Training - That Marathon May Kill You
A marathon or any event for that matter can be a very stressful to the human body if not
prepared for properly, and especially if an unhealthy diet, training, and lifestyle factors
are too much for the body to bear. High caliber long distance athletes and sports icons
have died, perhaps as a result of their running and other factors.
Jim Fixx, the author of the 1977 best-selling book, The Complete Book of Running, died
of a heart attack at the age of 52. Fixx is credited with popularizing the sport of running
and demonstrating the health benefits of regular jogging. His autopsy revealed that
atherosclerosis had blocked three of his coronary arteries by 70% or more. This lead to
the belief by many that running was not as beneficial as once thought. However, Fixx
was genetically predisposed (his father died of a heart attack at age 43 and Fixx himself
had a congenitally enlarged heart), and had several lifestyle issues he had a stressful
occupation, just went through a second divorce, and was overweight and a smoker
before he began running.
Ryan Shay was an American professional long-distance runner who collapsed five miles
into the 2007 Olympic marathon trials. He died of a heart attack due to a pre-existing
cardiomegaly (enlarged heart).
This is not as uncommon as you may think in distance athletes. A good friend of my
brothers growing up died of a sudden heart attack while out on a training run one day
with his fellow cross country team. He was only 24 and a national level runner. Steve
Larson, the professional mountain biker, road biker, and eventually-turned triathlete who
won Ironman USA in 2001, died suddenly in 2009 at age 39. Recently, (March 2012),
the famous ultrarunner Micah True, aka Caballo Blanco died of cardiac arrest while on
a training run.
A recent study (Jan 2012) in the New England Journal of Medicine looked at the
incidence and outcomes of cardiac arrest. (Cardiac arrest is when the body doesnt
efficient pump blood due to poor heart contractions whereas a heart attack is lack of
blood flow to the actual heart muscle.) The study found that atherosclerotic coronary
disease and hypertrophic cardiomegaly accounted for the majority of cardiac arrests and
the incidence rate was significantly higher during marathons, and in men over women.
The atherosclerotic coronary disease does not result in the traditional plaque rupture
leading to an embolism (blockage in a blood vessel), but ischemia lack of oxygen that
is unable to meet the demand the body requires.
In December of 2011 an article published in the European Heart Journal found that
marathon runners and others engaging in extreme endurance exercise may temporarily
damage the right ventricle of their heart. This was reversed one week later in most of the
40 athletes they studied but five of them showed lasting damage.
These cardiovascular damaging effects of long, hard training and racing are in-line with
what many long distance athletes put on their bodies. Athletes are taxing their
cardiovascular systems throughout a distance event much like its a chronic high
intensity interval session over a very long period with inadequate recovery. And
everybody has to sprint to the finish even if theyre last. If youre training aerobically
and will have built a sufficient aerobic base, then youll be racing primarily aerobically
and be able to withstand anaerobic periods during the race. The chance of any ischemic
incidence is greatly lowered, perhaps eliminated, in such a conditioned athlete.
I think, based off the groups of people I associate with as well as the types of patients I
see in my office, that the boom of half and full marathon racing is creating more and
more unhealthy people. Too many people should not be doing these events as theyre
not healthy enough even for a 10K. I say healthy, not fit as they have the fitness to
stick out the miles, but their health suffers because their lives and training are too
anaerobic. Interestingly, those doing ultras and Ironman distance triathlons seem to be
healthier and my thought there is it is because they are training much more aerobically
since these events can last in the 10-20 hour range, if not longer. There are of course
still a lot of unhealthy long distance triathletes and ultra runners, but from my experience,
its the people who want an obtainable goal and sign up for a half or full marathon that
end up injuring themselves and decreasing their overall health.
Perhaps those who put the stickers 13.1 or 26.2 on the back of their vehicles to say
they went the distance should also include their heart rate, maybe their time too but
heart rate is more important. Its much more respectful to the body for a 40 year old to
run a marathon in 4:00 at a 140-150 HR than do the same race in 3:30 at a 155-165 HR.
A marathon run by a Kenyan in 2 hours is often going to be much less stressful on his
body than someone running a 4-6 hour marathon.
