NSAIDs: Why Runners Should Think Twice - by San Francisco Running Podiatrist

Ibuprofen is often referred to as "vitamin I" by marathon runners and triathletes. I have spotted ibuprofen tablets in the road on nearly every marathon or Ironman triathlon I have entered. Usually the tablets have been dropped and sprinkled on the asphalt just before an aid station, presumably by some miserably sore athlete hoping to kill the pain and keep on running. But just because its popular, doesn't mean its a good idea.

Non-steroidal anti-inflammatory drugs (NSAID's) are the most commonly consumed over-the-counter medication. The anti-inflammatory drugs includes aspirin, Motrin (ibuprofen), Aleve (naproxen) and others. Because these seemingly harmless drugs can relieve minor aches and pains while also decreasing inflammation they are very popular among endurance athletes.

But there are actually two very good reasons why you might want to think twice before popping those pills.
1. NSAIDs slow tissue healing.
2. NSAIDs can damage your kidneys.

I have had dozens of running buddies tell me that they routinely take 600-800mg of ibuprofen after long runs or intervals. This is a common tactic to decrease inflammation and attempt to prevent delayed-onset muscle soreness. There is no doubt that this can work, but at a price.

NSAIDs SLOW TISSUE HEALING.

The very first phase of any wounded tissue healing is the "inflammatory phase." By taking a medication that interferes with inflammation you can actually decrease the tissue healing that takes place after your workouts. This really seems counterproductive.

If you think about how hard you work to stay on pace that last couple of miles during your hard workouts, it would seem you would want the maximum recovery benefit as well. There are a number of studies that show NSAIDs can decrease the effectiveness of the recovery process, and in effect, your workouts.

As long ago as 1986 a study showed that NSAIDs appeared to interfere with recovery from muscle strains. Your hard run workouts (particularly intervals, mile repeats and progression runs) are nothing more than controlled induction of muscles strains. Of course, when your muscles respond to these workouts, they heal and increase your muscular strength and fitness. Interfere with this process and you don't get the maximum bang for your workout buck.

Twenty years later, another study showed that NSAIDs also impaired strength and interfered with tendon-to-bone healing. This is important for any runner or triathlete with tendonitis. Achilles tendon injuries, peroneal tenditis, and posterior tibial tendonitis all have the potential to completely halt your marathon training. If you have any tendon pain, you definitely need to heal as quickly as possible. You have to treat the problem by seeing a running specialized podiatrist and not just covering up the pain.

NSAIDs CAN DAMAGE YOUR KIDNEYS

Your kidneys are metabolic waste-removal machines. They filter the blood and help you get rid of any waste by-products. They also clear NSAIDs.

When you exercise hard, your blood flow is diverted from your internal organs to your hard working muscle groups. Runners know this best in terms of the limited capacity to eat while running. Because of the reduced blood flow to your digestive track, you might get a gastric revolt if you eat too much during a strenuous run. The same sort of decreased organ blood flow happens in the kidneys, but you don't get any warning such as nausea when you tax your stomach.

Studies from New Zealand and England have shown that during sustained exercise NSAIDs can decrease renal (kidney) function and increase the risk of developing acute renal failure. To make matters worse, consider that many marathon runners and aching triathletes will take OTC pills (which are 200 mg each) at a prescription strength (600-800 mg). Taking big doses when your you are exercising further increases the risk of kidney overload and kidney damage.

While NSAIDs are great drugs for the right circumstances, they should be respected. As hard as marathon training and speed workouts are, you want to make certain that you get the best recovery and the most strength gain possible from those workouts. During the race, you must realize that running at your limit is going to hurt. Fight the temptation to relieve the pain with ibuprofen during the race. Otherwise you might find yourself wearing a hospital gown under that finisher medal.

