Friday, March 24, 2017

Running and Your Heart, Part II: The Athlete's Heart

Last week, inspired by some recent schoolwork and research, and mildly prompted by my collapse at Rocky Raccoon,  I started a series of posts on distance running and cardiac health.  The first post used my last twenty miles at Rocky as a jumping-off point to talk a little bit about pulmonary edema, and rather obliquely about cardiac illness.  I'd like to delve a little bit more into the relationship between endurance exercise, heart health, and heart disease.  In light of some of the recent media coverage of these issues, we're going to discuss some facts and address some common misconceptions and/or misinterpretations of some of the data out there, with the goal of all of us becoming better informed regarding this topic and better able to make rational decisions about our athletic future.

Before we can get into dysfunction, though, we have to talk about normal function, and about the physiologic adaptations that the heart makes to long-term endurance exercise.  Many of these adaptations are beneficial, but they're not without problems, either.

The normal heart
Chambers (and valves) of the heart

I don't think there's any need to get into a bunch of esoteric facts about the heart (It pumps six liters of blood per minute! It weighs 300 grams!) but we should first go through a few basics.  I'm sure you can remember from ninth grade biology that the heart is a muscle that pumps blood through the body.  You might also remember that the heart is split into two sides (left and right), each of which has two chambers (an atrium and a ventricle).  The right side of the heart pumps de-oxygenated blood to the lungs, where the red blood cells bind to oxygen.  Blood from the lungs then returns to the left side of the heart, from where (whence?) it is pumped out to the rest of the body so that the various tissues and organs can use that oxygen.  Having delivered oxygen to the tissues, the blood then returns to the right side of the heart to begin the cycle again.  Blood flows throughout the circulatory system in what is essentially a series of tubes; veins carry blood to the heart, while arteries carry blood from the heart.

OK, simple enough.  From a basic standpoint, that's all we need the heart to do: pump oxygen-poor blood to the lungs, deliver oxygen-rich blood to the rest of the body.  So when we talk about cardiac disease, we're most generally talking about a failure of the heart to fulfill that function.  But there are a bunch of different ways in which this basic function can be compromised.  For our purposes, there are three systems inherent to normal heart function that we want to be familiar with in order to understand possible dysfunction: the coronary arteries, the conduction system, and the heart muscle itself.
Coronary arteries

We spoke briefly about the heart muscle last week; simply put, the muscle squeezes, increasing the pressure within the chambers of the heart, and forces blood out into the circulation.  The muscle is the heart's engine.  The coronary arteries are responsible for delivering oxygen to the heart muscle.  Wait a minute, you're saying, didn't you just say that arteries carry blood AWAY from the heart?  Yes, I did!  Thanks for paying attention!  Arteries do indeed carry blood away from the ventricles, but in this case they don't have to go very far.  The coronary arteries arise from the aorta immediately after the blood leaves the left ventricle, and they surround the heart, supplying oxygen-rich blood to the muscle.  When you hear the term "heart attack," this is usually used to mean an interruption of blood flow to the heart muscle, usually due to a narrowing of, or blockage within, the coronary arteries. We're going to do an entire post about the coronary arteries next week, so for now, just think of them as the heart's plumbing system.

The conduction system, then, is the wiring.  This system is comprised of electrical fibers that coordinate the heartbeat.  The depolarization of these electrical cells causes the atria, and then the ventricles, to contract synchronously.  The contraction of the atria forces blood into the ventricles, and the contraction of the ventricles forces blood out into the circulation.  When you see that familiar tracing that we all know represents a beating heart:

what you're looking at is a graphic representation of the heart's electrical activity.  (I'm not going to go into what each of those little squiggles means, but if you're interested, read this.)  Without the orderly input of the electrical/conduction system, these contractions may lose their synchronicity, robbing the heart muscle of its ability to pump blood effectively--or contractions can cease altogether.

The athlete's heart
Note the enlarged (dilated) cardiac chambers
in the athlete's vs. non-athlete's heart.
Like any other muscle, the heart responds to exercise by adapting to stress.  Weight lifting, for example, places the skeletal muscles under stress, ultimately causing the muscles to adapt by increasing muscle mass and size (hypertrophy).  Similarly, aerobic exercise means that the muscles requires more oxygen, necessitating increased cardiac output (the amount of blood the heart pumps).  Over time, the heart muscle adapts by increasing the mass and thickness of the muscular wall of the left ventricle.  Other adaptations include dilation (or enlargement) of the various heart chambers, and dilation of the coronary arteries (which I'll discuss more in next week's post).   In the absence of a history of vigorous exercise, many of these structural changes--hypertrophic ventricular walls, atrial dilation--would be considered pathologic.  That is to say, when we see these sorts of things in the population at large, they are usually the result of chronic high blood pressure or underlying cardiac disease, are usually associated with a loss of the heart's pump function, and can lead to congestive heart failure, pulmonary edema, and other general badness.  But in endurance athletes, who demonstrate these changes in the setting of preserved pump function, they are usually considered normal adaptations to long-term vigorous exercise that we term the athlete's heart.

