Building Endurance

You don’t have to aspire to the Olympics to want to go faster and farther in your own athletic goals. According to Tanya Kalyuzhny, DPT, MDT, director of physical therapy at the ONS Greenwich office, there are different schools of thought as to how to safely and most effectively build up your endurance, however, there are a few proven methods that may help you in the long run.

“Heavy weight training as an effective tool to build endurance has gotten a lot of attention recently due to a number of new studies pitting control groups against groups trained in different forms of heavy weight training,” Tanya explained, “In each study, runners who underwent challenging resistance exercise programs achieved significant improvement in running economy and capacity when compared to those who did not train with weights.”

Another approach to go longer distances at greater speeds involves adding a half mile or mile to your weekend running sessions, even if it is at a slower pace, she suggests. Combine this with weekday sessions that alternate between 30 minute walk-run combinations and tempo runs. A tempo run is a shorter distance run at a faster clip than a runner’s comfortable pace. Skip the longer run every fourth week to allow your body to recover. When you resume the following weekend, add another mile to your route. To further increase your stamina, pick up the pace for the last 25 percent of the run.

Technical efficiency is also a key element in building endurance. Running tall with your feet striking at your center of gravity, directly below your hips, will give you the greatest efficiency. Particularly if you can keep up a cadence of about 160 -180 steps per minute.

Another endurance training option Tanya recommends is to incorporate the Yasso® 800 method into routine. This once a week training program calls for running 800 meters – usually two laps around a track, in the same amount of minute/seconds that you want to achieve for you marathon time in hours/minutes. For instance, if you want to run a marathon in 3 hours and 57 minutes, you would then aim to run your 800 meter sprints in 3 minutes and 57 seconds. Start with 3 or 4 800 meter go-arounds and increase the

Prevent Running Injuries
Proper fitting running shoes can help prevent injury

repetition each week until you are running 10 x 800 meter sprints.

Off road, recovery practices that include days off, quality sleep and nutritional replenishment will give you the energy to pursue a high level of performance in your training sessions. It will also protect you from the overuse and stress injuries that plague nearly 80 percent of distance runners. Studies have shown that sleeping between eight and ten hours a night leads to increased performance and mental fortitude in athletes. Unless you are an elite marathon runner, you should be taking at least two day’s rest each week. You should also be varying length and intensity of training from one day to the next.

Refueling should begin immediately following a workout. First by replacing fluid and electrolytes, about 16 – 24 ounces for every pound you lose during exercise. Within a half hour, add a smoothie or snack containing complex carbohydrates and protein. This will restore muscle glycogen and promote protein synthesis. Another light meal containing carbohydrates, healthy fat and protein should be eaten a few hours later.

Without a committed recovery routine, your motivation could suffer as well as your body. When paired with physical exhaustion, psychological stress can drain the desire and energy to get up and out, and hit the road another day.

Tips for Running in Winter

Like it or not, winter is here. Whether you’re training for an endurance race or just a dedicated runner, New England winters are particularlyWinter running challenging to one’s safety and resolve. According to Alicia Hirscht, DPT, SCS, CSCS, director of physical therapy at ONS/Stamford, snowy pathways and icy sidewalks, reduced daylight and frigid temperatures all present real risks for those who are willing to brave winter weather conditions to get in their run. But there are a few sensible precautions you can take to stay safe and warm.

LAYER UP

“Experts agree that the trick to staying warm while you’re out in the cold is to layer, but not too much,” Hirscht said. Even though it’s cold outside, your body will generate enough heat to perspire, so it’s important to wear moisture-wicking inner layers to help your body stay warm and dry. Your outer layer should be made from a material like Gore-Tex which lets out the heat while also protecting you against the wind. When deciding how many layers to add, Hirscht suggested that you dress to feel a little chilly when your first step outside. “You will warm up as you get going,” she said. Bearing in mind that everyone’s tolerance to cold is different, in general, if the temperature is below 40, you’ll want two layers beneath your jacket – a light weight base layer and a light fleece top or vest.

We lose as much as 30 percent of our body heat through our hands, feet and head. A hat and running gloves or mittens are essential, again those made of wicking materials are the best. If your hands are particularly sensitive to the cold, Hirscht advised slipping disposable heat packs into your gloves or mittens. If you local running store doesn’t keep them in stock, you can usually find them in a ski shop.

Sometimes it’s impossible to avoid running in slush, but you can keep your feet warm and dry if you forgo light, mesh covered running shoes in favor of sturdier versions with breathable, waterproof uppers. If you don’t feel like buying winter trainers, treat your current shoes with a waterproof spray. If your feet are prone to blister, putting a balm on your feet will keep your toes and heels dry and minimize the friction between soggy socks and shoes.