Extreme racing and training can take a toll on an athletes body; even a highly fit
individual. But this doesnt mean that aerobic conditioning is bad as discussed in Part I.
Dietary and lifestyle factors play a huge roll here. Inflammation is clearly one main factor
that will raise your risk of not just performing poorly, but perhaps dying from working out
or racing. Inflammation of the body can be measured via a blood test to test for Creactive
protein. CRP levels increase dramatically in acute inflammation and remain high
when there is chronic inflammation. Elevated CRP levels are associated with diabetes,
hypertension, and cardiovascular diseases. Inflammation is often dramatically increased
following a marathon. Although the inflammation may subside in many, if there are
several other health factors involved then the athlete could be in a chronic state of
inflammation. A healthy CRP level should be <1.0 mg/L, although normal is allowed up
to 3.0 mg/L. Ive raced 20 Ironman races and check my CRP at least once a year. It is
always well below 1.0 mg/L , often <0.5 mg/L.
If you keep it aerobic the majority of the time, running long distance can be very
beneficial to your overall health and longevity.
In 2010, researchers from the University of Nevada, Las Vegas published a review of
fourteen studies comparing longevity and mortality in elite athletes with that of the
general population. Included in these studies were data for endurance athletes, power
athletes and mixed-sport athletes. They concluded that elite endurance (aerobic)
athletes and mixed-sports (aerobic and anaerobic) athletes survive longer than the
general population, as indicated by lower mortality and higher longevity. The studies of
power (anaerobic only) athletes were inconsistent.
Long-distance runners and cross-country skiers lived significantly longer than the
general population (2.85.7 years longer). Soccer, ice-hockey and basketball players,
track and field jumpers, short-and middle-distance runners, and hurdlers also survived
longer than the general population (4.0 years longer).
Though the studies looked at elite athletes and not the average Joe running marathons
or playing a hard weekend soccer game, it does provide merit that aerobic activity is
very beneficial to the body but it has to be true aerobic exercise. Anaerobic exercise
combined with aerobic exercise is beneficial too, but only when a sufficient aerobic base
has been built, (Part II). Its most likely safe to say these types of elite athletes have a
superior aerobic base.
Keeping inflammation at bay is highly dependent on diet. Zero partially hydrogenated
oils and as few refined vegetable oils (corn, soy, safflower, sunflower, canola, peanut) as
possible are important steps in keeping inflammation down. Good fats from extra virgin
oil, fish oil, coconut oil/milk, eggs, and avocados are also vital, as is a diet low in refined
sugars and carbohydrates. (Think Paleo Diet.) Obviously, most long distance athletes
are carb-junkies. They drink sugary fluid replacement drinks and consume gel packs
often, usually daily. Due to improper training (lack of an adequate aerobic base) theyre
burning predominantly sugar when training rather than fat so they must consume more
and more sugar to fuel this cycle. This all provokes and sustains inflammation and
makes their tissues insulin resistant, rather than insulin sensitive. Insulin resistance is
very, very bad. How long can you train without food or some sugar water before having
blood sugar handling problems such as cramping, lightheadedness, or even bonking? If
its less than one hour then youre very anaerobic. Aerobically conditioned athletes wont
break down and bonk or hit the wall as the miles add up.
Some note a general guideline for a well conditioned aerobic athlete can be seen in their
race times over various distances. Generally, for example, if your one mile run is at 7:00
then your 5K race time should be around 22:30 (7:15/mile), your 10K time around 46:30
(7:30/mile), your half-marathon 1:41:30 (7:45/mile) and your marathon time around
3:30:30 (8:00/mile). Though genetics play some role here, if youre running your 5K at
23 minutes and your marathon time is around four hours (or more), youre not
aerobically conditioned to run so far. Youre running the race too anaerobically
As discussed in Part II, the more you develop your aerobic system the more you develop
your mitochondria. The more mitochondria you have, the less lactate your body makes
at a given intensity. This raises your lactate threshold, so what was once mostly
anaerobic is now less (and more aerobic). The net result? Youre faster, more efficient,
and much healthier.
Developing the aerobic system is important actually its vital. There is no shortcut to it.