What's the big deal? Aren't adaptations good?

So, in general, we think of the chronic adaptations associated with the athlete's heart to be beneficial, or at the very least neutral.  They allow for us to increase our cardiac output to meet the demands of intense aerobic activity, and do not appear to be associated with the sort of pathology we would otherwise expect from these kinds of changes in heart morphology.  However, there is some evidence that suggests that there may be some downside to some of the adaptations of the athlete's heart.

For example, take the dilation seen in the heart's chambers, particularly the left atrium and right ventricle.  There is a hereditary disease called arrhythmogenic right ventricular cardiomyopathy, a rare condition that causes dilation of the right ventricle and fibrous deposition or "scarring" within the myocardium (the muscular layer of the heart wall).  This fibrous tissue can interrupt the electrical pathways of the heart (remember that conduction system stuff?), serving as an origination point for life-threatening ventricular arrhythmias (abnormal heart rhythms).  The dilated RV seen in long term athletes can be accompanied by similar fibrous deposition, leading to some speculation that there may be an "exercise-induced arrhythmogenic right ventricle" that may mimic the inherited condition.  (Some have posited this as the theoretical framework for the death of Ryan Shay at the US Olympic Trials marathon in 2007, though that--in fact, all of this--remains unproven.)  Dilation of the left atrium also seems to place athletes at increased risk of atrial fibrillation or atrial flutter, two abnormal heart rhythms that, while not as dangerous as ventricular arrhythmias, can still cause significant cardiovascular complications.

No bueno.

Another interesting cardiac finding associated with ultra-endurance exercise relates to cardiac enzymes.  Many of you are probably familiar with rhabdomyolysis, a fun little problem in which repeated skeletal muscle trauma (as seen in, say, a 100-mile run) causes breakdown of muscle tissue and the release of enzymes called myoglobin and creating phosphokinase into the bloodstream.  Just like skeletal muscles, heart muscle contains these enzymes; but there are also enzymes that are specific to cardiac muscle, notably troponin.  Troponin is generally only minimally detectable in the bloodstream; elevated troponin levels generally imply damage to the heart muscle, usually from ischemia (lack of blood flow)-- a "heart attack."  Now, several studies have detected significant elevations in troponin levels following prolonged exercise.  Does this mean that we're giving ourselves small heart attacks during every ultra we run?  Probably not; while troponin elevations following heart attacks tend to peak many hours after the event, and persist for several days to weeks, post-exercise troponin elevations typically appear, and resolve, very rapidly.  Furthermore, while there have been studies showing reduction in LV and RV function following ultra endurance events, in almost every case function has been demonstrated to return to normal within one week, unlike what we would see in a "heart attack."  It appears possible that the transient elevation in troponin following extreme exercise is related to increased permeability (leakiness) of the cardiac cell membranes rather than ischemia, cell death, or permanent heart damage.

What does all this mean?

I know, I hit you with a lot of information, and right now you might be freaking out a little bit.  Freaking you out is not the objective of this post.  We're going to talk big picture in a couple of weeks, and hopefully when we're done you'll feel pretty comfortable with the whole deal.  For now, here's the take-home points:

  • there are several adaptations that the heart makes to accommodate long-term, vigorous aerobic exercise
  • most of these adaptations are generally beneficial
  • there are some morphologic changes (that is, the the size/shape of the heart) that may increase the risk of arrhythmias in athletes
  • most of the evidence we have at this time shows correlation, not causation, and much of the framework surrounding this remains theoretical/speculative
Again, we'll go big picture in a couple of weeks, and I'll be able to draw things together a little bit more.  The point of all this is just to make you a little more aware and informed about some of the interesting stuff that's out there, and maybe to generate some fodder for a discussion with your doctor if you have questions or concerns.  

If you want some really detailed reading on this stuff, check our these highly scientific articles:

Monday, March 13, 2017

Running and Your Heart, Part I's been an interesting couple of months.  I think I've mentioned this before, but since late last year I've been involved with the Heart Center, the preeminent cardiology group in the Hudson Valley, in establishing a new sports cardiology practice.  I'm not a cardiologist (which will become eminently obvious over the course of the next couple of posts) but I have more than a layman's understanding of the athlete's heart and many of the cardiac issues that endurance athletes deal with.  Plus, I've always had a major interest in exercise physiology, and have been looking for an opportunity to break into that field for some time.  Starting within the next couple of months, we'll be opening the doors on our new sports cardiology practice (spiffy title pending) and I'll be working part-time as the group's exercise physiologist.  So exercise science and the athlete's heart have been on my mind quite a bit recently.

