Sunday, May 25, 2008

Maggot Q & A

Q: What about knee pain? My knees have dull, generalized pain ... my knees swell … Any opinions on the running is bad for your knees if you have bad knees theory?

A: Running really isn’t bad for your knees. It can make them hurt, sure, but it doesn’t cause destruction. Football players, who run explosively while carrying 300 pounds, destroy their knees. Runners don’t.

The most common cause of knee pain in runners—especially women runners—is something called “patellofemoral syndrome,” “chondromalacia,” “runner’s knee,” and some other terms I forget. There’s a reasonable description of it here. It’s not dangerous, but it is annoying and painful. The best treatment seems to be strengthening your quadriceps; those little knee sleeves with cutouts for the kneecaps might help.

ITB syndrome give you pain along the outside of your knee; stretching that band helps that one.
After 2-3 months of retraining, most of these problems are solved.

My basic rule: If running is clearly making a problem significantly WORSE, you might not want to do it. Otherwise, go ahead.

Q. I have LESS pain now than before I started exercising regularly. WTF???????

A: You know that line in Apocalypse Now, “I'm here a week ... waiting for a mission ... getting softer … every minute I stay in this room, I get weaker…”? Every day you spend babying yourself is a day you get weaker. No matter what might be wrong with you, you’re not going to get stronger sitting on your ass. Not that I want any Maggots going on homicidal missions into the jungle, but if you get off your ass, you will feel better.

Q: Side cramps. Any tips to help avoid this? Sometimes it gets so bad that I can't finish the run and even sometimes run for a few days after that.

A: This problem plagued me for years. A “stitch” doesn’t even begin to describe how painful this can be. I figured out that I could usually avoid it by—yes—starting slowly, but it wasn’t until I finally learned what it was that I could really fix it. For most people, this is, basically, a cramp in your diaphragm (no, not the birth control device, the thin flat muscle under your lungs that helps you breathe and gives you hiccups). It comes about when your breathing and your stride don’t mesh well, and can be prevented/treated by focusing on your breathing. For me, it works to breathe in step with my feet. Doesn’t seem to matter which foot, but choose one and breathe in or out every time that foot strikes. If you’re already cramping up, slow waaay down while you do this. And if you give yourself a good 5 or 10 minutes of starting slowly, it seems to help a lot. I still have trouble every now and then if I forget to start slowly—happened yesterday, in fact.

Q: Any comments on treadmill vs. road running?

A: I say, however you can do it, do it. There’s running and there’s not running. Running = good. That said, I imagine that if you run exclusively on a treadmill, there are a lot of muscles that are used in traversing uneven ground that are left underdeveloped. I find it fun to get on a fancy treadmill every now and then just to see the numbers.

Q: How do you deal w/ the guilt? (I'm running, therefore I'm not at the work or with the kids.)

A: Do you feel guilty about brushing your teeth? About going to the doctor? About eating dinner? About taking a dump? About washing your clothes? You get the idea. I have felt this twinge, but then I realize that this makes me SO MUCH BETTER of a mother/person that I should feel guilty if I don’t do it. I tell my son that it’s something I have to do to be healthy and feel good.

Q: Any advice for running with a group?

A: I have run solo for much of my running life, but I think groups can be great if you stick to a few rules: 1) No discussion about when/where/if. It happens every week at exactly the same place and the same time. Maybe no one else shows, but so what? If you spend a lot of time figuring out schedules etc., it breaks down quickly. 2) Resist competition. If you want to run next to someone, figure out who is naturally faster and then spend the next five minutes with the faster person running far BEHIND the slower person, until the pace is established.

Q: Am I just buying the hype from the shoe companies or is there a real benefit to replacing my shoes?

A: If your feet/ankles start to hurt, you probably need new shoes. I used to resist this, but after years and years, I’ve found that if I get good shoes from a real running store (i.e. NOT the sneaker store at the mall), my feet feel a lot better. If new shoes don’t feel good, take them back and get different ones. A real running store will exchange them even after you’ve run in them. As for replacing after a certain number of miles—I don’t know, probably not a bad idea. I just replace mine yearly.

