Are You Running Too Much? The Wall Street Journal Weighs in on Running

I don’t think I’m running too much here.

Like many who write about running, I felt compelled to comment on Kevin Helliker’s provocatively-titled, predictable, yet oddly written article, “One Running Shoe in the Grave: New Studies on Older Endurance Athletes Suggest the Fittest Reap Few Health Benefits,” that appeared in this past Tuesday’s Wall Street Journal.  Helliker’s article summarizes one of those periodical reports by hand-wringing cardiologists warning us about the dangers of excessive exercise.  The assertion that seems to have caused the most controversy among serious runners is the idea of what constitutes excessive: twenty to twenty-five miles per week and a pace of eight miles per hour – or 7:30 minute-per-mile pace.  This is not a lot of mileage, although the pace stipulation does logically lead to a future blog entry concerning how fast should we be running our long runs.  Helliker’s article reads like a typical throwback to the “exercise is actually bad for you” pronouncements that usually accompany the deaths of notable runners such as Jim Fixx and Micah True.  Men’s Health, for example ran an article on October 14, 2008, entitled, “Are You Running Yourself to Death?”  This is by no means a recent development. In the wake of the first running boom, cardiologist Henry A. Solomon foresaw several of the arguments of Dr. O’Keefe’s upcoming editorial in the journal Heart – in The Exercise Myth (Harcourt Brace Jovanovich, 1984).  At my most cynical, I would dismiss Helliker’s gloss of O’Keefe as merely a way to sell papers.

There are some interesting observations, however, to be made about “One Running Shoe in the Grave.”  First, it’s telling that O’Keefe’s recommendations to scale back under twenty miles a week and slow down – especially if you are over fifty – are being made on the basis of research that is only showing an association. There may well be some legitimate issues with the statistical significance of the sample size, particularly concerning high-mileage, high-speed elite athletes.  There was also no mention of the sex of the runners in the study. I’m sure we’ll find out more about research design when Heart is published next month. Ominously, I noticed that when questioned about his research, Dr. O’Keefe, rather than talking about methodology, accused his critics of being “chronic exercise addicts.”  Using a dismissive, catchy phrase to derail intellectual inquiry is a common rhetorical strategy of the academic under threat. I have the feeling that this report might be dead in the water once we get to take a closer look.  Academics confident of their numbers usually don’t childishly lash out against their critics.  It is also odd that Dr. O’Keefe bases his recommendations on his personal experience as a “former elite athlete” on a “sense” that his athletic regimen was aging him prematurely. I think he might need some evidence here to back him up. Most credible scientists get a bit skittish when talking about an individual’s “sense” trumping observable fact.  I want some numbers.  It will be interesting to see what people say when the full editorial in Heart is published.

There is another assumption that Helliker makes that is fully debunked in the accompanying comments to his article: everyone exercises to live longer.  In fact, most people do not take up running in the expectation that it might prolong their lives. Unsurprisingly, as many of the commenters explained, they run because it improves their quality of life, not the quantity.  At its most prosaic, it is great to be a runner for the stress release running provides, for the ability to walk up several flights of stairs without being winded, or for the ability to proceed through a busy day without becoming overly exhausted. But, as the devoted runner knows (and this is only reflected in the last quote of the article which is intended to point out that most serious runners won’t listen to this “sound” advice) is that running is fun and for many that have caught the running bug, racing is even more fun.  We don’t do this merely for the real and (possibly) perceived health benefits.  Here’s a dose of reality: longevity is never guaranteed. People die everyday in unanticipated ways.  Many, however, have realized that running makes them feel better while they are living.  I can’t stress enough the quality of life aspect of running, as well as what Dr. George Sheehan argued was the appealing “play” associated with running.  For Sheehan, at its core, running constituted a return to childhood play for adults – racing even more so.  So, the appeal of running – and this is by no means an original thought – far surpasses any quest for longevity.  The fact that these articles arguing that exercise might be bad for you come out on a predictable basis backed by the authority of cardiologists makes me wonder: why?  I think it has something to do with the popularity of running and some perceived threat that it poses to the status quo. It can’t be a coincidence that we have seen this type of article – ostensibly backed by reputable science – at the peak of several running booms.  There is more to be said about this, but it will have to wait for another blog entry.