This was obviously at the forefront of my thoughts during and after Rocky Raccoon.  As a brief recap, I was running very well at Rocky through 60 miles (9:12) and, despite a nosebleed and some other minor issues, was still on pace for a top-6, sub-16 hour finish through 80 miles (12:45).  In the last twenty miles, however, I developed some rather scary breathing issues, including some rattling breath sounds starting around mile 88 that had me concerned I might be developing pulmonary edema.  Pulmonary edema is basically fluid buildup in the lungs; it can occur for a variety of reasons in sick or elderly individuals, but is much less common in young, healthy folks.  (I'm referring to fluid within the lungs; this is different from a pleural effusion, or fluid around the lungs, which is an entirely different issue I'm not going to address here.)  Mountain climbers can experience high-altitude pulmonary edema (HAPE), which is basically a failure of the pulmonary (lung) vasculature (blood vessels) in response to the physiologic demands of altitude--obviously not an issue in Huntsville, TX.

The most common reasons for a buildup of fluid in the lungs are basically an inability to remove fluid (kidney failure) or an inability to circulate fluid (heart failure).  Reports of kidney failure following extreme endurance events, due to a condition called rhabdomyolysis, are not uncommon.  Rhabdomyolysis occurs as a result of extreme muscle breakdown, when large amounts of a muscle-based proteins myoglobin and creatine phosphokinase (CPK) are released into the bloodstream.  Without proper fluid intake, these proteins can accumulate in the renal tubular system, causing kidney failure.  Kidney failure can lead to anuria (inability to urinate) and pulmonary edema, as the body cannot excrete excess fluid and hydrostatic pressure causes fluid to leak into the lungs and other tissues.  In a 100-mile race, this is certainly a possibility (though remote).  However, I wasn't terribly concerned; I had urinated several times during the race, without any blood (a telltale sign of muscle breakdown called myoglobinuria), I had been taking in adequate fluids, and it was not an overly warm day.  Also, rhabdo-induced renal failure is usually a later finding; it was hard to believe that my kidneys could have already failed to the point where I was going into pulmonary edema less that fourteen hours into the event.  My real fear was my heart.

The most common cause of pulmonary edema is heart failure.  Basically, if the heart muscle is weakened (by any of a variety of mechanisms; most commonly, a heart attack), its ability to pump blood adequately can be compromised.  This can lead to a backup of blood flow throughout the body. When the blood does not flow adequately through the venous system, that can cause an increase in the amount of pressure within the veins.  That increased pressure can cause fluid to leak out of the veins, where it doesn't belong--including into the lungs.

Fortunately, not my chest X-ray
Now, I had no real reason to be concerned about my heart.  Other than some mild hypertension, I have no personal history of heart disease, and no other significant risk factors; I had even undergone a recent CT angiogram of the coronary vessels (more on this in subsequent postings), which was normal.  But as I mentioned, I've been rather immersed in sports cardiology and the athlete's heart recently, and as I'll talk about in the next few posts, there are a lot of unlikely but unpleasant possibilities that can befall those of us who take this running thing a bit too seriously.  At its essence, the heart is a rather simple pump, but the underlying components of the organ are a bit more complex, and therein lies a lot of potential problems.  The relationship between exercise, heart health, and heart pathology is actually quite fascinating, and I'll explore that a little more as promised in coming posts. But certainly in real time I was less fascinated and more, well, freaked out.

Anyway, I finished the race by walking the vast majority of the last 18 miles or so, and since then have recovered more or less normally.  I had the usual post-race leg swelling, which in this case brought on some additional anxiety but ultimately resolved as expected.  For a few days afterwards I felt as though I was getting short of breath just walking around or climbing stairs, but I think that may have all been in my head.  A week later I went for an echocardiogram, which is an ultrasound of the heart.  This test shows the activity of the heart muscle in real time; it can show if there are areas of the muscle which are not functioning normally (wall motion abnormalities), if there are problems with leaky heart valves, and how much blood the heart pumps with each beat (ejection fraction).  My cardiologist said my heart was very photogenic:

He also told me that, other than some normal findings associated with the athlete's heart, everything looked good, and that my ejection fraction was normal.  And after a two-week break, I started running slowly again.  It's been a longish recovery period, but now five weeks post-Rocky I'm running more or less normal mileage and feeling just about ready to get back to some harder training again.  (Though the estimated 24" of snow coming our way tomorrow may preclude that for a little while.)