It takes consistency and discipline in training. Consistency means you have to stick with
it and give it time. If youve never developed your aerobic base then it could take several
months, maybe a year. Follow the aerobic & anaerobic training guidelines to know when
you should add in some anaerobic training and/or weights. The discipline is not just to
stick with it, but to keep yourself from going too hard. A heart rate monitor becomes very
important with aerobic training and you may not be able to train with your friends, unless
they want to go your pace. Running long and hard too often, just like many people
training for a half or full marathon, can definitely kill you, but so can a life of no running
or little movement activity. Slow down, and take the time to develop superior fitness and
The Potty Squat
5 Reasons To Full Squat
September 24, 2012 by James Speck
The full squat is one of the most basic and fundamental human postures. Due to industrialized society's heavy reliance on chairs and modern footwear however, it has become a position that many people have difficulty achieving.
Born To Squat
The full or deep squat refers to a position where the knees are flexed to the point that the back of the thighs rest against the calves with the heels remaining flat on the floor. Young children under the age of four will instinctively go into a deep squat when they want to reach for something low, and often hold themselves in a stable squatting position to engage in play.
Among Asian adults, squatting often replaces sitting.1 So what happens to Westerners, as we grow into adults, that causes us to lose this ability? This is primarily a case of use it or lose it. Many cultures throughout history would rely on the squatting posture as a means of performing work, eating meals, or resting. Modern society has all but eliminated the need to squat in our daily lives.
A second reason relates to the design of modern footwear that often features an elevated or raised heel. Habitual shoe wearing causes a shortening of the calf muscles and Achilles tendon, and a gradual loss of the ankle mobility required to properly do a squat. This often leads people to perform a variation called the Western squat, where the heels remain propped up in the air.
Fortunately, many of the adverse effects brought on from frequent sitting, improper footwear, and squat avoidance are reversible. When performed correctly, the full squat carries many benefits for physical health. Squatting can be performed as a body weight exercise, to reach something on the ground, or simply as a rest position.
5 Health Benefits of the Full Squat
1. Ankle Mobility
Limited ankle dorsiflexion range of motion is a common problem linked to a number of other issues in the body, including overpronation, bad posture, and runner's knee. A loss of ankle mobility is caused by both inflexibility in the calf muscles and Achilles tendon, and stiffness in the joint. A proper squat, with the heels flat on the floor, requires good flexibility at the ankle. Getting into and maintaining a full squat is a great way to improve ankle mobility and restore full range of motion.
2. Back Pain Relief
Many people have an excessive curvature in their low back as a result of the pelvis being pulled down in the front by tight hip flexor muscles. During a full depth squat the pelvis rotates backward, allowing the spine to elongate. This stretches the tight or shortened muscles in the low back. The body's position in a deep squat also produces a traction effect that decompresses the spine by creating space between the individual segments of the back.
3. Hip Strengthening
In a person whose hip muscles are weak, you'll often see their legs move inward (adduct) and internally rotate when they perform closed-chain movements, like jumping or going down stairs. This adducted, internally rotated position puts the knee at an awkward angle and can lead to injuries. A full squat moves the hips in the opposite position, abduction and external rotation. The squat strengthens the muscle groups responsible for performing these actions, allowing them to better control the position of the entire leg.
4. Glute Strengthening
The gluteus maximus is one of the largest muscles in the body, and with good reason. The muscle comprises the bulk of the buttock region and is integral to performing many activities we do on a daily basis like walking, lifting, and running. The glute max is also an important stabilizer muscle of the trunk and leg. EMG studies have shown that during a squat the glute muscles become targeted only after descending past the half way point.2 This means the same strengthening benefit cannot be achieved from only squatting in a partial range of motion. Coming in and out of a deep squat is by far one of the most effective ways to strengthen the glutes. Not many people are going to complain about having a firmer backside.
5. Posture Correction
The cumulative effect of working on the areas listed above is an overall improvement in both static and dynamic posture. When joint mobility and lower body strength are restored the entire musculo-skeletal system will naturally be able to assume better alignment, which has a tremendous impact on the way we look, feel, and move. The full squat is a way to reverse some of the bad habits the body has assembled from our modern lifestyle.