Q: I noticed that no one ever talks about fat people running.

A: That’s because my advice is the same for the very small and the very large: Go SLOW. Focus on time, not distance. Get good shoes and a good bra. You will, sadly, have to spend more on your bra and maybe your shoes than a small person does, and it is likely that you will be slower for longer. But there is no reason you can’t do it, and boy do I give you credit: if you strapped 130 pounds on me and told me to hit the trail, I would have a VERY hard time, if I could do it at all. You’re working harder than anyone else, and you should feel proportionately prouder. I also direct you to the most excellent Jul.

Q: Do you have any advice for running in the morning?

A: Ugh. I am an awful morning runner myself, for two reasons: 1) I am soooo much more stiff in the morning that I have to be really careful or I end up hurting something and 2) I’m not really in need of stress relief until the end of the day, so the reward of running is much less. So I’m probably not the best person to ask about this. But that hasn’t ever stopped me from dispensing advice: I don’t do it without some cereal and coffee first.


Vic said...

OMG, a female using quotes from "Apocalypse Now" and talking about one of favorite things to do no less. You have my admiration. :)

Anonymous said...

Another tip about side cramps: I find it helpful to focus on intentionally and forcefully exhaling and letting my inhalation be more of a "recoil."

Anonymous said...

I agree with Cait on the side cramp tip - a couple good forcable exhales always seems to do the trick.

I would love to run more, but am not able to do it without taking the kids along . . . we have a BOB that I LOVE, but jogger + 2 kids = 80+ pounds! I try to stick to relatively level terrain to keep from being pulled downhill or dying on an uphill stretch. My biggest problem is trying to coordinate the running and the pushing - any advice?

Anonymous said...

It's kind of killing me to miss this spring and summer of running, and to know that by the time I'm able to get back to it — autumn at the earliest — I'll only have a few short weeks before winter kicks my candy ass. I do not like treadmill running, and so far have avoided it, but I may succumb this winter because the idea of not running for a whole year is completely dispiriting.

Do you have any tips for treadmill running to make it, well, not suck?

Blue said...

yay! you answered my knee pain questions here. thank you.

i should have also asked about inserts for shoes. my running store (a real one, not a sneaker store in the mall) told me that people really should buy new inserts for the shoes, to supply extra support. when i was trying them on they were all as annoying as Steve Urkel, but she assured me i'd get used to them. it's been 2 months and i still notice them all the time...but i'm carrying on regardless.

the inserts were $35, which seemed like a lot. but if they'll make some physiological difference then of course that's nothing. but i wonder if i'll ever know. so, docmomma, what's your opinion on spendy inserts? good, not necessary, imperative, couldn't hurt? inquiring newbies wanna know. ♥

Paige said...

my first 5k is july 4th and my 3 mile route I do now I have been running over a mile at once and then walking and running the rest - more running than walking this week and I am doing it in 45 minutes - down from an hour 2 weeks ago. I just bought new Nike Pegasus shoes and feel good except for an annoying little pain in the muscles next to my right shin bone. Any good stretches for this muscle? Can it do a lot of damage if I run through it -- it feels great when I run and hurts when I walk (2 on a pain scale of 10) -- any advice?

Erin said...

Julie, my only tip to make treadmill running not suck is to put it in front of the TV and watch something good: something Tivo'd or a movie that I watch part of each day until it's done. Otherwise, I would count the minutes by staring at the clock on the wall. The living room scenery just doesn't change enough.

That said, I must go out and buy some better sneakers because I miss running. I really miss it. I have gotten weaker and softer, and I know how much I need to do it for myself.

Anonymous said...

MrsSSG Try the Wharton Stretch Book or the Wharton Back Book. I think their stretches are the best around.

Paige said...

thanks so much leslie!

Anonymous said...