Dr. Christopher Segler is a multiple Ironman finisher and marathon runner. When not busy seeing athletes in his podiatry house call practice, you can find him riding through Nicasio Valley, running in Golden Gate Park, or doing mile repeats at Kezar Stadium. If you think you have tendonitis or any running related foot pain, he will come right to your Bay Area home or San Francisco office to help get you back on the road to recovery as quickly as possible. (415) 308-0833. www.AnkleCenter.com

Ironman 70.3 California Race Report by San Francisco Sports Medicine Podiatrist

On Saturday March 27, 2010 I officially started the triathlon season with my first half Ironman.

The Rohto Ironman 70.3 California in Oceanside, CA is one of the most popular events on the 70.3 circuit and this weekend I got to find out why.

Given that I have competed in many full Ironman distance triathlons (but no half-Ironman events) I really only had three main goals for this race:

1. Finish injury-free! (bad form for a podiatrist to get injured while running)
2. Finish in 5 hours 30 minutes or less.
3. Test the engine and see what I need to do to prepare for the 2010 Ironman season.

PRE-RACE DAY:
Early that morning I went out for the obligatory short ride and transition run. It felt great to loosen up all of the 8-hour car ride stiffness sustained from the drive down from the San Francisco Bay Area. The weather was perfect! I picked up my registration packet and went back to the room to meet Paige and Alex and go for a swim with my favorite 2 year-old.

Because the swim portion takes place in the Oceanside Harbor, athletes are not allowed to swim at the site before race day. No big deal as swimming is swimming and it all looks pretty much the same on race day… arms, legs, and churning confusing.


Because the bulk of the bike leg winds through Camp Pendelton, competitors are not allowed to ride on the bike course. This would be the first race where I would have basically know clue of what to expect on the bike.

I just figured I would treat it like one of my group rides in Marin with my biking buddies in the Bay Area. I usually don’t really know the routes I am being led on when we head somewhere new, so this should feel similar. I’d try to just take it as it comes and pay attention to my heart rate and perceived exertion.

RACE DAY:
We rented a condo right by the harbor which made race morning stress-free as can be. Up at 4:00 a.m., peanut butter and jelly sandwich down, make coffee, shower, get dressed, pump up bike tires, fill aerodrink bottle, gather gear, etc.

It seems like every race lead to some item forgotten in transit to transition, and this was no exception. I had everything meticulously organized. But just as I was headed out of the door I realized it was cold and decided to put on a fleece jacket. In doing so I forgot to put my backpack on again.

So I headed out into the dark and streamed in line with the other 2300 or so athletes heading to transition. I found my spot and racked the bike. When I got ready to lay out my running gear, I realized the conspicuous absence of the back pack.

No big deal as the condo was only about ¼ mile away. I did a warm-up jog back to the condo and grabbed the back pack. Paige, Alex and I then headed back to transition so I could add my towel, running shoes, hat and number belt to the #589 pile in transition.

With everything in place, just had to wait for the start.


SWIM 1.2 MILES:
The goal for the swim was simple. Relax and swim 1.2 mile in 40 minutes without getting worn out or beaten up.

My swim wave was relatively early and I got to start right at 7:00 am. The cannon went off and away we went. The water was clean, clear and way warmer than San Francisco Bay! It seemed like no time before I was rounding the red turn buoy at the mouth of the harbor. I drafted a little, but mainly tried to stay clear or the flailing arms and kicking feet that surrounded me.

When I got back to the boat ramp, I checked my watch and saw success! Swim time of 39:33, no black eyes, and no one kicked me in the head. I felt great knowing I could get out on the bike without having to extract an impacted earplug (at least this time).

Transition 1:
After the 600 foot long run in a wetsuit, I made it to the bike. Stripped the wetsuit, put on my socks, helmet, Garmin, sunglasses and away I went!

BIKE 56 MILES:
The bike course was great! Lots of gentle rollers, some big long climbs interspersed with plenty of flat stuff where I could get on the gas. I can say with confidence that the course is beautiful as it wind through the Marine Corps base. Big green mountains, wildflowers and blue ocean dominate. There is also the occasional “Tank X-ing” and “Live Fire Zone” signs just to remind you where you are. The soldiers volunteering on the base provided (no surprise) perfect order and execution at the aid stations.

