This model however very rarely works for endurance athletes. Instead health problems and sports-related injuries are almost always the result of many factors working together, often over a long period of time.
What athletes and recreational distance runners should be aware of is doctors are not trained in the health problems of endurance athletes. They see a young, "healthy" person with a disease or injury and assume the problem and solution are straight forward. For example: "you have anemia" - "you must have heavy periods" (I will get back to the anemia example). Or your knee hurts - you must have IT band syndrome - but the why and the root of the problem eludes them.
When a runner writes to me via email or Facebook about a health problem they face that the problem is rarely, if ever, straight forward. Let's face it, I also know this from my own battles with health problems over the last many years.
In other words, when I see a runner, triathlete or someone who trains hard - a lot, say "I finally found out exactly what my problem is!" Before I know more details, I generally won't believe the solution to their problem is as simple as they think.
Take for example exhibit A: cytomegalovirus (CMV). This virus has come to the fore due to (Salomon) athlete Neal Gorman. He is an ultrarunner who was trying to figure our why he was feeling so tired and sluggish. He is NOT an athlete who contacted me for advice so I feel I can safely use him as an example without risking a breach of doctor-patient confidentiality. He was diagnosed with CMV. Normally this virus does not cause symptoms in healthy adults. He however had 1. elevated liver function tests and 2. the specific type of antibody which indicated active disease. He was given what appears to be the correct diagnosis by a very astute clinician who knew to look for this illness.
However, the underlying question is why. Why should a young, otherwise healthy adult get active disease (symptoms) from CMV when adults with normal immune systems who are exposed to the disease and don't react? He discusses openly his lack of sleep leading up to it. We can only speculate how much months of years of hard training led to a compromised immune system. (we already know the immune system of ultra runners is compromised following ultras - aka the "window" for infection of 3-72 hours, but what are the more long-term effects on the immune system?).
Read this article on Irunfar about the importance of sleep. Read these articles about overtraining: 1., 2, 3. I can not emphasize enough though that overtraining is far from simple itself. There are so many things that can predispose to it - or push a person over into having symptoms, but training is the one necessary component. (November 2012 when I went to the Urgent Care with lymph nodes and spit glands the size of fists, of course the doctor had no clue what he was dealing with - so we endurance athletes need to help care for each other and create awareness within our sport/s - and if it is our field of training and interest, contribute to high quality, non-biased research)
2. Take basically any viral or bacterial illness: pneumonia, mono (which, for some unexplained reason my 38 year old husband has - again, normally this is a disease of college students), sinusitis, any upper respiratory illness. The list goes on and on. Ultrarunners are NOT just exceedingly unlucky.
Let's face it: if we want to train to run ultramarathons, we have to get 1. adequate sleep (preferably 8 hours a night) 2. variation in our training and 3. avoid overtraining - ie, not just getting miles in for the sake of miles -or running too many ultras so we fail end the year with excess energy. (for once I AM ending this year with excess energy!) - that is the whole POINT of running: to get energy, to feel better!
3. Anemia (lack of red blood cells): I am including this because it seems almost every female runner I know suffers from it.
There are so many reasons for anemia in runners (and non-runners). Especially females. Sure, the ladies bleed regularly, but there is a small amount of bleeding from the GI tract every time you run and probably small amounts from muscle (that would escape through the urine). Then there is the increased need for iron, often not met with adequate dietary intake. Finally, there may be an element of gluten sensitivity (the amazingly complicated "story of wheat" and it's role in human disease remains to be fully elucidated, but I have a suspicion, though no proof it is contributing to anemia). I would be amiss if I did not also mention alcohol, which is toxic to the bone marrow. Finally if you add to this upper GI distress, ulcers, GERD, there is probably microscopic bleeding due to that as well.
I have previously been hospitalized with anemia (I was a 70 mile/week runner at the time). The thing that really confused the doctors was that I did not menstruate (how can a female who doesn't menstruate be anemic?). I learned a lot about anemia through this hospitalization. Normally they would have sent me home saying "sorry about your heavy periods", but a critical level of hemoglobin in a female who didn't menstruate was- well -freaky.
They sent me to get an upper endoscopy and colonoscopy and there was "nothing wrong". I almost got a bone marrow biopsy - and they might have muttered the word "cancer". At 23 years of age, it seemed wild.
I have now not been anemic for years. And what I have done is - improve my diet (increased protein & iron), given up gluten and take probiotics daily. (I am NOT saying this is your solution, but it was mine and it took years for me to find this solution.). And by the way, I DO menstruate now - barely, but it's there.
4. Depression. I am not sure if depression, fatigue or recurrent viral illnesses is the most frequent problem among endurance athletes, but the big D is certainly the most important one to discuss.
Depression also scares doctors (like it scares everyone). I am going to go out on a limb and say that ultra runners in particular may have depression tendencies (or mood disorders) to begin with. One of the most amazing things about running is it is a mood stabilizer/improver. And by the way, I just read that "dirt" - just breathing it in - can be like a dose of prozac. Nice.