OK DM, I'm not trying to throw a monkey wrench in your proclamations, but can you really assure this maggot that I can't trash my knees by running? I guess I'd feel better if you were an ortho or some other bone-joint doc sayin' it.

'Cause when it hurts, and the knees actually swell, I don't see how pounding pavement can be good. I see how walking can be therapeutic, but running? hmmmm ... and I may not be carrying 300 pounds like a linebacker, but even with proper form, the force exerted by my body when I run is much greater than my mass alone.

Anonymous said...

r3, I had the same doubts/fears.

YMMV, but Dr. Mama's advice workewd for me. My orthos (all three of them) told me to stop running for my arthritis, and the pain just got worse the more sedentary I was.

They all told me to swim. I told them to take swimming & shove it. (I hate not being able to breathe normally, fighting for space in a crowded pool, inhaling chlorine, etc.) I kept telling them I would never swim regularly, that running was the only sport I'd ever loved, and they kept telling me to get over it, my running days were over.

Now that I run, per Dr. Mama's advice for no more than half an hours at a time, only every other day, and so slowly that I could probably walk faster, my joint pain is ALMOST GONE. I had really disabling joint pain and now I wouldn't even think I had arthritis at all if I hadn't seen the x-rays.

I confess I *do* have some increased joint tenderness at the time of the exercise and immediately afterwards, but the total quantum of my pain over the course of a week or a month is reduced by 70-80%. -Victoria

Anonymous said...

Glucosimine works for joint pain. I first discovered it with my arthritic dog who became a brand new puppy after a couple weeks of taking it. Same with people.

I started running again shortly after the maggot tricks post (it had been YEARS) doing the couch to 5K program, using one of the podcasts to keep me on the right schedule (it's great, just plug in and run when the guy says "run" and stop when the guy says "stop"), and I have to say in the 6 weeks I've been doing it, I haven't missed a single day, I haven't had a single stitch in my side, and feel fantastic. My knees are bothering me a little bit, but I think it's due to my flat FLAT feet because I think they are rotating inward. So I bought some arch supports and hopefully that will resolve the problem.

I had no idea how powerful running slowly could be. I quit my gym, and have no plans to return. It's a very liberating feeling.

Thanks doctormama!

Anonymous said...

The patellofemoral syndrome is what stopped me cold when I tried running. I should try the cut outs you mentioned. Heck, I should also seach your site for the link to the place where you can by extra large size running bras, because honestly, that is my other, em, big problem.

Sara said...

Hmm. I always thought that the side pain was blood backing up in the liver or spleen and stretching the capsule a little. Interesting to know.

That said, I haven't gone once since starting internship. That's so sad. I must start again.

Unknown said...

The original Maggot entry is what got me thinking about running. That maybe, just maybe I could do it.. My therapist then strongly suggested it, and I've been running for almost 2 months.

It's not pretty, and I'm just reaching the point where I can run for almost the whole 30 minutes, but I'm doing it. I followed the original advice, and can happily report that have only overdone it once (yesterday - biking and running in the same day are still too much for my shins to take).

No weight loss (yet), but I can feel leg muscles building, and I love the way it makes me feel both physically and mentally.

For lots of reasons, my life has been extremely difficult the past 18 months, and I have been disappointed by the way I'm handling it. Not so, running. I am doing it myself and it is giving me so much.

Thanks everyone, and please keep posting about running. I am soaking in every bit of it.

Anonymous said...

OK, one more quick question. I'm not sure where you are, but here (Texas) it is already oppressively hot in the afternoons (98+). Morning running isn't really an option since I have to work so early. Any advice on running in the heat? (Other than, "Wait until 7:30 when it's only 85 degrees, dumbass." Ha.) I haven't been able to go in over a week, and it's killing me the thought of only being able to do an aerobics video in the house until October. (Yes, it really stays that hot for that long here.)

Anonymous said...