I kept a constant low-stress level on the bike course. I went hard, but easy enough that I knew I could still run the half marathon. After 2 hours 45 minutes and 9 seconds (20.35 mph average) I was back in Oceanside and ready to run.

RUN 13.1 MILES:
The run course is a mostly flat out-and-back two-loop affair. The best part was that it runs along the ocean and passes directly in front of the condo where I could see Paige and Alex waiving and cheering from the balcony.

I really wanted to make sure I finished in under 5:30 total. So after some quick math I knew I could coast in as long as I maintained an average pace of 9:00 per mile for the entire half marathon. I went about 9:30 min/mile pace for the first mile to try get moving and loosen up my legs. Then I started to gradually increase the pace.

About two miles from transition I saw my old motorcycle road-racing partner Fred Provis cheering for me out on the course. Fred is one of those guys who can make anyone feel like a champion. He definitely put a spring in my step. The next few miles felt much better. By the first turn around I knew I would make the finish on target.

By the second lap I was in a comfortable groove. I fought the urge to push the pace knowing that I might invite injury, or blow it and end it walking. Given that I had a goal of getting a qualifying slot for Ironman Arizona (as well as doing Ironman Canada five months from now) I knew I should be sensible and just keep the pace steady.

About a quarter mile from the finish I realized I was still slowly creeping up on another guy in my age group. I had been behind him for about 5 miles. For some reason passing him suddenly seemed important.

Right after I crossed the bridge to the harbor, I kicked it in high gear and shot past him. Confident that I was far ahead, I slowed down. Next thing I knew he flew by on my right as we entered the last 50 feet of the finish shoot. I started chasing him as he peered back at me over his right shoulder.

I was picking up speed as we approached the finish line. Then the poor guy suddenly stood bolt upright, grabbed he right hamstring and started limp-running to the line just ahead of me. When I crossed the line he was holding onto a volunteer with one hand his his hamstring with the other. I patted him on the back and said “You reeeeeeally earned that one!”

My total time was 5:29:42. I made my goal with 18 seconds to spare. And most importantly (unlike the guy in front of me), I was injury free. Best of all, I went to watch the roll down... and secured my Ironman Arizona slot. See you in Tempe in November!

Let the training begin...


Dr. Christopher Segler is an Ironman triathete, marathoner, and an award-winning Sports Medicine Podiatrist in San Francisco. He has written extensively on the subject of podiatric sports medicine and running injury prevention. His San Francisco Podiatry practice focuses on house call appointments for busy professionals and athletes who want to prevent or recover from running injuries. He offers the convenience of podiatry house calls at Bay Area homes and offices so that his clients don’t have to lose time going to the doctor or getting custom orthotics. You can learn more about common running injuries at AnkleCenter.com and Doc On The Run.com.

Runner's Pedicure???

Question: "What in the world is a runners pedicure!!! What I am looking for is someone who knows what happens sometimes when you run a half or full marathon. Yes the dreaded black toenail. My toes have mostly recovered but my girlfreind is insisting I get them in shape or keep my shoes on!" - Rick J.




Answer:As a Bay Area podiatrist and active runner (marathons and Ironman) I can tell you that you don't necessarily have a fungal infection just because the toenail is getting thicker and uglier. There is a very common condition among distance runners and triathletes. It is often referred to as "Runners Toenail." Podatriss call it "traumatic onychauxis." If you run a marathon or half marathon and get the black toenail, you have caused enough trauma to the nail bed (under the nail) to bleed. It is basically a bruise or bllod blister under the nail. Repeatedly beating up your toes in this way leads to the root of the nail getting smashed, deformed and becoming missahpen. Then the toenail grows out thicker. It may be greyish, or yellowis in color and often looks like a fungal nail, but it may not have any fungal infection. A pedicure can often thin the nail and return more of a normal appearance to it. Podiatrists can also prescribe topical solutions that decrease the buildup of keratin on the nail that makes it look like a fungal toenial. The bad news is that there is no "cure" for runners toenail. But you can keep your toenail looking presentable with a pedicure. If it gets worse over time (and you haven't had any more episodes of black toneails) it might be a fungal toenail infection. The only way to know for sure is to see a podiatrist. Your foot doctor with then take a sample of the toenail and send it off to a lab for anlaysis. A test called a PAS reaction will determine whether or not there is any fungus living within the nail plate. If there is no fungus, then you have "traumatic onychauxis" (runner's toenail, in plain English. You can also visit http://www.MyRunningDo... for more info. Best of luck! - Dr. Christopher Segler, San Franciso Podiatry House Calls