So, apparently this has all been much ado about nothing, fortunately, though it's forced me to think a bit about the role of the sport in my life.  It's a silly pursuit, of course, for those of us who are not making a living at it; sure, it's better than plenty of other bad habits we could have, but there probably isn't anything in our lives that needs to be taken to the extremes that we ultrarunners face regularly.  I did have some fleeting thoughts about what life would look like without 110-mile training weeks.  Unfortunately I don't think I'm mature enough to make any difficult decisions about it at this point, though with a clean bill of health it doesn't seem I'll be forced to do so for awhile.  So for now I'll keep plugging away and trying to slay whatever dragons strike my fancy in the coming months.  (Plus there's always the Western States lottery to look forward to.)

However, there's an awful lot of information out there regarding distance running and long-term health, and a lot of it can be very confusing.  So in the next few weeks I thought I'd try to demystify some of that information, in case anyone else is struggling with some of these decisions regarding their future in the sport.  Next post we'll talk a little bit about the athlete's heart and some of the various changes related to distance running, and whether or not we need to worry about those things.  After that we'll go into the association between ultrarunning and coronary artery disease.  And I'd like to spend a post on the relationship between strenuous exercise and overall mortality, which has been in the news quite a bit recently.  So, check back soon for more possibly accurate, semi-scientific information.

Thursday, February 16, 2017

Race Report: Rocky Raccoon 100

It's been almost two weeks since Rocky Raccoon, my first real 100 miler (not counting last year's 24-hour at North Coast, though maybe I should).  I've been struggling with various, conflicting emotions since I crossed the finish line in Texas.  Relief at being finished.  Disappointment at not having achieved most of my goals.  Frustration that, despite excellent preparation and race execution, I was left with a sub-par result, largely due to circumstances outside my control.  Pride at having actually accomplished the task of running 100 miles, still in a relatively respectable time.  Concern and fear over what I might be doing to my body.  Uncertainty as to where I go from here.

I came into Rocky about as prepared as I could've hoped.  I'd had four months of basically uninterrupted training since North Coast, averaging over 100 mi/week for the previous 13 weeks (including recovery weeks!) with a nice mix of track work, hills, tempo, and marathon-pace efforts.  Greg had almost fixed my chronic Achilles tendinosis.  Scott had basically tortured my muscles into balance.  My weight was perfect, right in the 137-lb. range.  Four weeks earlier, I had run a solo 50K in 3:39, feeling completely relaxed; my last 10 miles were easily the fastest of the run.  I had no excuses.  I flew to Houston on the Thursday before the Super Bowl with my great friends Phil and Laura (and Francis Ford Coppola, who was on our plane); Phil would be running his second 100 (after an epic battle with the Grindstone course last year) and Laura would be crewing me and pacing my last 25 miles.
All smiles at the start, with Phil.
photo: Laura Kline
The opening pace was about as fast as I expected.  My pre-race goal was 15 hours (I didn't know exactly how realistic that was, but I knew I could run 16 hours, and I wanted to be mentally prepared to try to run faster than that), and based on previous years I figured that a 15-16 hour performance would have me comfortably in the top 5.  I was anticipating a quick start, though, so I lined up several rows back and let folks go crazy in the early stages.  I stopped to pee around four miles in and was very pleased to find that Phil had been running right behind me (why he hadn't said anything for the first half hour is beyond me).  He was planning on running in the 17-18 hour range, so this pace was a bit faster than he needed to be, but he was happy to run comfortably with me and plan on slowing down later, so we settled in to 9:00 pace and wiled away the miles chatting and making sure not to go too fast.
With Phil at mile 23, cruising along.
photo: Laura Kline
We finished the first 20-mile circuit in 2:58, right on pace (if not place; we were easily outside the top-20, already over 30 minutes behind the leaders; but I knew there weren't about to be twenty sub-15:00 100s out there) and resolved to slow down just a tad over the next lap, so as not to overdo it.  Phil was the pacemaker for most of lap 2, and did a masterful job in guiding us through a 3:02 lap for a 6-flat split at 40 miles.  The course was fun--a mix of singletrack and doubletrack, with a few more rolling hills than I had anticipated, but mostly excellent footing and eminently runnable.  The aid stations were well-stocked and staffed with hilarious, enthusiastic volunteers.  All in all we were having a blast.  I stopped briefly at 40 miles to eat a little peanut butter and chat with Laura for a few seconds while Phil ran through the aid station and opened up a little gap on me, but I had been moving just a touch better over the last several miles and was not concerned about catching back up; by 42 miles were running together again.  I was a few seconds in front when we came to an intersection that had clearly had the markings tampered with; it took us a minute or two to sort out where the signs had been switched around and get back on the right path.  (Where does this compulsion come from, to fuck around with course markings?  How is this fun for whoever is doing this?  I could almost understand it if you were sitting there and laughing at stupid runners getting confused and running in different directions, but why are you switching markings and then just walking away?  What pleasure does that bring you?)