Awesome advice everyone. Just a really quick question: my mother-in-law insists that running is bad for the PC muscle, since the high-impact nature of running puts too much pressure on the pelvic muscles. I am exceedingly faithful with the kegels, and with keeping a good posture, but is there any validity to this claim? Please put this nagging fear to rest!

Anonymous said...

I'm more of a swimmer, and when we got stiches our coach would always recommend switching up our breathing. I usually breath every 4th stroke, so I'd go to every stroke for a bit, and then go back. It worked, and so I would try to do the same with running. Instead of breathing in for three steps and out for three, I'd do in for two steps or one, and then go back to the longer intervals.

Amy H said...

Alright, you've inspired me. I'm 5 months postpartum today and it is time to take off this baby weight before it turns into plain old weight. With that said, anyone have advice on a good running bra for a nursing mom? None of my pre-pregnancy ones come even close to fitting. My chest is currently enormous so good support is a must but little one is still nursing enough that easy access is essential.


Anonymous said...

@amy, check out the Title Nine catalog - - a great resource, you can order online, and they have some triple-x rated bras for those of you who have extra bounce in your steps.

Anonymous said...

allison, i have no idea if running hurts the PC muscle (but that sounds like a bunch of bs), but the Kegelmaster -- a $90 wonder that will do far more than ordinary Kegels could ever hope to do, google it - will more than counteract any running effects. I don't know why ever gynecologist in the country doesn't know about it. It is the bizzomb and I'm not kidding. Do it for two weeks and you'll thank me. (Except you can't cuz I had to go anon for this post...)

Mignon said...

I'm still not a runner. I'm sorry. I just hate it. I do it once a week when I can't play soccer, but still. It doesn't make me feel good, and I stress about it for hours up until actually doing it.

But I have this to say about shoes and expensive insoles: SO IMPORTANT. For me and my husband (who runs mucho), it makes life so much happier to have feet that aren't constantly hurting. I play tennis twice a week, and a couple matches played in the wrong shoes (they felt fine, even while playing), nearly ruined me. A foot doc showed me what type of shoe I needed, and which insole was best, and I've been foot-happy since.

Also, a trainer friend told me once that treadmills are more forgiving than concrete/asphalt, and may reduce impact-type injuries, but I agree with you, DrM. The benefit of strengthening stabilizing muscles benefits all joints in the long run. ha.

L said...

This blog has been a life saver for me as a newbie runner. I am training to run my first marathon in October and was feeling discouraged in my early training but then I found your blog and read your tips and things are going so much better. Thanks so much for sharing your very sage advice.
I'm running really slowly now, like a granny lady but I'm running! I'm running!

Whitney said...

I linked to your "listen up, maggots" post from '06 (?) and was so inspired! I just got back from my first "run" at the slowest pace imaginable. You spoke right to me when you said that competitive people have a hard time running slowly! I've never liked running (except with a soccer ball on a field and that's been YEARS ago now), but I enjoyed myself a bit tonight...felt silly, but good.


BTW, I also got a lot from your "picky, picky" post. It spoke directly to me as I have always picked at *anything* on my body...many times to painful results. I'm not often inspired to change two major habits in one day (sitting on my butt being the fist)! Thank you.

Erika said...

Julie, when I run on a treadmill I use one of the random settings so that I at least get a mix of hills/flat. makes it at least somewhat more interesting.

DM, any thoughts on plantar fasciitis/heel spurs? I've had lots of trouble w/ PF in the past, but it was mostly better until I started running. Now that left heel hurts. And a podiatrist will probably say "don't run." Foot stretches, I guess...

Anonymous said...

heat running: did this living in Africa - bring water, go hydrated and start super slow and build up your time. it actually feels great when you get used to it.

any post c-section running advice out there? used to run (in hte pre-kid life I had) and now need to start LOVE this blog!


Ozma said...

I too must commend you on your Apocalypse Now reference as well. Yes, it makes me love you all the more.

I'm getting soft. OK, this month: Running. I love treadmills though. I will have to work up to going outside again.

Anonymous said...

Dr. Mama, please can count me as one of your success stories.