Training Programs: Your Map To Success

How many miles you have to run in order to finish a marathon? If your answer was a quick 26.2 miles, that’s not exactly correct. The reality is that most people who decide to run a marathon will run hundreds of miles before completing that marathon. The last 26.2 miles makes up a small percentage of the actual mileage in training that goes into completing that event.

Of all of the trainable aspects related to any sporting activity, endurance is the one that an athlete can affect more than any other. On day one, before any training begins, a runner may be able to run a 100 m sprint at 65-70% of his or her potential speed. This same runner on day one might only be able to run about a mile without stopping. However, after a period of months of training, it would certainly be reasonable for this person to run 26.2 miles. This would indicate a 2600% increase in endurance. Those same sort of gains in performance can simply not been made by any human being regarding speed. 

Distance running is for most people a lifestyle change that provides enormous benefits. In order to accomplish any goal in distance running, whether marathon half marathon or 10K, it takes a great deal of training and daily dedication. In order to achieve any goal, particularly one regarding a distance running event, it is critical to have a training program that can be followed consistently. In a sense, a training program is your roadmap to safely completing a given event. 

The goal of any training programs is to get you across the finish line in your desired time. If your goal is to simply complete a marathon, slowly and progressively increase your mileage at a very slow pace and you will eventually be able to run 26.2 miles. The problem with this strategy is that most marathons have cut-off times. This means that you not only need to complete the distance, but must do so within a specific time frame.  If you have a dream of qualifying for the Boston Marathon, this timeframe is much shorter. That means that you will need to train not only for endurance but also for relative speed.

Regardless of the specific training program that you choose, they all combine certain elements. The long run is a staple of distance running training programs.  The definition of a long run is relative. It simply must be long enough to stimulate an increase in endurance. 

This brings up a question that I get from beginning marathon hopefuls.  Why is it not just advantageous to go run 20 or 25 miles on a regular basis and just gradually try to increase speed?  There are both physical and mental reasons why this strategy will fail. First, the amount of muscle and tissue damage that occurs on very long runs is significant. Second, it is very difficult to increase speed while running very long distances. Basically speed and endurance are opposing strengths that cannot be built simultaneously. Third, the overreaching limits to maintaining a goal pace is in the brain. And the brain must be trained as well. 

When you run at a fast pace, particularly for long distances, there are very specific physiologic limiters in play. Your body can only store so much glycogen in its muscle. You also only so much fat burning capacity. Your body also has resistance to muscle damage as well as limitations mechanical inefficiency.  

When any of these specific physiologic limits become reached, your brain takes over. Chemical signals are sent to your brain when you are running low on muscle glycogen. Your brain also makes calculations on physiologic set points such as core body temperature and decreases output when your brain fears injury. Your brain is capable of picking up chemical signals related to muscle damage.   We know that these markers exist in your bloodstream and are actually the ones measured when you have a heart attack. When your brain notices an increase in temperature, or an uncomfortable level of chemical signals related to intense exercise or tissue damage, fatigue sets in, and your brain forces the body to slow down.

This does not mean that you cannot adjust each of these given tolerances that your brain will allow. Through training, your body can become used to a higher set-point of core temperature. Through specific speed work and training your body, your brain can become accustomed to higher levels of chemical markers and tissue damage without fear of injury and without forcing your muscles to shut down. This is why almost all training programs consist of base training/endurance phases, progression phases, and peak phases. 

