dylan Wykes. In fine form, and not afraid of hard work, each of the champion’s gave their response, and all this week, we’ll feature their expertise. Yesterday, Lanni Marchant, the fastest all-time female marathon runner in Canadian history, took the questions. Today, Reid Coolsaet, Olympian and second all-time fastest Canadian, takes over. Love you Reid, here’s wishing you a speedy recovery, my friend.

Jill asks: I am training for the Toronto marathon In October. This will be my first full marathon and I hope to run at a pace of 4:45-5:00  min/km. I have always included some heavy strength training (squats, deadlifts, etc)for races of lesser distances but find it very difficult to incorporate it into marathon training because of the need for enough recovery. My question:  does heavy strength training have a place in marathon training?


Reid responds: Strength training has a place in marathon training. It’s hard to pinpoint what exactly everyone’s definition of “heavy.” However, if strength training is going to take away from your recovery then cut back on the amount of weight and/or the frequency of sessions until you find it isn’t taking away from your main training, running.

Shannon asks: I’ve been battling a chronic high ankle sprain for almost a year now. I’ve tried physio, laser therapy and acupuncture and it’s still not healing. I’m so anxious to get back to running but I feel like tact might never happen. Any suggestions?

 

Reid responds: Seek out another medical opinion, perhaps some imaging and be patient. In the meantime stay fit with pool running or any exercise which doesn’t cause pain.

Claire asks: I have a question about recovery, because I’ve tried many different methods and not sure what works: What are some ways you recommend to recover from a long hard run? Do you suggest ice baths, leg elevation, stretching, massage, or just “taking it easy” for the rest of the day?
 Thanks!!

Reid responds: I’ve always incorporated many recovery methods. Start off with a proper cool-down after hard sessions. Eating protein and carbs right after a long hard run might be the most important piece of recovery. Massage, ice baths (or leg wraps), active isolated stretching, compression gear should all help a little bit too.

Yaron asks: I am running new York this year. I have been running for 8 years but never raced outside the GTA. What tips do you have for an “away” race and specifically for New York.

Reid responds: Book a hotel early for NYC and familiarize yourself with getting to the start line. There are 50,000 people trying to get to the start line, it will be hectic.  Seek out restaurants where you will be comfortable with the food and find a supermarket to have the things you’re used to. For NYC it would be wise to be used to hilly terrain towards the end of your long runs, Martin Goodman Trail will not suffice.

Raymond asks: Ran 32K after a week-long cruise today, avg 6:02 pace. Won’t qualify for Boston at this pace but at least I completed the distance though with negative thoughts creeping in at around 24K.  My question to REDACTED would be how he fights off the negative thoughts that get louder as the body tires.

Reid responds: First off, it’s good you know that everyone gets negative thoughts when they’re tiring. When that happens using a simple, positive, motto can get you back on the right track. “Keep It Moving” is one that I’ve used in the past to say in my head to override the negative thoughts. Some people find that picking short term goals along the way helps the distance seem more manageable.

Tony asks: Training for Scotia, an October marathon in Toronto, and I am a little ahead of schedule for the fall races… since February I have been training continuously.  Ran a few 30k, halfs and a full since March. As I focus on Scotia how do you prevent peaking in your taining too soon? I am almost ready now.

Reid responds: Taking a day off now and then and holding back on speed work until you’re closer to the race can push your peak back a little. After I ran a few marathons I got a better idea of when I need to train medium-hard and when to start implementing marathon specific sessions. If you feel as though you’re “holding on” now then start your marathon training a little later next build-up. But you might pleasantly surprise yourself because it’s better to be ready early than too late.

Charlotte asks: Do you remember your first race (what race) and what you were feeling as you finished?  My race finishes have been all over the place, just curious! 

Reid responds: My first race was a XC race in grade 6 and I finished second to a good friend. I was surprised that I was ahead of that many people and I’ve been hooked ever since.

Chris asks: I know your lower legs take a pounding in the lightweight racing shoes.  How do you prevent late race cramps?

Reid responds: I prevent late race cramps by practising in my race shoes (NB1400) so my muscles are used to the mechanics of that shoe. I also make sure I’m getting in plenty of electrolytes (as well as carbs) in my drinks.

Simon asks:  I am preparing for my first full marathon later this year (I have done 10ks, halfs). How best can I train to keep my pace same or even increase at the end for the duration of a marathon. What is the best training to increase running strength for throughout a long run? Also, are there any key pre-run stretches to do, to avoid injury and to run better?

Reid responds: I really like doing one or two specific long sessions where I increase my pace throughout the run. For me that is a 5km warm-up, 29km progression where I start slower than race pace and finish faster than race pace, and then a 3-5km cool down.  Doing a long run once a week in training will help help your speed in the later stages of a marathon. I use Active Isolated Stretching (Flexibility) to help avoid injuries.

Fernando asks: My question is around recovery, as an older runner (39 I think) has his recovery plan changed over the last decade? If so, how? For the recreational runner in his early 40’s logging 60 or so miles per week over a 5 or 6 day a week schedule-any key pieces of recovery advice for me?

Reid responds: I find that I have to run slower on some of my runs in between my hard sessions to make sure I’m recovered for the next one. I also do more recovery techniques in a week than when I was in my 20’s.

Brian asks: I have run 6 prior marathons. My best time is 3:20. I shooting for 3:15. What would you suggest my longest pre-marathon training be by distance?  Thank you for your consideration and inspiration.

Reid responds: I like to do at least one full distance run in my build-ups, sometimes even as long as 45km. Not everyone needs that but I would say that it’s helpful to run longer in time than anticipated finish time at least once in your build-up if you’re serious. So maybe that is a 3:25 run, where you won’t cover 42.2km.