I have on multiple occasions been forthright about why I started running - and that was because I could not sleep. And no sleep = depression no matter what kind of genes you have.
There are so many reasons a person can become depressed. There is no doubt that there are genetic tendencies towards depression. But there are also clear triggers and aggravators.
Again, I know this first hand. It probably would be a really difficult subject to write about depression if I didn't.
Two years ago at Christmas, I had lost a lot of weight. I had also run a lot of long races post-partum. I am well aware that setting a marathon PR 2½ months post-partum is not "normal", but it was so dang gratifying to me. I had no clue the cycles of mania and depression it would send me on (I had experienced them before, but never so rapidly or to that extreme). I don't even know if it was the post-pregnancy training alone - probably that in combination with hormonal swings, weight loss, lack of sleep and the stress of constantly moving between countries and doing a PhD. But it is clear that 1. overtraining and 2. rapid weight loss/low BMI are triggers for my "bipolar". I do not even know if it can be called "bipolar" with these as triggers, but I do not doubt that everyone has triggers for their depression (or mania) and that mood and other psychiatric disorders can be to a certain extent managed by identifying triggers.
I also noticed that depression tends to be worse around Christmas. Two Christmases ago I was in a hopeless state. Last Christmas I felt I was getting better, but could not stop crying at two Christmas parties in Denmark--- I had to go hide in bedrooms. I was even diagnosed with major depression but then went back to the doctor a few weeks later and it was - gone. (I have to mention my sister in law, Beverley, a psychologist, who helped me enormously at this time last year).
There are a lot of things around Christmas that lead us to depression (the expectation of being happy, low Vit D, fatigue, loss of control) which is why I chose to write this post today.
And that brings me to the last health problem of this post: injury. In ultra running or long-distance triathlon, injury is so rarely "if only I hadn't stepped in that pothole". Injury is repeated misuse of the body without adequate rest, cross training, healthy diet and sleep.
I can not encourage you all enough to get into a good pattern that you can stick to the rest of your life.
The last two weeks I have been on constant cross training (I have only run twice). I absolutely love cross-country skiing, snow shoeing - and you throw swimming and yoga in there and I am as happy as a clam. I thought today - if there were beautiful powder snow all year long, I might never run again. (of course I would)
Over the last year, I have been the healthiest I have been since I can remember. As far back in my memory as I can go as a child, I suffered from stomach problems. I have been injured every year -except this one - since I was 22. This year, no injury has lasted longer than a week. I have the old hip problem, but it is improving. Folks, this is not just luck. I even stopped at Desert Solstice 24 hour in time (after 50k) before doing any permanent damage. I know that it was not my achilles per se that was acting up, but a long season of hard ultras (and improvement I never dreamed of) and a body that needed a break.
Here is a brief list of a combination of things that led to a healthier, happier (and faster) year:
1. Giving up wheat and taking probiotics and well as generally cleaning up my diet (no artificial sugars, no high fructose corn syrup) has apparently helped.
But it is not just this.
2. I have changed my running style to pose - so the stress is more on the muscles than the joints. I may land on my heal some (most) of the time, but at least my knee is bent so my hips and back aren't taking the brunt of the stress. And it is a more efficient style with more rapid cadence.
3. And it's not JUST running style, it is respect of the body and knowing when it is time to rest.
4. It is also prophylactic rest. Don't run every day. Take at least a day off a week. Some people say do nothing, but I say cross train. Nothing super hard, but just get out there are use your muscles differently. And I am really feeling great with this couple weeks of cross training. I know Chrissie Wellington, Kilian Jornet, etc. recommend an "off-season"
5. Sleep. (and sleep well- no caffeine in the afternoon or night. And NO BABIES ;-)) There is a Flaming Lips Song that says - "you have to sleep late when you can and all your bad days will end". I love this song, but the real truth is, you have to sleep early when you can. If we had not gotten an au pair, I never would have started achieving this!! (hard to underestimate the importance of this on my health these past 6 months!)
On that note, my family and I should probably sleep. But I have to say how thrilled I am to for the first time in 3 years to NOT be depressed on Christmas.
|SLG, Mattias, Meow, Christian. Christmas Eve.|
|Grandma Joyce, Mom, Christian, Emily, SLG, Mattias &; Meow|
|Snowshoe running + sled surfing with Christian on North Lake.|
|Out skate skiing with SR before he knew he had mono! We miss you SR and wish you weren't working seven 12 hour shifts in a row!|
Final note: if you are interested in learning about advancements in health-related research in ultra running, you may consider attending the Medicine & Science in Ultra Endurance Sports conference in Squaw Valley June 24th-25th. I will be there and this is one of the few (if not only) venues for discussing heath as exclusively related to endurance exercise. I only hope that I can run Western States the weekend after (that will require placing in the top 3 females at the Ice Age Trail 50 miler).
Running/Skiing Song of the Day: so happy to run across an old fave "Stutter" by Elastica.