What can you do to prevent and reduce ITB syndrome symptoms?

• Warm-up by performing active stretches prior to running. Save stretching for AFTER the race. Dynamic Warm-Up and Stretching.
• Take a break from running. Add cross-training, such as biking, elliptical or swimming to your weekly routine in place of some of your runs. This will allow you to continue to improve your cardiovascular endurance and fitness level while giving your legs a much needed rest. Any activity that you choose MUST be pain-free!
• Watch your stride. Can you hear your feet hitting the ground? Do you consider yourself someone who takes long strides? Over striding results in significant stresses to the muscles, bones, and soft tissues of the lower body. This can result in various injuries, including ITB syndrome. Shorten your stride to reduce impact on your joints and improve your running efficiency.
• Replace your shoes. Depending on what you read, it is recommended you change your shoes every 400-600 miles. But don’t get too caught up in the exact number. Listen to your body. Pain can be a sign your shoes are wearing down. It’s also important to purchase your shoes from a reputable shoe store that understands how to assess the right type of shoe for you.
• Don’t forget the ice. Ice can reduce pain and inflammation and should be utilized on the affected area for 20 minutes, 2-3 times per day.
• Roll it out. Using a foam roller can help decrease the tension in the iliotibial band. Lie on your side with your thigh of the affected leg contacting the foam roller. Your arm and opposite leg will help to support you. Gently roll up and down the foam roller from your knee to your hip. Repeat 10 times., once a day. Foam Rolling for Runners on Runner’s World.
• Stretch it out. Stretches that target the front and the outside of the hip improve the length of the affected muscle and iliotibial band. Dynamic Warm-Up and Stretching.
• Strengthen your glutes. Performing exercises that target the buttock muscles can help to stabilize the femur and prevent it from rubbing on the iliotibial band. Glute Strengthening to Prevent Knee Injuries.

Amy Flick is a graduate of Marquette University, Milwaukee, Wisconsin. She obtained her Bachelor of Arts in Psychology and a Master of Physical Therapy. She is an Orthopedic Certified Specialist and a member of the American Physical Therapy Association. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

Base Run
This is a short to moderate length run at a natural pace. This type of run should be done frequently to stimulate improvements in aerobic capacity, endurance, and proper running style.
Example: 5 miles at natural pace.

Long Run
This type of run is a base run, meaning running at your natural pace though it should leave you moderately to severely fatigued. The point of this run is to push and increase your endurance. The distance should be specific to your current level of endurance. This run should be long enough to give you the confidence you will need to complete an upcoming race.
Example: 10 miles at natural pace.

Progression Run
This run starts at your natural pace and will end with a faster segmented race pace. This is meant to be moderately challenging, but easier than tempo and interval runs.
Example: 3 miles at natural pace + 1 mile at 10K pace.

Fartlek Run
This is a base run with short, fast intervals within. It is a good way to develop efficiency and fatigue resistance at faster speeds in the early phases of a training cycle. This running style can also be a stepping stone into later training phases of performing interval and temp running.
Example: 5 miles at natural pace with 6 times for 30 seconds at a 5K race pace scattered throughout

Hill Repetitions
Hill running is short segmented, hard uphill running. This is to increase aerobic power, fatigue resistance and strength. The ideal hill would be a moderate grade of 4-6 percent. Hill repetitions would be best introduced after a solid base of training has been established to advance into higher intensity training.
Example: 1 mile warm up jog plus 10 times for 1 minute uphill at 1,500m race effort with 2.5 minute jogging recoveries and a 1 mile cool down jog.

Tempo Run
This workout pushes one or two sustained efforts toward an athlete’s lactate threshold intensity. This is the fastest pace that can be sustained for 1-hour in highly fit runners and the fastest pace that can be sustained for 20 minutes in an average runner. This type of running is to increase speed for a prolonged time period and to increase pace.

Example: 1 mile warm up jog + 4 miles at lactate threshold pace + 1 mile of cool down jog.

Interval
An interval work out consists of short intervals of fast running separated by slow jogging. This allows you to put more fast time into your run than with a single prolonged effort; working towards avoiding fatigue with fast running speeds.
Example: Long Interval–1 mile warm-up jog plus 5 times for 1 km at a 5K race pace with 400m jogging recoveries plus 1 mile cool down jog. Short Interval–1 mile warm-up jog plus 10 times for 300m at an 800m race pace with 400m jogging recoveries plus a 1 mile cool down jog.

Recovery Run
This type of run is best done after a race or strenuous workout or run. It should be done at a steady, slow pace. It should be a comfortable run though fatigue most likely will be present from previous workout.
Example: 3 miles easy.