Potty Squat Continued..............
The Modern Squat
When a person not used to performing a full squat attempts to squat down, often times their heels will lift off the floor, or they will fall backwards. These are two signs of a loss of ankle flexibility. Here is a picture demonstrating the difference between a full depth squat and the Westernized squat that occurs when the ankles are stiff.
Notice how in the Western squat the ankle remains at about a 90 degree angle. Without adequate ankle mobility, attempting to go any lower would move the center of gravity behind the base of support, and the person would lose their balance and tip over backward. The disadvantages of remaining up on the toes include:
" a higher center of gravity and smaller base of support (the toes), making this a less stable position.
" an overuse of the calf muscles to stay in the position, making it unsuitable for resting
" increased compression of the soft tissue between the upper and lower leg
Many adults instinctively go into the Western squat because it has become physically impossible for them to get their heels down. Correctly performing a full depth squat is a sign of good mobility and strength and can be a reasonable goal for anyone looking to improve their fitness.
Preparing to Squat
Since the squat is such a basic and functional movement, simply practicing getting into the position is often all that is needed to achieve proper form. For anyone unfamiliar with the squatting movement it would be wise to work on the smaller components first, to build up the necessary strength and motor control needed to get in and out of the position. Here is an article and video showing the fundamentals of good squatting technique and providing some recommendation on ways to progress for beginners.
For someone who finds they have the strength to squat down but then have difficulty getting their heels flat without losing their balance it might be necessary to do some extra calf and ankle stretching to gain flexibility. Here is an article that goes over some helpful ways to increase ankle dorsiflexion.
Are Squats Bad for Your Knees?
Some people may have heard advice that performing a full squat is dangerous or bad for the knees. Squatting like most exercises carries a certain degree of risk, but the notion that squats hurt the knees is largely a myth.
When performed properly the risks are greatly reduced and usually outweighed by the benefits that can be gained from regular squatting.
Based on current evidence, full range of motion squatting using your own body weight is not only a safe activity, but one that can have a great influence on overall physical health. Still, it is important to be aware of the risks to lower any potential for injury before performing any movement the body is not accustomed to doing. The two major concerns usually voiced over squatting are the potential for joint wear leading to arthritis and ligament injuries.
Squats may actually decrease the risk of arthritis
During a squat there are increased comprehensiveness forces on the joints of the knee. Very few studies however have shown that squatting can cause damage to the joint. One retrospective study on a group of elderly subjects in Beijing found that those who reported squatting several hours a day in their youth were more likely to demonstrate osteoarthritis of the tibiofemoral (TF) joint.3 A later study however found that squatting actually decreased the risk of TF arthritis when performed at least 30 minutes a day.4
The reason for these contradictory findings is not clear. The important thing to remember is that, as is true for most activities, moderation is key. The body is certainly capable of adapting to a natural squatting position, and almost all of us were able to do it at some point in our lives.
The other joint in the knee subject to increased loads during squatting is the patellofemoral (PF) articulation, between the underside of the knee cap and the femur. The compressive forces at the PF joint increase as the knee moves into flexion (depth of squat). However, during that time the contact surface of the joint also increases.5 The increase in contact area distributes the joint forces over a larger surface area, which maintains, or even reduces, joint stress as you get deeper in your squat. Patellofemoral compression force should still be a consideration though for anyone with a history of anterior knee problems or cartilage damage of the patellofemoral joint.
In regards to ligament injuries, the idea the deep squatting when performed as a weightlifting exercise causes ligament laxity in the knee can be traced back to an older study performed in the 1960s. Later studies have refuting these results and actually found that squatting enhances knee stability.6,7
The same principles that apply to other forms of exercise also apply for squats. Squatting too often, holding the position for hours on end, or not allowing your body to recover between squatting session can place you at risk for injury.
