Water Running during Injury
Photo from http://www.sanctuaryequinerehab.com/pool_treatment.html
If Gavin, a race horse slated to race in today's Kentucky Derby can do it, so can YOU! Water running is one of the best cross training exercises you can do if running is contraindicated. Water provides buoyancy, decreasing load on joints while at the same time providing added resistance.
Most injuries that require rest from loading of joints will benefit from water running. Those with ligamentous tears of the knee should not water run until cleared by physical therapist or doctor to do so. Those with incisions post surgery should ask their doctor first before entering a pool.
Ask your PT for specifics on how to water run!
What Color is Your Pee? Signs, Symptoms and Causes of Acute Exercise-induced Rhabdomyolysis.
The infamous 2007 Chicago Marathon and Coach Amy's first.
Really, Amy? Are you asking me the color of my pee? I'm not suggesting you report the color to me. However, urine color can indicate a condition afflicts endurance athletes called acute exercise-induced rhabdomyolysis (AER). The media has once again brought this condition to the forefront with the recent hospitalization of several Oregon Ducks football team members.
What is AER?
AER is an acute, serious, and potentially life-threatening condition for which the hallmark symptom is cola-colored urine. AER occurs in the case of severe skeletal muscle damage sustained through injury or profound overexertion.
AER can cause damage to the kidneys, liver, and long-term nerve and muscle damage. The incidence of this condition in endurance athletes is still being determined [1].
Acute kidney failure may be less likely in AER than in other rhabdomyolysis causes [2]. Therefore, it is conceivable that some endurance athletes go undiagnosed and treated yet suffer from other long-term complications, such as damage to nerves and muscles.
Signs and Symptoms
I listed the signs and symptoms of AER below [1], but not all athletes with AER exhibit these symptoms. Other conditions may cause these symptoms as well.
Dark brown urine (cola colored)
Confusion
Vomiting
Muscle pain (not normal delayed onset muscle soreness)
Generalized weakness
Causes of AER
As with many issues afflicting the endurance athlete, the cause of AER is a combination of "the 'perfect storm' where there are several [contributing] factors (heat stress, dehydration, [muscle exertion], non-steroidal anti-inflammatory [e.g., Alleve, Ibuprofen] or other drug/analgesic use, and viral/bacterial infection)." [3]
The most common cause of AER is "too much."
Too much too soon (e.g., returning to sport or starting a new form of exercise without a gradual introduction).
Too much eccentric contraction of the same muscle group (e.g., high reps of heavy-weight jump squats).
Excessive heat (running long distances or racing in high temperatures without acclimatization).
Other significant contributors to AER include high exertion in concert with the following:
Dehydration
Certain medications, namely statins and NSAIDs (Aleve, Ibuprofen)
Hyponatremia (overhydration - too little sodium)
When you look at the list of causes, it is sobering, right? How many triathlons and marathons have you raced under the "perfect storm" of extreme heat before being acclimated, dehydrated, taking painkillers (even though your coach told you not to), and coming off an injury or illness?
One case study tested four ultra-distance runners (two different years) after they ran the 95-mile off-road West Highland Way Race [4]. All tested positive for severe cases of AER. Each raced in at least half of the "perfect storm" conditions.
Takeaway
The takeaway from all this? Train smart with a solid training plan, do not take NSAIDs before or during a race, avoid racing when sick or after a recent illness, and acclimate to hot weather running or modify if you find yourself in those conditions unprepared.
As always, listen to your body. Be aware of contributors to AER and its symptoms. If you have cola-colored urine after extreme exertion and one more of the other signs, seek immediate medical attention; If treated early, we can reverse AER. When not appropriately treated, the long-term consequences could be severe; once an athlete has suffered from AER, they are more susceptible to recurrence.
Sources
[1] Brudvig T, Fitzgerald P. Identification of Signs and Symptoms of Acute Exertional Rhabdomyolysis in Athletes: A Guide for the Practitioner. Strength and Conditioning Journal. 2007 Feb;29 (1):10-14
[2] Sinert S, Kohl L, Rainone T, Scalea T. Exercise-Induced Rhabdomyolysis. Annals of Emergency Medicine. 1994 June;23(6):1301–1306.