End of lap 2, 40 miles in.
photo: Laura Kline
I kept the pace steady throughout lap 3; I still felt very good, but did not want to go overboard yet, and focused on trying to run the same splits between aid stations as I had on the first two laps.  Phil fell back and I was on my own; I could track my progress to some of the leaders, though it became obvious that a lot of people had dropped out already and I didn't have a clear sense of where I stood.  My splits were not far off, especially accounting for the few minutes we'd lost at the tampered intersection.  The seven-mile Damnation loop between the second and third AS on each lap did become a bit of a slog.  This was the longest stretch between aid stations, and also the longest segment that didn't involve an out-and-back section, so it was rather isolating; it was a good hour of basically solo running, with few landmarks, and by the third time through it was starting to feel like a chore.  But I maintained through 50 miles in 7:34 and finished up lap 3 in 9:12, now in sixth place.  Fifth was a good 20-30 minutes ahead and looking strong; seventh was about 8-10 minutes back (Phil was about 10-15 back, in around 10th).  I knew by know that I wasn't going to break 15:00--negative splits are almost impossible in a race this long--but I told Laura that I'd be at the 75-mile mark in 11:45-12:00, and that 16 hours was easily doable.

I pressed on through lap 4.  After running through every aid station for the first 30 miles or so, I had developed a nice AS rhythm: two cups of Coke, half a banana, a few bites of PBJ, grilled cheese, or a quesadilla, and some pickles.  A minute or so, in and out.  I'd been running the whole way with my Orange Mud Hydraquiver Single Barrel, so I had 26-ounces of fluid with me, which I was generally drinking twice per lap starting with lap 2--one time with GU Brew, then refilling with water for the second half of each lap.  My fueling and energy systems felt pretty good.  I'd taken a few salt tablets, but not many.  I had peed probably four times in the first 70 miles or so; it was a little concentrated, but certainly not brown or anything concerning.  The Damnation loop on lap 4 was interminable; even though it was only about 4-5 minutes slower than I'd been running on the previous laps, it felt like it would never end.  Still, I maintained a nice pace through mile 72, on target to meet Laura at 75.5 in about 11:50.

In a race this long, things are going to go wrong at some point; how you deal with them is what separates a good race from a bad one.  At 73 miles, things that didn't need to go wrong started to go wrong.  I started feeling pretty tired and was struggling a little bit, when I started bleeding from my right nostril.  This isn't unheard of for me, especially when conditions are as dry as they were in Texas, but it certainly was an issue I didn't want to deal with at that point.  I slowed down a little and managed as best I could, and came in to the aid station to pick up Laura right around 11:53 or so.  (For comparison, my 12-hour split at North Coast was about 76 miles, so I was right there, if not a couple of minutes faster.)  Laura was ready to rock (and freezing cold, having been waiting for about 30 minutes as sunset approached) but I had to sit and manage my issues.  A volunteer pulled up a folding chair and brought me some tissues to pack my nose; Laura brought some Ramen and refilled my bottle.

"What else do you need?" asked the volunteer.  "I've got some whoppies.  You want some whoppies?"

Did I want whoppies?  I didn't know.

"I'm sorry, what?"

"Whoppies?  You need some whoppies?"

Shit, I didn't know what he was talking about.  I racked my brain, trying to think of what I was forgetting.  I'd been reminding myself for the past few miles that I wanted to tell Laura to give me a Zofran tablet (for nausea) when we got to mile 80...more as a precaution than anything else, though my stomach had felt mildly queasy...I knew I wanted to drop my vest pack and just use a handheld on the last lap...I couldn't remember what I had decided about whoppies.  Did I want whoppies?  Would they bother my stomach?  Wait, what the fuck was a whoppy?  Why couldn't I remember what a whoppy was?  Laura was back with my bottle, but she didn't seem to know about whoppies either.

"I'm sorry...what are you saying?"


"What...oh. Wipies."

Texas accents, man.

Once I had cleaned the blood off my hands and face with some wet wipes (aka wipies/whoppies), we started off at an easy jog.  I led most of the way back to the start/finish, not running the 9-10 minute pace I had been doing earlier, but holding a steady 11:00 pace for the next four miles or so, coming through 80 miles in 12:46.  I needed to run only 10:30 pace to break 16 hours.  Fifth place was over thirty minutes in front, but seventh place was about twenty minutes behind.  Sixth was mine, barring disaster.  I dropped my vest and grabbed my handheld, took the Zofran and, at Laura's suggestion, a caffeine tablet, as my energy levels were starting to sag a bit, and we started off, headlamps blazing, Laura in the lead, running ten-minute miles.