The full squat is a natural human posture often used as an alternative to sitting in Asian cultures and among young children, but rarely performed by adults in Westernized countries. Spending time in a squat position offers many health benefits and can serve as way to correct postural imbalances. Squatting is a safe activity when performed properly. Someone who is healthy and in relatively good physical shape without a history of knee injuries should be able to squat safely with minimal risk. Individuals with a history of knee injury need to give consideration to the increased forces placed on the structures of the knee when squatting. A lack of ankle mobility is usually the limiting factor that would prevent an individual from reaching full depth. The ability to do a full depth squat is a sign of good physical health.
1. Dobrzynski J. "An Eye on China's Not So Rich and Famous". The New York Times. Retrieved Sep 23 2012.
2. Caterisano A, Moss RF, Pellinger TK, Woodruff K, Lewis VC, Booth W, Khadra T. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res. 2002 Aug;16(3):428-32.
3. Liu CM, Xu L. Retrospective study of squatting with prevalence of knee osteoarthritis. Zhonghua Liu Xing Bing Xue Za Zhi. 2007 Feb;28(2):177-9.
4. Lin J, Li R, Kang X, Li H. Risk factors for radiographic tibiofemoral knee osteoarthritis: the wuchuan osteoarthritis study. Int J Rheumatol. 2010;2010:385826.
5. Besier TF, Draper CE, Gold GE, Beaupré GS, Delp SL. Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res. 2005 Mar;23(2):345-50.
6. Chandler T, Wilson G, Stone M. The effect of the squat exercise on knee stability. Med Sci Sports Exerc. 21(3). Pp 299-303. 1989.
7. Escamilla RF. Knee biomechanics of the dynamic squat exercise. Med Sci Sports Exerc. 2001 Jan;33(1):127-41.
How Far How Soon "The Ultra Dilemma"
The Ultra Dilemma
October 21, 2013 by Sock Doc
In todays endurance world, covering longer distances has become the new and
expected normal. Gone are the days when racing a fast 5K or 10K meant something and
were even starting to lose the concept that running one marathon is a big deal. Yet
much like triathletes feel its imperative to race an Ironman as soon as possible
regardless of ones current fitness level, trail runners are viewing ultras the same way
the more distance the better. But for most, more training and racing eventually leads to
poor health and even lowered fitness levels.
More Isnt Necessarily Better
How much is too much when it comes to training and especially racing? Well that
depends on you the individual and what your body is capable of handing in regards
to the stress demands you choose to put yourself through. As Ive addressed in the Sock
Doc Training Principles, the more frequent and the more intense your training, the more
you need to rest and recover. For most competing in long distance events, such as
marathons and ultras, recovery is going to be affected by the demands of everyday life.
Most athletes have work, family, and other life responsibilities beyond training and
racing. Simply put, if your only job isnt to train and race, then youre already at some
disadvantage because your recovery (and training) time and energy are required
Many endurance athletes are Type-A personalities who excel in what they do outside of
racing. They work long hours and have active families. These athletes are already
stretched for time and energy resources, and theyre often lacking proper sleep and
recovery. So when they add in more and more distance, it quickly can, and does, take its
toll on the body.
How Much Distance Can a Body Handle?
Professional athletes are more likely able to handle longer distance events more often
than amateur athletes. The time commitment to properly train for these events is huge.
Unfortunately, many athletes today do not put in the necessary time needed to train
adequately for these events; yes that includes recovery. Running a couple short
distances during the week and logging in some massive miles over the weekend doesnt
teach your body to adapt properly to cover distances in a safe, efficient, or fast manner.
At best youll get fit quick enough to race the distance while most likely having to deal
with some nagging health and injury-related problems along the way, or soon thereafter.
Ive been in the endurance racing scene since the early 1990s. Back then, (and sorry if I
sound like your reminiscing grandpa), there werent marathons or ultra-distance events
every weekend, or even every month. You trained for the one big long distance event of
the year, and for many that was a race lasting a few hours. In my opinion, I dont think
its just a coincidence that during that era we saw athletes such as Mark Allen and Paula
Newby-Fraser win the Ironman World Championship multiple times (six and eight
respectively). They werent racing big events throughout the year as athletes are doing
today, and part of the reason they werent was because those events just werent
available. But now these events are, and with the increased amount of endurance
events we are seeing more athletes racing more often and ultimately they inevitably
break down and their careers end way sooner than anticipated. You can only race so
fast, so often, for so long. So next time you think youre not performing well because of
old age perhaps consider youre not training properly, and that could mean youre just
training and racing way too much.