Finally, I need to mention the “oddly written” part of Helliker’s article. Several commentators in the Wall Street Journal also pointed this out.  This is the story of Meghan Newcomer, a 32-year-old professional triathlete, who passed out during several races, and whom Helliker uses as an example of why 50-year-olds need to run less. Newcomer was told to triple her intake of salt, which solved her race-collapse issues. This looks like it was more of an issue of hyponatremia and certainly not a cardiac problem, so why the story? Yes, it makes that much sense.

Although this article has generated a fair amount of discussion, it is ultimately part of an old narrative that often rears its ugly head when running gets too popular – an old story verging on a non-story.  I think the real story here, is the opening up of a larger conversation about why people run – not as controversal, but ultimately more useful.

Leg Cramps and How to Deal with Them

It looks like before my next race I will be ingesting several spoons of yellow mustard followed by a pickle juice chaser.  When I told my wife about distance runners combating leg cramps with packets of mustard, she indicated that it might be because they had to slow down to vomit after consuming the mustard while on the run.  It is true that decreasing speed to reduce stress on the cramping muscles is one response that works, but the slowing down part is not something I’m interested in pursuing.  This blog is about avoiding slowing down.

I’ve been doing some research into leg cramps and how to deal with them since writing my first blog entry in which I mentioned my experiences with leg cramping during several recent races.  Most of the articles point to some unsurprising causes of leg cramps; but there doesn’t appear to be much scientific evidence for causes or agreements on cures.  This is definitely an opportunity for some self-experimentation.  I’ll take one for the team and start with the mustard. Although, truthfully, this isn’t going to be all that tough for me, because I love mustard. We’ll see how much I love it five minutes before a race…

Before I discuss remedies to leg cramping during racing, let me review the potential causes.  I would say that the most commonly mentioned cause of leg cramps is dehydration.  Muscles are 60% water and the way that many articles discuss the connection between dehydration and cramping makes it appear that there is an obvious link between water loss and cramping due to this fact.  It appears, however, that rather than causal, there is merely a correlation between dehydration and cramping.  I did find it interesting that while watching some college football recently, when players started experiencing severe leg cramps on the field, reports from the bench stressed dehydration and announcers were quick to confirm this diagnosis.  A recent New York Times article, “A Long-Running Mystery, the Common Cramp (February 14, 2008),” by Gina Kolata, actually calls into question the connection between dehydration and cramping. Kolata cited the expertise of Dr. Schwellnus, who studied cramping athletes and found that they were no more dehydrated before or after a race than those who did not have cramps.  I think it is also telling that some early medical writing concerning distance running – Bob Anderson and Joe Henderson’s 1975 classic, Guide to Distance Running – doesn’t even mention water loss as a harbinger of leg cramps.

This leads us to a consideration of the second major theory of running cramps – the electrolyte hypothesis.  This theory rests upon one of the earliest and commonly agreed upon reasons for cramping: sodium deficiency.  The Guide to Distance Running recommended salt tablets as a cure, and provided a recommended intake schedule: it seemed like a lot of salt.  Sodium deficiency, however, is still seen today as a problem.  How does it work?  According to Dr. Michael F. Bergeron, in “A Long-Running Mystery, the Common Cramp,” when the fluid that bathes the connection between muscle and nerve is depleted of sodium and potassium through sweat loss, the nerve becomes hypersensitive and cramping results.  Bergeron’s description of the cramping process accurately describes how my leg cramps have always progressed: little twitches followed by full-blown cramps.  His remedy?Drink salty fluids. Thinking that sodium deficiency might have been a contributor to my leg cramps while racing, I made sure that I ate a salty meal the night before my latest race.  I also had Gatorade to drink on the morning of the race.  Considering that I experienced cramping during my recent 10K earlier than I had during my half-marathon, I concluded that sodium might not be the answer.  It is, of course, possible that I didn’t have enough salt, or that there are several variables working together to contribute to my leg cramps.  Despite the fact that there seems to be a consensus that sodium depletion leads to cramps, Dr. Bergeron had to admit that there were not any rigorous studies to confirm the electrolyte hypothesis.  In fact, despite sounding like what many of us experience, a recent examination of Iron Man triathletes and other endurance athletes found no differences in electrolyte levels between those who experienced muscle cramps and those who didn’t.