I struggled to keep up as we started off, though my legs felt alright, and tried to keep suffering through what seemed to be a bad patch.  But after a mile or so, I could tell it wasn't simply a bad patch.  My breathing didn't feel right.  I was fatigued, to be sure, but beyond that, I was struggling to keep my breathing under control.  I was hyperventilating on every uphill.  After about two miles, I told Laura I needed to slow down to try to catch my breath.  I wasn't sure what the problem was.  Maybe the caffeine, I thought; though I'm pretty habituated to caffeine, and had been drinking Coke and taking caffeinated gels for the past several hours, maybe the tablet had been too much, and it was causing my heart to race.  We stopped at AS 1 (83 miles) and I sat again to check my pulse.  120 beats/minute.  Nothing out of the ordinary; certainly nothing to cause unusual shortness of breath.  I rested a few minutes, drank some hot broth, and we walked on.

Over the next few miles, I tried to run on the flat and downhill sections whenever I could.  Uphills left me gasping for air and were not runnable.  We decided we'd have to try to just wait out whatever was happening.  I had no chest pain and was still urinating.  My legs actually felt fine; on the sections were I could run, I was holding sub-10:00 pace with any real soreness or achiness.  And maybe the breathing was getting a little better.  I'd just walk the uphills until it went away.

It was on the final Damnation loop where everything went to shit.  I started feeling a rattling in my chest when I was running; I tried to cough up phlegm but nothing would come up.  At first, it was only on uphills; by about 88 miles I could hear a rattling sound even on flat segments.  By now I was starting to freak out a little bit.  I doubted it was my kidneys, as I had peed only a few miles earlier.  Was my heart OK?  All the reading I'd been doing for work and school about ultrarunning and heart disease started playing with my mind.

"Laura, I think my lungs are filling up with fluid.  I think I just have to walk."

So, we walked.  Every so often I'd try running for a bit, but the rattling came back after fifteen seconds or so and I was too freaked out to keep going.  Walking seemed OK, and my legs felt fine, and I was still going to be able to finish, so we just walked.  I felt bad for Laura, who had given up an entire weekend and flown all this way and supported me all day to basically be reduced to walking for 18 of the 25 miles she was pacing, but I couldn't do anything about it.  I was still in sixth, somehow, through ninety miles, but by about 91 folks started straggling by.  Phil and his pacer Mike came past at about 93; he looked so strong I wanted to cry, but I put on a brave face and we just trudged through.  I was able to run for about fifteen of the final 25 minutes or so, and finished the last lap with Laura in 5:01, for a 17:48, 12th-place finish.

I went straight to the medical tent, although I felt generally OK, and had one of the docs listen to my lungs, which he pronounced as clear; my heart rate was about 140 when I first sat down, but came down to 90 within the first couple of minutes.  I was still having a hard time taking a full, deep breath without coughing, which would persist for the next couple of days, but otherwise things seemed to be fine.  I'm still not sure what the issue was/is.  My best supposition is that the dry, dusty air caused some bronchospasm and a bit of an asthma-like reaction; several folks, including Phil, commented on how dusty it had been, and I had my nosebleed as evidence.  But I'm scheduled for a chest X-ray and an echocardiogram tomorrow, so we'll make sure everything is ok.  (I'll try to post a bit on the echo, and some various ultrarunning/heart-related issues, next week.)

My favorite existential sign.
This is the next morning.  No, I don't look good.
So where do I go from here?  I won't make any long-term decisions until after the echo results are in. If everything is OK, I assume I'll get back to training in another week or so, and I'll put together a race schedule for the summer/fall in the coming weeks.  I'm glad to have finished, and to have my buckle, and my WS qualifier, and yes, a 17:48 is not anything to sneeze at.  But everything pointed to a sub-16, and my legs were certainly up for it, and my fueling and everything else seemed to be on point.  I'm equal parts frustrated and concerned, combined with the usual apathy/ennui after a major race is over.  It's not a great headspace to be in right now.

I learned that I can prepare for and execute a 100-mile race plan.  I confirmed, after Bandera and North Coast, that I can compete among the second tier of US ultrarunners at long national championship races--I'm not going to win, but after the true elites beat the shit out of each other, I'm certainly in the next wave of guys that are picking up the pieces.  And I learned that bad patches are just bad patches, and that I should recognize them for what they are, and not panic and try to force myself out of them by taking caffeine pills or whatnot; they just need to be endured until they end.  What all this means for me going forward, though, is still a bit of a mystery.