Humans Evolved to Run, Not Race
Im all for endurance racing, but Im more for training properly and racing to the point
where your health doesnt suffer permanently. I say permanently because running these
types of races too often can result in permanent injuries and health problems. Yes, being
outside and active for long periods of time often is very healthy, not just for your body
but for your mind too. But when you ramp it up to the point of trying to get from point A to
point B at a pace above a certain threshold, (defined by each individuals fitness level),
then youre inversely affecting your health. Many athletes are training improperly to the
point where they are chronically affecting their health in a negative way with more and
If we look back to how humans are thought to have developed as persistence hunters,
we see that our hunter-gather ancestors didnt just run hard for hours upon hours to
track down their food. They tracked their food at a slow, aerobic, fat-burning pace rather
than pushing their bodies hard for prolonged periods. Now sure Ill entertain the idea that
there were some stellar human athletes back then, (probably more than there are today),
and they could perhaps comfortably cover ten miles of harsh terrain in an hour or so. But
just like the small handful of elites today, they are just that the minority. Humans arent
evolving in the same linear fashion to run these longer distances faster and more often.
Ive discussed previously that for elite marathoners running a sub 2:30 they are most
likely creating less damaging stress on their body than the average amateur running
a four to five-hour race. Its all about how efficient you are and how quickly your body
breaks, (or doesnt break), down.
Breaking Down Your Body
Everybody has their breaking point in a race. If youre healthy and you trained properly
and follow your race plan (pace and nutrition) then ideally you wont break down until the
very end of the race, if at all. I define this point of breaking down when your body no
longer can keep up with the demand you are placing on it and muscle imbalances begin
to occur. Your muscles will be affected by the stress placed on your nervous system
which is constantly monitoring each and every system in your body particularly your
digestive, hormonal, and cardiovascular systems when it comes to racing.
How do you know when youre starting to break down? Its happening way before you
bonk and even before you start to feel fatigued. Little signs such as misjudging a rock
and almost tripping is a good way to tell youre starting to falter. A tight muscle that
comes out of nowhere say in your calf or maybe a side stitch more signs of your
body fading. A change in your gait is also another huge sign of a broken athlete as gait
is so closely influenced by glucose regulation, yet you might not realize this until you
literally fall or see a photo of yourself and see an altered posture.
The problem with breaking down is not just a loss of performance but also impaired
health. Oxidative damage (from excess free radicals), inflammation, and high levels of
stress hormones (particularly cortisol), go hand-in-hand with racing hard (and for many
training hard too). The more you train broken, and the longer you race broken, the more
you run the risk of not just injury and illness but also other health problems, particularly
immune system issues such as auto-immune diseases and yeah, even cancer.
Plan For the Big One
Yup, I threw out the Big C there in that last sentence because chronic stress will slowly
but surely take its toll on your immune system. It may take years for you to realize the
negative effects of training too hard, too often, and racing too long, too often, but it will
eventually catch up with you if you dont balance the intensity and duration with rest,
recovery, and the adequate fitness necessary to train at these high levels.
If you want to safely participate in long-distance events then you have to put in the time
and effort to build stellar aerobic endurance. The longer you train and race in a fatburning
mode the less likely you are to break down resulting in better performance.
Once you build your aerobic fitness, (which can take years for most people), then you
can add more and more distance, to a certain extent, to take your fitness to the next
level without compromising health.
Dont get sucked into racing such long distances so often, especially early on if youre
new to the sport. Ultras require a high level of fitness as well as mental stamina which
takes significant time to develop. Personally, I think that one race a year over 50K is
more than most can safely handle, yet we hear of so many doing multiple centuries. Aint
nothing wrong with going shorter. Speed and strength are healthy attributes every
human should have to some degree, lets not forget that.
Theres more to this game than just being effective (covering the distance and finishing).
You want to be an efficient human athlete which means you can cover the distance in a
manner where you can still function the next day and next week and youre better for it
all around mentally and physically.