Race Pace
This is it, RACE day, you made it! Your adrenaline will be pumping with all the pre-race activities and people, but remember not to over do it starting your race. You definitely want to push yourself, but without burning out. You may have a goal time to finish your race; if so, pacing is very important. For bigger and longer races often there are pace groups to help you reach your goal time. If you would like to calculate your own race pace target or pace for training workouts this is one link to try: http://www.runnersworld.co.uk/general/rws-training-pace-calculator/1676.html

Modified from: Running 101: The 8 Basic Types of Running Updated: Oct 29th 2010 10:50 AM
UTC by Training http://running.competitor.com/2010/10/training/running-101-the-8-basic-types-of-runs_7984

Megan Check received her bachelor’s degree in psychology with a child and youth emphasis from the University of Wisconsin-LaCrosse and a master’s degree in occupational therapy from UW-Madison. She is a registered occupational therapist and licensed in the state of Wisconsin.

There is limited research on dance injuries outside of ballet. Most dance injuries are of the lower extremity and back (except the wrist and hand, which is most involved in break dancing). Risk factors for injury include dancing on hard surfaces; shoe wear; and increased hours of training per day; years of dance; and performance level. Most injuries are soft tissue (non-bone) overuse injuries, although there are some unique injury patterns (such as posterior ankle pain with repetitive activities on the toes or ball of the foot, or the ‘dancer’s fracture’ of the outside of the foot).

Medical problems of dancers include eating disorders, menstrual disorders, decreased bone density and burnout.

At ThedaCare Orthopedics Plus we are well positioned to evaluate and treat dance injuries, and work with your primary provider’s office when necessary regarding dancer-specific medical problems.

Dr. Erica Kroncke is a licensed medical physician with added certification in primary care sports medicine. A graduate of the Medical College of Wisconsin in Milwaukee, Dr. Kroncke enjoys helping patients reach their full potential and enjoys working with them on improving their health and well-being. She has completed several research projects including safety equipment in extreme sports and the correlation with high risk behaviors in adolescents. As a former high school and college athlete, she uses her experiences to help athletes of all ages and abilities become as healthy as possible. For more information  call 920-831-5050.

One of the best ways to stay motivated is to find a “workout buddy.” If you make plans to meet with someone at a set time and day, you make more of an effort to make it happen. You can motivate each other to stay fit. My workout buddy is my husband. He motivates me to exercise on days where if he were not there, I wouldn’t. I then turn around and become the motivator on days where he just is not feeling energetic. Sure, there are days where we help each other make some really good excuses not to exercise. But, more often than not, we help each other workout more than we would without the support person.

You should also wake up early and workout before going in to work. This does not work for everyone’s schedules, but if you can wake up an hour earlier and get your workout done at the start of the day, there are benefits. You feel more energized during the day, there are typically fewer conflicts or time demands at this time of day, and you free up time later in the day for other activities.

I recommend you vary your workout routine. Keep exercising exciting and fun by not doing the same routine every day. I often recommend alternating high impact activities (such as running, tennis, basketball) with lower impact activities (such as elliptical use, swimming, exercise bike) to help maintain joint health. Too much high impact activity can increase your risk of many orthopedic complaints such as shin splints, stress fractures, tendonitis, etc.

Go ahead and join a gym. Once you are at the gym, other distractions are limited. Many places of employment are also offering access to an exercise facility on site. This is optimal because you can use the facility even before you leave work and get home where, as we all know, there are many distractions.

Many people I know are also utilizing applications on their smart phones as a motivator. Some applications track running routes, showing how far you ran, how fast, elevation changes, etc. and map your route out on your phone. Your workout history is saved and can even be posted on social web sites such as Facebook. That way, you can even have a “workout buddy” that is not in the same city. You can post workouts to each other to help motivate one another. This does not have to be all running related. Some smart phone applications can be used to log different activities such as hiking, walking, canoeing, really anything. There are also web sites available where you can log your workouts and post them to others; this is not a motivator limited only to those with smart phone access.

I volunteered at the Fox Cities Marathon this year and saw many people wearing shirts that asked “what moves you?” and left an area for them to write in their own reasons. Many wrote in the names of family members. Improving your health is a great way to show loved ones you care. There were many other reasons people had for becoming more active. With the approaching cooler weather and shorter daylight hours, the question remains: what motivates you to remain physically active?

Anne Schultz received her bachelor’s degree in biomedical sciences and her master’s degree in physician assistant studies from Marquette University. She is a member of the American Academy of Physician Assistants. As a physician assistant, Anne provides diagnostic, therapeutic and preventative healthcare services to patients under the guidance of a physician. When working with patients, Anne said, “educating patients about their condition and treatment options is essential to achieve the best results.”