If we can’t directly attribute leg cramps to dehydration or sodium deficiency, what is the next viable theory?  It’s the fatigue theory.  According to Dr. Schwellnus, cramping is caused by an imbalance between the nerve signals that excite a muscle and those that inhibit its contractions.  The critical imbalance occurs when a muscle grows fatigued.  His recommendation is to exercise less intensely and for shorter times and to regularly stretch the problematic muscles.  Interestingly enough, the Guide to Distance Running also cites fatigue as a cause of leg cramps – too much running at too high intensity without adequate rest essentially makes one more susceptible to cramping in subsequent runs. The fatigue theory makes some sense for those of us who only experience cramping issues while racing.  Ominously, my leg cramp issues have emerged as I have quickened the pace during races.  Over the last year, I have gotten faster and this has required greater intensity.  I am wondering if my endurance has outstripped my muscular-skeletal capacity, thus resulting in the ability to overstress my body during racing.  Obviously, we can’t really endorse Schwellnus’ recommendation to exercise less intensely, although we can get behind additional stretching and massage.

After having assessed the prevailing theories behind cramping during running, and finding convincing evidence that there is little agreement on what causes cramping, we are still left with the pragmatic consideration of what to do.  My own experience would indicate that dehydration is probably not the problem, although lack of fluids is directly linked to sodium depletion, which might be a problem.  This uncertainty, again, points to the problem of adjusting several variables at once, thereby obscuring what may or may not be working.  In response, I am going to do something entirely different.  I just read an article by Pete Williams, “Mustard: A Cure for Cramps?” on the Core Performance website (CorePerformance.com) that suggested eating one or two spoons of yellow mustard to prevent muscle cramps.  The theory is that cramps can be caused by a deficiency in acetylcholine, the neurotransmitter that stimulates muscles to work and mustard contains acetic acid, which helps the body produce more acetylcholine. Williams points out that it is possibly the vinegar common in both pickle juice (a traditional anti-cramp remedy) and mustard that stimulates the necessary neurotransmitter. There are, of course, no scientific studies on the connection between vinegar and cramp prevention, but the anecdotal evidence convinces Williams.  He also mentions that ingesting mustard packets might merely also be another way of getting additional sodium.  For me, the mustard cure has an appealing magic bullet aspect that I am willing to try.  Hey, I like mustard, so the idea of having several spoons before a race with the possibility that I will not have to experience leg cramps is very appealing.  The theory of why it might work doesn’t sound totally wacky.  I’ll report back after my next race.

Too Many Variables

I think one of the reasons that there are so many books, magazines, newsletters, articles, websites, and blogs devoted to running is because there are so many (perhaps too many) variables to consider when deciding upon training methods, shoe selection, and, most importantly to the masters runner, injury prevention and injury remediation.  Part of this stems from the fickle nature of the human body, as well as the fact that our experiences of our own, individual bodies are often unique to us. This is a roundabout way of getting back to Dr. George Sheehan’s assertion that “we are an experiment-of-one.”  The nature of good experimentation itself, however, militates against this idea. You can’t, for example, run a good study without trials, control groups, and enough subjects to result in statistical relevance, to name several aspects of experimentation that require multiple subjects.  One of the things that runners do is to try to adapt the results of experiments and studies to their own individual needs.  As everyone visiting this website is probably aware, this is a tricky endeavor because, simply put, we are all different.  I am increasingly convinced that there are no universal solutions and that it is important to step back from the bandwagon and assess what is really going on before pronouncing a magic training bullet. (I’m looking at you, barefoot running…)  What works well for one runner might not work as well for another, or might even result in less than favorable results, to put it mildly. This recognition extends to all aspects of running, not just injury prevention and recovery.  This, of course, helps to explain websites devoted to constant discussions of training plans and shoe reviews.