Patagonia Strider shorts and top, courtesy of Mountain Peak Fitness/Red Newt Racing
inov-8 Race Ultra 290s (discontinued, unfortunately, but really looking forward to the new Roclites)
Orange Med Single Barrel HydraQuiver, Handheld, and trucker cap
GU Roctane gels and GU Brew

Friday, February 3, 2017

Nerve Gliding

I'm currently in the Best Western Inn & Suites in Huntsville (home of Sam Houston, the patron saint of Texas), about 16 hours ahead of the start of Rocky Raccoon, my first official attempt at the 100-mile distance (notwithstanding last year's 24-hour effort at North Coast).  Right now I've literally got my feet up, propped on a pile of pillows, and I'm watching a Law & Order marathon, so I'm about as happy as I could possibly be.  In about an hour we'll head out for a little shakeout jog before dinner.  I feel pretty good.  The last few months of training have gone great.  I'm a man without an alibi.

I've talked before about how much I hate tapering, and this time around hasn't been all that different.  But I've added a new element to the pre-race routine that seems very promising that may give me a bit of an edge come tomorrow afternoon.  Prior to my last effort at Recover from the Holidays, I visited Greg at Momentum PT for a routine called nerve gliding.  Basically, the brain and the nervous system are in control of pretty much everything that happens to you during a long race...and if we can fool the nervous system into thinking we don't feel quite as bad as we think we do, we can actually run faster and longer than our brain would otherwise allow.  I'll let Greg explain it better:

Common issues and complaints related to physical/athletic performance are fatigue, cramps, decreased muscle activation/strength, diminished coordination and good ol' fashioned bonking just to name a few.  This is especially the case when talking about events that significantly test one's endurance or during long periods of exertion.  There is a complex interplay between many systems in the body to cause these issues but it is impossible not to implicate the nervous system with each one since it is still the CEO making final decisions based on the information it receives.

Most, if not all, runners have experienced these issues at some point during training or a race.  One of the main factors is when the nervous system has had enough,  the rest of the body will follow suit pretty quickly making it very difficult to reverse course.  Even if everything else like nutrition, training and rest went according to plan, nothing can defy the limits of your nervous system.  So those muscle cramps at mile 22 in a marathon are probably not a salt or nutrition issue anymore; it's more likely to be exertion-related fatigue of the neuromuscular system resulting in those muscle cramps.  The good news is that the nervous system is not static, but is actually quite adaptable and something that can be trained leading to an elevation in performance.  Who doesn't want that?

Before going any further, a quick (simplified) physiology lesson is in order.  The nervous system runs on a baseline level of sensitivity but this is something that can change.  It can become more sensitized which means it is more easily triggered causing it to fatigue and run out of fuel faster or less sensitized which means it is less trigger happy and runs more efficiently (read: less fatigue).  In essence, a less sensitized nervous system is able to provide a more accurate picture of any sensory information coming in to the brain since it's not being triggered over every little and insignificant type of stimuli.  An accurate picture going into the brain results in a better, more consistent output to your neuromuscular system.  You can probably see where this is going: good info in + good info out = improved performance.

The question, then, is how to accomplish this?  The short answer is through what are known as nerve mobilizations or nerve glides.  In the case of runners, the posterior nerve bundle of the leg, the sciatic nerve, is important to target because it innervates the hamstring and calf muscles which tend to be susceptible to cramps.  You can think of them as very specific and repetitive short duration stretches which  can be done in a variety of ways.  Just like many systems in the body, when exposed to some kind of stress, the nervous system will adapt and become "stronger" and more efficient.  Nerve mobilizations are a way to expose the nervous system to new stimuli and gently push its boundaries so that it becomes more comfortable with more stress.  This can be combined with other desensitization and calming/relaxation techniques to compound the effects of nerve mobilizations.  The end result is a robust and fatigue-resistant operating system that allows you to push yourself physically with fewer issues.  A nice bonus is that recovery tends to be quicker after your race or training session as well. 

Get it?  Just like the musculoskeletal system and the cardiovascular system, the nervous system is adaptable.  Placing it under some gentle stress shortly before the race teaches it that the stress it will experience a day or two later is manageable.  Our perception of the stress, and of fatigue, changes.

The routine takes about thirty minutes and is pretty painless.  Greg does some static stretching of the hamstrings, placing some strain on the sciatic nerve; it's mildly uncomfortable but not bad at all.  Then he places some gentle traction on the legs and moves them back and forth (abducting and adducting them, if you're anatomically inclined) while kind of shaking them around.  It's actually pretty relaxing.

Does it work?  I only have the one anecdotal experience to report from last month...which was awesome.  I ran a very relaxed 3:39 solo 50K, feeling much less leg strain and fatigue than I usually would for an effort like that.  And the next day, when I would normally be pretty sore from a long, hard road effort, I was able to cruise an easy sixteen miles, definitely fatigued but without any significant soreness or discomfort.  Maybe it's a placebo.  But if it's even a 1% advantage, that's at least ten minutes in 100 miles.  Tomorrow, I'll need every ten-minute advantage I can get.