• Keep walking after you finish the race. During the race, blood has been redirected to the working muscles in your legs and away from your internal organs. It’s important to continue walking after you finish your race for about 20 minutes to allow the body to re-equilibrate your blood supply. Otherwise, you may feel nauseous (not enough blood flow to the stomach) or dizzy and weak (not enough blood flow to the brain).
• Replenish your body’s fluids. Begin drinking fluids slowly at the finish line as soon as your body is able to tolerate it without feeling nauseous. Sports drinks containing electrolytes and sodium are best to replace the fluid and salt your body has lost during the race. Keep track of urination color and frequency after the race to monitor your hydration status.
• Slowly add food to restore energy. Begin eating solid food when your stomach feels like it can handle it. Good sources of energy including sodium and potassium are bananas, pretzels, bagels, energy bars and other easily digested high-carbohydrate foods. Studies have shown that your muscles are primed to take in and recharge their energy supply most efficiently in the first few hours after the race. Eat slowly, and be aware of any nausea to avoid throw up.
• Take a lukewarm or cool shower. Avoid hot showers until you are completely rehydrated, because they can dilate your blood vessels and cause you to get dizzy and pass out. Avoid hot tubs because they will worsen the swelling and inflammation in the muscles and joints.
  
• Avoid pain relievers. We recommend avoiding aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) until you are rehydrated as indicated by passing light yellow or colorless urine. These products can be harmful to the kidneys if taken when the kidneys are stressed by dehydration and prolonged exercise.
• Ice up for sore muscles. For sore muscles and joints, we recommend applying ice or cold packs for 20 minutes three to four times per day for the first two days post-race. Remember not to apply ice directly to your skin. Gentle stretching for the calves, quads, hamstrings, IT bands, glutes and low back can begin right away.
• Take good care of your skin. Skin care is important to limit damage and prevent infection. For scrapes, chafe, and open blisters, wash twice daily with soap and water, applying antibiotic ointment and covering with bandage for the first few days is best. For larger blisters that have not been broken, apply cold packs and consider carefully draining them. If you choose to drain them, we recommend washing with soap and water, then wiping with alcohol, letting the alcohol dry, and then popping them with a sterile needle near the edge of the blister. Take care of the popped blister as noted above and watch carefully for any sign of infection. If you see redness or pus develop, seek medical attention.
  

Megan Check received her bachelor’s degree in psychology with a child and youth emphasis from the University of Wisconsin-LaCrosse and a master’s degree in occupational therapy from UW-Madison. She is a registered occupational therapist and licensed in the state of Wisconsin. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

“If you have asthma, make sure you stay true to your controller therapy,” Dr. Maguire said. “Consider taking one-to-two puffs of your albuterol or rescue inhaler before the race.”

Runners, especially asthmatics, should have a “low threshold to stop their race” if they have a shortness of breath, he added.

In addition, those with heart disease should check with their primary care doctor if a race is even appropriate with air quality risks.

However, Dr. Maguire has consulted with the race medical director, Dr. Erica Kroncke, with ThedaCare Orthopedics Plus, and they want to reassure participants and their families that medical stations have respiratory medications – including oxygen – if they are needed.

“I wish all runners good luck this weekend!” Dr. Maguire added.

Fast forward five years and I’m waking up in the emergency room after a major grand mal seizure that almost took my life, not even able to remember my name. An MRI and CAT scan confirmed a large brain defect and further tests confirmed an epilepsy diagnosis. Without heavy doses of medication I was at risk for another seizure. I lost my short term memory, balance and depth perception, my driver’s license for three months, and something as simple as putting an outfit together became completely overwhelming.

Recovering from the seizure and adjusting to the medications, with nasty side effects, left me depressed and purposeless for seven months.  It wasn’t until I read a running article stating that less than one percent of the population would ever attempt an ultramarathon that I started to break out of my rut. I found I really wanted to be part of that percentile, so I signed up for the Fox Cities Half Marathon and finished it 31 days later. After I completed the Miami Marathon that following January I started researching and training for my first ultra, the Ice Age 50k.

My medication has prevented me from having any more grand mal seizures but it hasn’t stopped me from having mini seizures called auras, which I’d been unknowingly having for years even before my big seizure and still have on a regular basis. They last only a minute or two and have no physical side effects other than to leave me disoriented, emotional, and extremely tired when they’re over. I made the mistake of never telling anyone about them all those years because I couldn’t put my symptoms into words until it was too late.

After finishing that 50k I felt like I could do just about anything again, so I signed up for the North Face Endurance 50-miler and put it on my bucket list. Several months of 50-60 mile weeks and back to back long runs later, I was on my way to another personal victory.  The stress of running all those miles and dehydration triggered several auras in a row, forcing EMTs to pull me from the course at mile 40, totally devastated.