There are five basic workouts that are put together in various combinations in order to comprise a training program.  The first is the long run.  This workout has one specific purpose and that is to get your body used to moving over ground for a very long distance.  The progression is very gradual and you should not do more than one long run per week.

The second workout is the quarter-mile repeat. A marathon runner will typically do anywhere from six to 16 repeats, with two minutes rest in between, during one session. The idea with these runs is that by only going one quarter mile at a time, your body gets used to moving at a very quick pace without taxing the lungs. The main focus is increasing the rate of turnover.

Tempo runs are another workout which are crucial to developing stamina.  These workouts are typically shorter in duration, maybe four to eight miles.  They’re also at a faster pace, typically anywhere from 20 to 45 seconds faster than your desired race pace. Tempo runs will make your race pace actually seem easier.  For a marathon runner, they will typically only lasts four to eight miles.

Recovery workouts are one of the elements that are least frequently utilized. They are also crucial. If you are putting in heavy miles there is no such thing as a recovery run. Running puts enormous stress on the legs. If you are running very low mileage, it is possible that running at a slow pace can serve a recovery function.  However, cycling is a much more efficient and effective recovery workout. A side benefit of cycling is that it breaks up the monotony of running. In a sense it will also provide you a mental break from training.

The fifth workout is a rest day and it is also often neglected.  Most training programs include at least one rest day per week.  The definition of a rest day means that you do not train. You do not go hiking, cycling, or perform manual labor. Think lazy. Rest means rest.

The following is a sample training schedule for a beginner half marathon. This schedule assumes that you already have running for a couple of months 2-3 miles a day at least 3 days per week. 

Wk Mon Tues Wed Thurs Fri Sat Sun Total mi 

1 2 mi easy Rest/XT 2-3 mi easy Rest/XT Rest/XT 3 mi long Rest 7-8 mi

2 2 mi easy Rest/XT 3 mi easy Rest/XT Rest/XT 3-4mi long Rest 8-9 mi

3 3 mi easy Rest/XT 3 mi easy Rest/XT Rest/XT 4 mi long  Rest   7 mi

4 3-4mi easy Rest/XT 3-4 mi easy Rest/XT  Rest/XT 4-5 mi long Rest 10-13mi

5 4 mi easy Rest/XT 4 mi tempo Rest/XT Rest/XT 5 mi long Rest 13 mi

6 4 mi easy Rest/XT 4 mi tempo Rest/XT Rest/XT 6 mi long Rest 14 mi

7 4 mi easy Rest/XT 4 mi tempo Rest/XT Rest/XT 7 mi long Rest 15 mi

8 4 mi easy Rest/XT 5 mi tempo Rest/XT Rest/XT 9 mi long Rest 18 mi

9 3 mi easy Rest/XT 6 mi tempo Rest/XT Rest/XT 11 mi long Rest 20 mi

10 3 mi easy Rest/XT 7 mi tempo Rest/XT Rest/XT 7 mi long Rest 17 mi

11 4 mi easy Rest/XT 8 mi tempo Rest/XT Rest/XT 12 mi long    Rest 24 mi

12 4 mi easy Rest/XT 9 mi tempo Rest/XT Rest/XT 8 mi long Rest 21 mi

13 4 mi easy Rest/XT 8 mi tempo Rest/XT Rest/XT 10 mi long Rest 22 mi

14 4 mi easy Rest/XT 8 mi tempo Rest/XT Rest/XT 13 mi long Rest 25 mi

15 3 mi easy Rest/XT 4 mi tempo Rest/XT Rest/XT 6 mi lo ng Rest 13 mi

16 3 mi easy Rest/XT 2 mi tempo Rest/XT Rest/XT Half MarathonRest 18.1 mi

Easy: means run at an easy pace.

Tempo: means run at a pace 20-45 seconds/mile faster than your goal race pace.

Long: runs should be run 1-2 minutes/mile slower than your goal race pace.

Rest/XT: means rest if you bad, cross train if you feel good.

Rest: Rest is best the day after your long run. 