Some people have difficulty breathing when they exercise in extremely cold weather, especially those with asthma or exercise-induced asthma. If you are breathing heavily, the winter air may induce bronchoconstriction due to the air’s dryness and extreme cold. That’s why Hirscht and other experts recommend slower, endurance runs in the winter instead of high velocity sprints. If cold air affects your breathing, consider wearing a thin, skier’s face mask or waterproof gaiter, or wrap a lightweight scarf across your mouth and nose. Breathing through the nose instead of the mouth will also help reduce the impact of bursts of cold air in your lungs.

STAY VISIBLE

It’s up to you to make sure that you stand out to distracted drivers and or those whose vision is compromised by snow, glare or shadows in dim light. It’s best to have bright, reflective outer clothing or accessories such as reflective wrist bands or clip-on lights to make yourself more noticeable, particularly if your route takes you off the sidewalks and into the road.

HYDRATE

While we do sweat while running in the cold weather, we typically do not feel as thirsty to replenish those fluids as we do when running in warmer weather. Be mindful of this and remember to hydrate both before, during and after your workout. “As with any cardiovascular exercise, remember to continue drinking until you urinate after your exercise, and that the color of your urine is a pale yellow, not dark, cloudy or brown,” Hirscht said. For runners, the general guideline is to drink 16 ounces of water or sports drink before your run. Ideally, you should take in between 5 and 12 ounces of fluid every 15 – 20 minutes during your run, and another 8 ounces within 30 minutes after you stop.

BE SMART

If you are out on a particularly windy day, avoid getting a chill by facing the wind at the beginning of your run so it will be at your back when you make your sweaty return to home. If the temperature is at or below 0 degrees, or the wind chill is below minus 20, be smart and work out at the gym to avoid the chance of frostbite.

Regardless of the season, you should participate in a training program that consists of strengthening and stretching to avoid the types of injuries that can plague runners. This twice weekly program should include exercises for your core, hips, hamstrings and calves. Here are some injury prevention exercises for runners.

ONS to Sponsor BCA 5-K Run/Walk for Hope

THE WOMEN’S SPORTS MEDICINE CENTER AT ONS IS PROUD TO SUPPORT THE BREAST CANCER ALLIANCE RUN/WALK FOR HOPE 5K.

It’s not too late to register and join Dr. Katie B. Vadasdi, sports medicine specialist and director of the Women’s Sports Medicine Center at ONWSMC BCA 5k t-shirtS, ONS Stamford Physicial Therapy Manager, Alicia Hirscht, DPT, SCS, CSCS, and others from Team ONS for a pre-run warm up and stretch before we hit the road!

WHEN: Sunday, May 1, 2016

WHAT: Breast Cancer Alliance Run/Walk for Hope 5K

WHERE: Beginning and ending at Richards, 359 Greenwich Avenue, Greenwich

9:10 ONS Warm up

9:30  5K begins

10:45 One-mile kick off

The Women’s Sports Medicine Center at ONS is proud to support the Breast Cancer Alliance in its efforts to help eradicate breast cancer. Most of us know someone, or know of someone who has been faced with this disease. Last year, an estimated 1,700,00 American women were diagnosed with breast cancer, and nearly 600,000 American women died from it.

ONS Sponsors KicIt

Spin to Win game helps to learn about ortho/neuro and physical therapy.
Spin to Win game helps to learn about ortho/neuro and physical therapy.

The organization has 2 emergency shelters that provide a safe, healing environment for up to 20 children every day. The services are free and available to anyone. Last year Kids in Crisis helped over 6,000 children.

As a part of the Greenwich and Stamford communities, ONS selects opportunities to help  local athletes and non-profit causes. This past weekend, ONS sponsored the Stamford Kic It Triathlon which benefits Kids in Crisis.

Founded in 1978, Kids in Crisis works to help children and parents that are experiencing any kind of crisis, such as abuse, fights, family issues and more.

ONSbagsEach year, Kids in Crisis holds several events to raise support for the cause. There are three main events, Cards for Kids, Kic It Triathlon and a golf tournament. This past Sunday, June 28th, the 6th Annual KIC IT Triathlon was held at Mill River Park. ONS has been a sponsor of the event for 3 years. We are thrilled to help out such a great cause. The ONS booth featured fun, educational games like “Spin to Win”, to test your orthopedic/neurosurgical and physical therapy knowledge, and “Lil Bones,” an iPad educational game for all ages! Event-goers left our booth with ONS goodie bags that included educational literature, hot/cold packs, beach balls and other fun items. The proceeds from the triathlon and the other events help support Kids in Crisis and all they do for the children in our area.

Jason Solomon, PA-C
Jason Solomon, PA-C

This year we were proud to cheer on one of our own in the race. Jason Salomon, PA-C competed and said that although the roads were wet with rain water, the race is always a good race for any triathlete. Congratulations Jason on a great race!

ONS Stamford: Off to a Great Start

ONS_Stamford
5 High Ridge Park, 3rd floor, Stamford, CT 06905

On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit https://onsmd.com/ons-stamford/.