Thursday, January 12, 2017

Final 2016 Gunksrunner Ultra Rankings

Men's #1, and UROY, Jim Walmsley
photo: Geoff Baker
I'm still waiting on results from two races in mid-December to officially close out 2016, but I don't really expect either of them to substantively affect the standings, so here are the more-or-less final 2016 GUR.  As noted, I made some tweaks to the formula this year, placing a larger emphasis on level 4 and 5 races, which I think helped.  The question now is whether these races are a little over-valued.  I don't think they are.  Yes, performing well in only one or two level 5 races can really vault someone to a high ranking.  But, it should!  There were only ten level 5 events on the calendar this year; placing highly in one of them really should carry extra weight.  The biggest problem I think I have right now is accurately categorizing overseas races.  Several of them were level 5 this year: Comrades, obviously; UTMB; Laveredo; MDS.  Many others were also level 4, including Transvulcania, Transgrancanaria, Ultravasan, CCC, and several others.  But these races are taking on increased importance, particularly among the North American elites, and I need to be as methodical as possible about making sure these are accurately reflected.  I'm not willing to just accept that any race in Europe is automatically a level 5, as some folks would have you believe--every European field is not Western States, people!--but I need someone with a little more expertise to help out here.  Any volunteers? (Jason Schlarb, I'm looking in your direction.)  I may have to over-rank these races a little bit to account for the fact that the field strength multiplier will not be as robust as it should be (since the multiplier is dependent on the number of top-ranked runners in the race, and these rankings follow North American runners only, European and Asian fields will get some short shrift in this respect).

Otherwise, I'm happy with the balance that the rankings continue to strike between racing a lot and racing just a few big races.  There are certainly multiple runners on both the men's and women's side that obtained top rankings with varied racing schedules.  Some people are higher than I'd like to see them, some are lower.  That's OK, that's what UROY voting is for.

Twenty-seven of last year's top 50 women repeated in the top 50 this year, and twenty-two men did the same.  And allow me a brief moment of bragging to point out that yours truly managed to rank #94 for the year.  I don't know if that accurately reflects anything, really, but I'm kind of psyched about it.

Anyway, here's the final top 50 for 2016.  These runners will factor into the field strength multipliers for every race they run in 2017.  Nearly 4000 men and over 3500 women earned ranking points in 2016.  As always, you can view the entire list here, or anytime using the links on the Ultrarunning magazine site.  Use the CTRL-F function on the rankings sheets to find your own name.

Jim Walmsley
Kaci Lickteig
Brian Rusiecki
Magdalena Boulet
Ian Sharman
Kathleen Cusick
Andrew Miller
YiOu Wang
Zach Miller
Courtney Dauwalter
Dylan Bowman
Amy Sproston
Paul Terranova
Caroline Boller
Mark Hammond
Devon Yanko
David Roche
Neela D'Souza
Christopher Dennucci
Bethany Patterson
Jeff Browning
Cassie Scallon
Alex Nichols
Julie Koepke
Hayden Hawkes
Clare Gallagher
Cody Reed
Sarah Keyes
Jesse Haynes
Alissa St. Laurent
Tim Tollefson
Hillary Allen
Michael Daigeaun
Maggie Guterl
Paddy O'Leary
Amanda Basham
Mario Mendoza
Heather Hoechst
Jason Lantz
Nicole Kalogeropoulos
Matt Flaherty
Jodee Adams-Moore
Jason Schlarb
Kelly Wolf
Kyle Pietari
Sarah Schubert
Sage Canaday
Camille Herron
Michael Owen
Corinne Malcolm
Tim Freriks
Megan Roche
Jorge Maravilla
Laura Kline
David Laney
Keely Henninger
Chris Mocko
Sarah Bard
Jared Burdick
Aliza Lapierre
Aaron Saft
Darcy Piceu
Ed Ettinghausen
Sabrina Little
Dakota Jones
Anna Mae Flynn
Tyler Sigl
Megan Kimmel
Zach Bitter
Annie Jean
Dominick Layfield
Megan Alvarado
Jorge Pacheco
Liz Bauer
Mike Wardian
Kaytlyn Gerbin
Stephen Wassather
Angela Shartel
Brett Hornig
Amy Rusiecki
Chikara Omine
Abby Rideout
Masazumi Fujioka
Pam Smith
Chase Nowak
Justyna Wilson
Patrick Regan
Beverly Anderson-Abbs
Anthony Kunkel
Erika Lindland
Patrick Caron
Leah Frost
Ryan Bak
Denise Bourassa
Morgan Elliot
Katalin Nagy
Olivier Leblond
Darla Askew
Clark Messman
Megan Digregorio