I’m writing this short entry in advance of an upcoming piece on “leg cramps and how to deal with them” to think about how runners actually use information.  To help illustrate the point I am trying to make, I am going to tell a story. I imagine that it will be all too familiar for some of us.  During the spring of 2010, I was recovering from a hobbling case of plantar fasciitis when I started to notice a slight pain in my right shin. Not to worry, I told myself, it’s probably just shin splints – some ice, backing off the mileage, and this will go away in no time. A week later, the pain was more intense and it began to feel like my tibia was about to give out. I was starting to panic. I stopped running for a week. I got an MRI and an X-ray. I didn’t feel like it was getting better. The beginning of the summer was slipping away. I was missing goal races. I was getting depressed.  Then I did what many of us do when confronted by injury: I applied all remedies – all remedies at once.  I drank tart cherry juice, iced, used heat, discovered KT Tape, replaced my shoes, and swam.  My tibia did eventually improve; but I can’t tell you why.  Was it a combination of remedies?  Was it the cherry juice?  The swimming?  Thinking back on it, I did experience rapid improvement while I was drinking tart cherry juice, but it was ultimately way too expensive.  Perhaps it was the fact that I had been resting my leg for several weeks.

Anyway, the approach that most of us use to deal with injury is completely unscientific and usually consists of trying anything to get back to running.  We try several things at once, introduce numerous new variables, and are left wondering what ultimately worked.  From a psychological viewpoint, the “throw everything at the wall and see what sticks” injury solution makes sense – we want to get back to running as soon as possible because we feel miserable not running.  To develop efficient and effective remedies for future running injuries, however, this method can prove frustrating, because we are still left wondering what remedy or combination of remedies worked. I think the solution here is patience. This, of course, is difficult advice when it is your leg that is hurting.  We need to realize, however, that experience is one of the masters runner’s advantages. If we think long term, we can realize that there is always another race and that we can put our experiences gained over years of running to use in addressing the solutions to injuries in a systematic way.  I am suggesting here that to more accurately decipher the injury equation, we should be more willing to try one approach, see how it works, and then move on to the next. It will take more time, but it will ultimately prove more useful in establishing repeatable remedies.  I would suggest, then, that rather than bemoaning the problem of creating too many variables in injury remediation, we should think both more systematically and patiently in our approach to running injuries.

A Quick Introduction and an Initial Question about Leg Cramps

Warming up for my first road race, the Fourth of July Five Miler in Irondequoit, New York, 1980.

If you are reading this, you have stumbled upon yet another blog about running.  Before you go back to playing Words With Friends or laughing at the mishaps of anthropomorphized felines, let me win you over by briefly explaining why I am doing this.  This is a blog for masters runners who run for reasons that go beyond merely getting fit.  We like running fast and figuring out how to get faster.  We’re competitive – but usually more so with ourselves than with other runners.  Although we do throw in surges, kick to the finish, and stay around to receive our age group awards, we are usually more thrilled with a new PR.  I run because I like to run.  This has gotten me in trouble in the past during my scheduled rest days… I like to think that we make local road races more honest, so that the young guys can look at the results and realize that winning was not just a matter of showing up.  I’ll blog more about the intersection of the meaning of competition and the meaning of running in the months ahead.

I’m not going to claim that you should read this blog because the subject matter will be unique, or that I will have a completely new approach to the topic – there are, after all, many running blogs out there.  My intention is to write about running from the perspective of the mid-forties, mid-level runner, who is doing his utmost to get faster as he gets older.  One of the services that I intend to provide is to sift through the many technical running blogs out there to arrive at some practical information that is useful to the masters runner.  I also intend to start discussions about training and racing issues to hear directly from masters runners about how they have approached various problems. Look down. I’m starting this approach with some stories and requests for advice about leg cramping during races – not fun.