Next is a sample training schedule for an advanced half marathon runner. This schedule assumes that you already have been running for at least a year, have already run at least one half marathon, currently run 4 days a week and can comfortably run 8 miles as long run.  

Wk Mon  Tues Wed Thurs Fri Sat Sun Total mi

1 4 mi easy XT 20 min 3 mi tempo 4 x 400 Rest/XT 3 mi long Rest 11 mi

2 4 mi easy XT 30 min 4 mi tempo 4 x 400 Rest/XT 3-4 mi long Rest 12-13 mi

3 4 mi easy XT 30 min 4 mi tempo 4 x 400 Rest/XT 4 mi long Rest 13 mi

4 4 mi easy XT 40 min 5 mi tempo 6 x 400 Rest/XT 4-5 mi long Rest 14-16 mil

5 5 mi easy XT 30 min 5 mi tempo 4 x 400 Rest/XT 5 mi long Rest 16 mi

6 5 mi easy XT 40 min 6 mi tempo 6 x 400 Rest/XT 6 mi long Rest 18 mi

7 5 mi easy XT 60 min 6 mi tempo 6 x 400 Rest/XT 7 mi long Rest 19 mi

8 5 mi easy XT 60 min 7 mi tempo 6 x 400 Rest/XT 9 mi long Rest 22 mi

9 5 mi easy XT 40 min 8 mi tempo 3 x 1600 Rest/XT 11 mi long Rest 26 mi

10 5 mi easy XT 45 min 6 mi tempo 6 x 400 Rest/XT 7 mi long Rest 19 mi

11 5 mi easy XT 45 min 8 mi tempo 3 x 1600 Rest/XT 12 mi long Rest 27 mi

12 5 mi easy XT 60 min 6 mi tempo 4 x 800 Rest/XT 8 mi long Rest 21 mi

13 5 mi easy XT 60 min 8 mi tempo 6 x 400 Rest/XT 10 mi long Rest 24 mi

14 5 mi easy XT 40 min 8 mi tempo 4 x 1600 Rest/XT 13 mi long Rest 28 mi

15 5 mi easy XT 30 min 5 mi tempo 3 x 800 Rest/XT 6 mi long Rest 18 mi

16 3 mi easy XT 20 min 3 mi tempo Rest Rest Half Marathon Rest 19.1 mi

Easy: means run at an easy pace.

Tempo: means run at a pace 20-45 seconds/mile faster than your goal race pace.

Long: runs should be run 1-2 minutes/mile slower than your goal race pace.

Rest/XT: means rest if you bad, cross train if you feel good.

6 x 400: (Quarter mile repeats) means six separate 400 yard runs 

with 2 minutes rest in between.

Rest: Rest is best the day after your long run. 

Notice that both training schedules include a great deal of rest. There are also weeks where mileage ramps up, then decreases slightly before ramping up again. The difference between the beginner and advanced versions are the quarter mile repeats. Repeats are a great way to increase speed.  They are also a great way to get injured if you have not been running for a year or so. Proceed with caution. The beginner program includes much more rest and less speed work to emphasize the fact that building raw endurance is the primary aim to making sure you can go the distance on race day.

There are virtually thousands of different variations on the themes that we have created here. You can find many different training schedules in books, running magazines and online. The key to finding a race program that works for you is to make sure that the person who designed it shares the same philosophy as you. Some trainers think that you should run the entire race without any rest at all.  Others think that it is a good strategy to walk through the water stations only. There are still other proponents of walk, run programs where you may run four miles and walk one mile throughout the race. 

Regardless of which type of program you choose, sticking to the training s the most important step you can take to making sure that you can have a successful event come race day.

Dr. Christopher Segler is an Ironman Triathlete and award winning foot and ankle surgeon with a podiatry sports medicine practice in Chattanooga. He specializes in running injury prevention, sports medicine and surgical treatment of elite athletes. You can learn more about common causes of foot pain while running as well as sign up for a FREE monthly newsletter with tips to increase your running speed and efficiency at http:www.AnkleCenter.com or http://www.MyRunningDoc.com