However, I was determined not to let a seizure disorder control my life and on September 18th of last year I crossed the finish line of the 50-mile course in 10 hours and 20 minutes with my incredible boyfriend by my side and my mom waiting at the finish line. Another check off my bucket list! Never did I think I’d hit such a valley after being on such a high, but I believe everything happens for a reason and purpose. My dad taught me that you can’t always control your circumstance but you can always control your attitude towards them. Having epilepsy reminds me of the importance of taking care of myself and running has helped bring balance to my life again. For as long as I’m physically able to, I will continue pursuing new running goals and always moving forward.

What are some of the signs that my body is being over-trained? How do I know when I NEED a day off??

Runner’s World had a great article in the June 2011 issue. To summarize, they recommend paying attention to ten markers. If you say “yes” to three or more of the markers, you should strongly consider taking a day off.

1. You are losing weight.
2. Your heart rate is elevated. This is a sign of stress.
3. You aren’t sleeping well or aren’t sleeping enough. Sleep is necessary to help rebuild the muscle fibers you disrupt with a good workout.
4. Your urine is dark yellow in color. A sign of dehydration. You need to drink water.
5. You feel run down. Be honest with yourself on this one.
6. You are in a bad mood.
7. You feel sick.
8. You have pain or an injury.
9. You had a bad workout or multiple workouts.
10. Your oxygen levels are low (as measured by a pulse oximeter). Most people will not be able to monitor their oxygen levels and thus this marker will likely not apply.

Visit Runner’s World and click on the article “10 Signs That You Need a Rest Day” for more details.   Ultimately, you need to listen to your body and give it the rest it deserves when it needs it.

Modified from Runner’s World

Amy Flick is a graduate of Marquette University, Milwaukee, Wisconsin. She obtained her Bachelor of Arts in Psychology and a Master of Physical Therapy. She is an Orthopedic Certified Specialist and a member of the American Physical Therapy Association. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

Hydration is the No. 1 intervention in providing performing-enhancing effects when running.  When exercise or any event lasts more than 60-90 minutes, fueling is crucial to keep energy levels high and not deplete the glycogen stores in the muscles. Sweating increases electrolyte loss, which can cause up to a ten percent loss of contractile strength and an eight percent loss of speed while training. Hydration is important before, during, and after competition.  Luckily, fluid can be consumed in various forms, such as fruits and veggies, milk and smoothies, fruit juice, sports drinks, water and soups.

Fluid recommendations for prior to exercise include:

• Drink approx 7 ml/kg of body weight two hours before exercise
• If weather will promote profuse sweating, drink an additional 3-4 ml/kg of body weight within 20 minutes of exercise

Fluid recommendations during competition include:

• Start drinking early and often
• Drink 4-8 oz every 15 min. per hour of exercise
• Practice with hydration during training so your body can adapt to the water demand
• If event or training is more than 60 min., sports drinks should be used to accommodate the sodium loss

Fluid recommendations after competition include:

• For every pound of weight lost, replace with three cups of water or sports drink
• If urine is a dark yellow, that is an indication that you need more water

Hydration packs are also an option for use when training and during competition to ensure you have adequate fluid intake throughout the run.  Options include a belt with water bottles, a handheld water bottle, or a backpack hydration system for example.

Fueling

When exercising for greater than 60-90 minutes, a snack is necessary for energy stores. This snack should be about 200-300 calories. It should be eaten at least an hour prior to exercise and could include such foods as:

• Yogurt, milk, cheese
• Bananas, apples, pears, grapefruit
• Oatmeal, bran muffins
• Bean soups, lentils
• Energy bars

Post workout foods for recovery should be consumed with training lasting greater than 45 minutes. The optimal time for replenishment after exercise is 30-60 minutes post workout.  Options for replacing glycogen stores include:

• Bagels, rice cakes, graham crackers, popcorn
• Cranberry, apple, orange juice Baked potato, couscous, rice
• Raisins, watermelon, banana, orange
• High fiber/low sugar dry cereal
• DON’T FORGET TO ADD PROTEIN WITH THESE OPTIONS!!

During competition or training, use of gels, shot blocks or sports beans can be used for additional energy stores with exercise lasting 60-90 minutes.  It is very crucial to consume at least 8-10 oz of water with these gel options to avoid stomach cramping.

Below is a chart with examples for proper fueling during various exercise durations

Becky Czechanski received her bachelor’s degree in exercise physiology and her doctorate degree in physical therapy from Concordia University in Milwaukee. She is also a certified strength and conditioning specialist.