[3] Clarkson P. Exertional Rhabdomyolysis and Acute Renal Failure in Marathon Runners. Sports Medicine. 2007 April;37(4):361-363.
[4] Ellis C, Cuthill J, Hew-Butler T, George S, Mitchell R. Exercise-Associated Hyponatremia with Rhabdomyolysis During Endurance Exercise. The Physician and Sportsmedicine Volume. 2009 April;7(1):126-131.
How to Safely Transition to A New Run Shoe
So, we've covered how run shoes can play a role in running related injuries by affecting the degree of load on your body in our article, Do Run Shoes Matter? Now suppose a change in run shoe is in your future, how should you transition to a new make or model?
While a change in shoe may help you prevent injury, a sudden or drastic change is likely to cause injury. Sudden changes to a lower drop shoe, for example, can lead to achilles tendonitis, fracture in the bones of the foot, or shin splints.
The injuries caused by shoe changes usually occurs because the change was too drastic or too abrupt or both. Your muscles adapt over time to shoewear. You may have shortened and or weakened muscles if they were highly cushioned or had a significant drop. These muscles may not tolerate a change without addressing strength and flexibility first.
A gradual change in cushion and drop is critical. For example, someone who is currently running in a 12mm drop model should ease into a 10mm drop as opposed to jumping from a 12mm to 4 mm drop.
Likewise, someone who is running in a high stability model or one with lots of cushion should gradually move to a moderate/middle before moving onto a minimal/low. When shopping for new run shoes, ask the salesperson for the specs on the models that you are trying and compare them to your current ones.
Shoe Change DO’s:
start with shorter distance runs (2-3 miles)
alternate your runs with the new/old shoes
choose a model that provides a gradual change
listen to your body - slight post workout soreness may accompany your change but you should not experience pain.
strengthen muscles of the foot and calf when transitioning to less drop.
Shoe Change DON’Ts:
Do NOT change shoes just weeks before your race.
Do NOT change shoes if you are battling an injury for which you are not being treated.
Do NOT continue with the new shoes if you experience pain.
Many factors including running habits (volume, surface), foot strike, strength, cadence, goals, past injury history etc. all play a role in the make and model that is best for you. If you are currently suffering from an injury, you should be evaluated and treated before making any changes in shoe.
Do Run Shoes Matter?
Shoe used in Rice, Davis, Jamison study is shown bottom, right.
The answer is, yes! A soon to be released scientific study shows that forefoot runners (those that land on the ball of their foot - see photo below) experience less impact forces in the lower extremity with a minimalist shoe. [1] A minimalist shoe is defined as minimal cushioning and a heel-toe drop less than or equal to 4 mm as compared with a standard run shoe.
Forefoot Landing
There are several studies that reveal increased load on the lower chain whilst running/jumping on cushiony shoes and surfaces.[2] Seems counterintuitive doesn’t it?
A study is currently being conducted specifically testing a brand that sells models that are specially highly cushioned. I won't mention the brand here but since I've seen runners wobbling around in them, I've been cranky. I’ll keep you posted.
So generally speaking based on scientific studies, cushion + more drop = more force. More force can mean greater risk for specific running injuries.[3]
Run shoes are not the only factor on impact forces and possible running injury. I’d say they play a relatively small role in comparison. But, when you consider that running is jumping on one foot over and over again at three times your bodyweight and there are shoes that lead to increases in force sustained by the body, it stands to reason that they do matter.
So, if you are a forefoot runner should you go out and buy the least cushion and lowest drop shoes on the market and head out for a long run? If you currently wear cushion shoes, should you throw them to the curb and replace them with minimalist shoes? Ummmm....no!
For details on how to transition, check out my post: How to Safely Transition to New Run Shoes.
[1] Rice H, Jamison S, Davis I. Footwear Matters: Influence of Footwear and Foot Strike on Loadrates During Running. Medicine and Science in Sports and Exercise Coming Soon.
[2] Bishop M, Fiolkowski P, Conrad B, Brunt D, horodyski M. Athletic footwear, leg stiffness, and running kinematics. J Athl Train 2006;41 (4):387
[3] Zadpoor AA, Nikooyan AA. The relationship between lower-extremity stress fractures and the ground reaction force: A systematic review. Clin Biomech 2011;26(1):23-8.