I have been meaning to write a running blog for months, but have had trouble getting started.  I think that part of problem was the ill-conceived idea that I thought I needed to write a blog that would fill a very precise niche in the running community and that to facilitate this I would need to start by issuing some sort of running manifesto. You know the drill: what does running mean to me, what are our foundational assumptions, what does this blog intend to contribute to the dizzying amount of writing on running that already exists.  Not only was creating a manifesto far too much pressure, but I think it also threatened the reason to blog in the first place: to explore a variety of topics and ideas about running to help contribute to a more enjoyable pursuit for the mid-level masters runner.  (OK, so that sounds a little bit like a manifesto…)  So, this might be the way to start.  I’m writing a blog that will take my individual running experiences as a way to explore larger running concerns in what will ultimately be a collaborative attempt to facilitate better running experiences for the readers of this blog.  One of the critical touchstones for my thinking about running is Dr. George Sheehan’s oft-repeated quote, “You are an experiment-of-one.” True, but we can also add up our experiences or experiments to arrive at some best practices.

You are an experiment of one; but you also need to realize that this is a community endeavor – the successful runner is surrounded by support and seeks out competition, friendship, and advice.

I’m going to get right to it, because this preamble stuff is beginning to sap my desire to write.  I’ll leave the introductions to subsequent blogs – you can get to know me as I write.

On October 7, 2012, I ran in the Hudson Mohawk Half Marathon in Albany, New York.  Through nine miles I was on pace for an 1:30 half marathon.  This was my first half, so I had given myself a goal of getting under 1:40.  I probably started a bit too quickly and noticed when glancing at my Garmin that my splits up to 15K starting at four miles were under my previous PRs.  I was running well.  The perfect weather for me – mid-50s, as well as a flat course made it difficult to run conservatively.  There was also some racing going on.  I was back and forth with a group of guys around six miles and was passed by one of the top women’s masters runners in the region at around seven miles.  I could not keep up, but was still running well.  We really started to string out after eight miles and I found myself running alone, unable to attach to anyone in front of me and unwilling to slow down to run with the people behind me.  This is how things went for the next several miles. I was, however, gradually inching up on runners in front of me, and I was gaining confidence that I was going to be able to do some catching and passing during the last several miles.  I also felt that 1:30 was still within my grasp. I felt strong and was gaining confidence.  Then, I felt a slight twinge in my left calf.  I had to slow down.  Next, I felt more than a twinge in my left hamstring. I was forced to slow down.  Yes, for the final three miles of the race I experienced intermittent cramps in my calves and hamstrings that brought me to abrupt slowdowns and made it difficult to maintain any type of pace.  I lost several places and was forced into an odd heel-first sprint during the final meters to avoid being passed.  Ultimately, however, I was happy with my final time of just under 1:34. I really can’t complain about my first half marathon experience, but the final miles were painful and frustrating. Around eleven miles I was telling myself that I probably didn’t need to do this again.  Maybe 5K was really my distance.  After a massage and some chocolate milk, however, I soon realized that I wanted another crack at the half and was thinking that my next goal should be a sub 1:30.  Obviously, I will need to address the cramping problems and here is where the collaborative part of this blog comes into play.

Let’s talk about leg cramps. This has happened to me previously only twice before.  The first time was at the very end of a 5K in hot, notably humid, weather. I was kicking during the last two hundred meters and felt a crampy twinge in my hamstring. I had to back off, but managed to make it to the finish line without anything popping. I didn’t even feel any soreness after the race. The second time was at the Bill Robinson Masters 10K just after the halfway mark when the course goes up a very long gradual hill. As a started up the hill, I felt my hamstrings start to cramp and I had to slow down, which was frustrating because I wasn’t going all that fast to begin with. I chalked these cramps up to having gone down the hill (it is an out and back course) at a ridiculously fast pace (I was flying – this is how the pros feel!) and my legs were now trashed.  Luckily, I was able to gradually get back to speed. A good thing, too, because it was cold and I sure didn’t want to limp three miles back to the finish.

So, here’s the discussion topic: When have you experienced leg cramps, how did you deal with them at the time, and how have you tried to prevent them?

Additional: After I got most of this blog written, I raced in the Albany Running Exchange’s FRUN 10K last weekend (November 4) and again experienced hamstring cramps that started even earlier (around four miles) and were very frustrating, because I was running very well, but couldn’t maintain the pace when my hamstrings kept feeling like they were about to pop. It is now clear that this is a problem that I need to get under control. Any advice would be appreciated.