Overuse Injuries: Cause and Effect (Part I)

Cohen headshot for letterGloria Cohen, MD is a specialist in non-operative sports medicine who believes in taking an integrative approach to medical management by considering a patients’ bio-mechanics, cardio-vascular and pulmonary function as it relates to athletic performance. Aside from her impressive medical career, Dr. Cohen is a successful competitive runner who has qualified twice for the New York Marathon and is also an off-road and road cyclist. Her academic insights are a combination of both research and real-world experience, the following article is her most recent commentary on the topic of “overuse injuries”:

What is an “overuse injury”?
An “overuse injury” is an injury that results when excessive stress is applied over a period of time to bones, muscles, tendons, and other supporting soft tissue structures of a particular body part.  This differs from an acute injury which happens quickly and is traumatic in nature. Too much stress to a body part will cause the tissues to break down faster than healing can occur, thereby resulting in an injury. A good analogy would be to consider what happens to a credit card or a piece of metal when you bend it back and forth repetitively – first you see the stress reaction, and then with continued stress the item breaks in two.  As you can appreciate, we want to avoid the latter situation when it comes to the body.

What are some common examples of “overuse injuries”?
Every body part can be affected by an overuse injury.  Some common examples you might be familiar with are: rotator cuff injuries of the shoulder; epicondylitis or tennis elbow; patellofemoral pain syndrome of the knee; and tibial stress syndrome or “shin splints” for the lower leg.  Here are a few case examples of classic overuse syndromes:

Jogging injury.

  1. A 40 year old male has recently increased the intensity and frequency of his swimming activity over the summer months. He now complains of pain in the front of his shoulder with overhead and rotation motion. Diagnosis: Rotator cuff tendinitis
  2. A 30 year old female has been playing tennis daily, now competing in matches at a more difficult level. She complains of increasing soreness in the outside aspect of her elbow. She had tried to play through the pain, but had to stop. She says that she can barely lift a coffee cup now because of the elbow pain. Diagnosis: Tennis Elbow /Lateral epicondylitis
  3. A 20 year college student takes up running during her summer break from school. When she returns to school, she decides to train for a half marathon. As she increases her mileage, and adds speed work to her training program, she develops pain in the inside aspect of one shin. She now complains of pain with just walking. Diagnosis: Shin splints/Medial Tibial Stress Syndrome

What are some of the specific causes of these “overuse injuries”?
As a primary care sports medicine physician I recognize that there are sport specific issues which may contribute to the resulting injury; but there are common “intrinsic” and “extrinsic” factors which play a major role in the development of these types of injuries. “Intrinsic” factors refer to the elements that we cannot control but that we can modify.  These include biomechanical alignment, such as knock knees, bowl legs, flat feet or high arched feet; leg length difference; muscle imbalance; muscle weakness; and lack of flexibility.  These factors can be modified to maximize the individual’s performance, and thereby treat or prevent injury.  An example would be a conditioning program and sport specific training. The “extrinsic factors” include training errors, such as doing “too much too soon”; training surfaces – running on too hard a surface, or playing on an uneven surface; shoes – it is important to wear the appropriate type of shoe for your foot mechanics and the sport; equipment; and environmental conditions. Paying attention to the “extrinsic factors” will help you modify the “intrinsic” ones.

… to be continued in the next segment, Overuse Injuries: Recovery (Part II)

ONS Physiatrist, Christopher Sahler, MD on post New York City Marathon Tips for Runners

Christopher Sahler, MD
Christopher Sahler, MD

Christopher S. Sahler, MD of ONS is an interventional physiatrists specializing in sports medicine. His focus is non-operative treatment of musculoskeletal injuries, restoring proper function, reducing pain and promoting active lifestyles.

“Each year 50,000 people participate in the NYC marathon. If you are in that group and completed the race this past weekend, congratulations! It is an exciting accomplishment that you will remember for the rest of your life.

Now that the race is over, there are a few key points to remember that will help to maximize your recovery and minimize pain. Many athletes experience worsening soreness over the following days after the race. This is known as delayed onset muscle soreness and typically is most painful 48-72 hours later. After the race, your body is in a depleted state so it is important to take in plenty of water and healthy food. A combination of complex carbohydrates and protein help the muscles to repair themselves and re-build their energy stores. It is also recommended that you perform light, short duration activities such as walking, gentle jogging, biking, swimming etc. This helps to increase blood flow to the muscles and tissues that need the nutrients the most and helps to wash away the built up metabolic byproducts such as lactic acid. Gentle stretching and soaking in a warm bath may also help loosen up the muscles. Depending on your previous activity level, it is important to give your body time off before re-starting any intense exercise routines. Most runners should take at least one month off.

Congratulations again on the race!”

Dr. Sahler will present “Exercise as Treatment for Chronic Pain.” Learn how exercise can be used as a safe and effective treatment for chronic pain conditions. This free health seminar will be in the Noble Conference room at Greenwich Hospital Tuesday, December 2 at 6:00 p.m.  To register call 203-863-4277 or register online at https://www.greenhosp.org/CREG/ClassDetails.aspx?sid=1&ClassID=5348