In January, I was completely sedentary, obese, & suffering from pretty serious arthritis pain in my hips, as well as meralgia paresthetica & near-crippling referred pain from a bulging disc in my back.

The orthos told me there was nothing to be done about the hips until I got old enough for a replacement (I'm only 42). I had a couple of steroid shots in my back for the disc pain, but they did nothing. The spine ortho was talking about surgery. My PCP told me that weight loss would help the meralgia -- but how can you lose weight if you're in too much pain to exercise?

Then, I slowly decided to start trusting your advice that it's ok to run even if you're in pain. This is contrary to what the orthos were telling me, but then, they really weren't helping me, and I knew something had to change. The meralgia paresthetica was so severe that I felt like I was being tasered in my thigh several times a day.

I knew I had to lose weight to stop that pain. And I knew I had to get my weight under control to avoid the vascular disease & vascular dementia that seems to hit everyone I'm related to as early as their mid-50s.

So, I trusted you. I started running, very, very slowly (so slowly that my dog was walking on the uphill sections of our runs!), only half an hour at a time, only every other day.

Running itself isn't burning many calories, but there's something about being active that makes every other cahllenge in life seem more manageable. It made me feel optimistic, and powerful.

I made a strenuous effort to lose weight. Since the beginning of the year, I've lost 35 pounds. I'm now "mildly overweight" instead of "obese." Everyone keeps commenting on how different I look.

But the most significant change -- the one that nobody can see -- is that I have NO PAIN. My hips feel tender when I run, but the rest of the time? No meralgia at all. No referred pain from my disc at all. And no arthritis pain at all (except a little bit during & after runs).

This is incredible. I would say I have a 95% reduction in my pain. Back in December and January, when the pain was at its worst, nobody was giving me any hope that I could recover from my pain.

Back in December-January, I was panicking -- I felt like a decrepit old lady with no hope of avoiding vascular disease. I was in so much pain that I couldn't work. I was taking Vicodin every day, and feeling stoned all the time, and still in too much pain to think about anything else. Sometimes, I couldn't even carry on a simple conversation with my husband about what to have for dinner because all I could really focus on was how much pain I was having (especially in the car, where I would be forced to sit: this provoked the referred pain from the bulging disc & was near-intolerable).

Now I am pain free and I feel like I'm in charge of my life and my health.

I am convinced that there's something about exercise itself (not just the weight loss) that helps my body manage pain.

Anyway, what is so incredibly helpful about your website is not only that you tell us not to be afraid of pain and not to give in to it, but also that you set really strict limits on how much we can do.

In the past, I've always, always overdone it, gotten injured, and become discouraged. Now, doing only half an hour every day, I have had no injuries. And I also have no excuse not to exercise. If I feel like having a glass of wine in front of the t.v. instead of going for a run, I tell myself, "Oh, come on, it's only half an hour." And I go.

I think of you every time I go for a run. I think you would be so happy to see what a difference your advice has made in my life. -Victoria

Anonymous said...

Sorry, when I wrote "doing only half an hour every day, I have had no injuries," I meant "doing only half an hour every OTHER day." -Victoria

Mignon said...

Victoria, I'm always a cynic and rarely believe what people say in comments, but even so, you go. I mean it - if I were to see you IRL, I'd give you a great big sock on the arm and say, Girl! You Go!

Reluctant Diva said...

Another fat runner here! I weigh around 183 lbs. (I'm 5'4"), and I can run for 27 out of 37 minutes on a treadmill. (Of course, six years ago I weighed around 260, so my body must just feel relieved to be carrying so much less now.) I've worked my way up slowly and can now run over a mile consecutively for the first time in my life! The running is helping me lose weight, but I think the sense of accomplishment is even better.

I'm a treadmill runner because I have slight asthma that gets irritated by allergens outside, so I can breathe much better indoors. (I also have weak ankles that twist easily, so running on an uneven surface like the sidewalks in my neighborhood makes me nervous.)