Quick Update on Migration

It seems that I am 98% migrated from WordPress.com (what you’re reading now) to WordPress.org (where runnerunderpressure.com is now). However, a few glitches remain and from statistics on this site, it seems that some people are still seeing the old site rather than the shiny new one. To fix that, clear your internet cache and bookmark (or whatever you do to find me) runnerunderpressure.com again. Similarly, subscriptions simply didn’t migrate properly so if you were used to getting my posts in your inbox, you may have to resubscribe on the new site (right hand side) to get that to work. Finally, comments on .org are more strictly monitored than on .com and a few of you ended up in spam (sorry Ryan!!). I’m monitoring those closely now to get it all back on track, but if you aren’t showing up, just shoot me an email and I’ll hand enter your name.

I’m giving it another month but then I’ll be permanently inactivating the WordPress.com site so should you encounter a 404 error in March, that’s what happened! Sorry for the nuisance and thanks as always for reading. If you’re in Boston, sorry about the snow. If you’re in the Northeast, stay warm over the next 24 hours! This is undoubtedly a winter for the history books.

Week in Review 1/19/15 to 1/25/15

First things first, I have no idea what version of this blog you are looking for so if it looks the same, my apologies. If it looks shiny and new, fantastic! The two months after my initial WordPress migration snafu are up and you should be seeing a brand new version of this blog. However, the snafu seems to have continued a bit, so my big unveil is a bit anticlimactic.

Monday: Tempo with 5 by 5 minutes at T pace on the treadmill. 8 total. Legs after.

Tuesday: Recovery ski, 1 hour.

Wednesday: 9.2 mile run/skate in running shoes with LT.

Thursday: Workout! Warmed up then 5 by 3 minutes at I pace up and down Riverside. Down sections felt great, up sections were incredibly humbling. Legs after.

Friday: 3.5 mile recovery run.

Saturday: 5.5 mile run with 4 striders and arms afterward.

Sunday: 11 mile hilly long run on Spear Street. Felt great but got really chilled by the end.

Total: 45.2 miles

2 legs, 1 arms.

I wish this week featured a little more mileage but I’m happy to have gotten in a tempo run, speed work and a long(ish) run. With another incoming storm, it looks like I’ll spend much of the next week inside so I’ll adjust my workout plans accordingly.

The Heart of the Athlete

Sudden cardiac death in athletes is a personal and professional interest of mine. In the past few years, running, triathlon and nordic skiing have all had major events where an athlete died of sudden cardiac death (death within an hour of cardiac arrest). In general, these deaths are not attributable to what we consider “traditional” risk factors for cardiac arrest. Many of these athletes had an underlying condition called hypertrophic cardiomyopathy, a generally asymptomatic enlarging of the heart. Until it isn’t. One of the biggest questions that I hope to answer across my career is whether or not this hypertrophy is part of why these athletes end up excelling at endurance sports in the first place; that is, if we’re going to screen, does focusing on endurance sports make sense?

This article frames the conversation about screening nicely. As Dr. Maron points out, the more people you screen with a test that isn’t perfectly specific, the more false positives you have which can trigger a battery of invasive, unnecessary tests. As a coach, this is an issue that sits at the back of my head. Last year at the Craftsbury Marathon, an event where Olympians, high schoolers and weekend warriors can all race together, a skier from Dartmouth died on the course. Some of my skiers were right around him and it was a difficult conversation to have with them about the likelihood of them having a similar experience.

At this point, the Class I recommendation is to use a 14 point screening test and then refer to ECG and further testing if an athlete says yes to any of the items. It’s not a perfect tool but may be a start towards earlier identification of cardiac issues in a population we often consider our most healthy.

Not All At Once

Last week, I was on the phone with the mom of an alumna with whom I remain close and we were talking about balance and the tendency of some women to take on too much. She remarked that she once heard Madeline Kunin (former Governor of Vermont and generally incredible woman) say that “Of course women can have it all. Just not at once.” That quote has hung with me since our conversation.

I am rarely overwhelmed by my schedule. In the past week, however, I’ve felt a bit overbooked and increasingly like I’m doing a sh*tty job at all my commitments. As I struggled out the door for my workout on Monday, feeling like I should remain tied to my desk instead of running, I finally admitted that something had to give, at least for the next few weeks.

Right now, my priorities are the Boards and MMU Nordic. The former is self-evident from a career perspective. The latter reflects a core priority in my life: give back to the community that raised me. Every season of coaching is special but when a State Championship is likely and you have three and four year skiers who have given their all to get here, they deserve your all right back.

By the end of my workout, I’d come up with a temporary solution (which I suppose made the whole run worth it). Until the end of ski season, I’ll use ski practice as my recovery days. I have two days a week slotted in as recovery runs and since the purpose of a recovery run is to just move, skiing will do just fine. This saves me a double workout twice a week and takes some pressure off. Is it the most specific workout for running? No. But it will have to do. Yesterday was an incredible day of skiing and it was made even better by being able to enjoy it for what it was, not worrying about when I was going to get my run in.

What compromises have you made to better fit running into your life?

Week in Review: 1/12/15 to 1/18/15

This week was all about making like Elsa and letting it go. I had hoped for a 53 mile week and ended up with only 36 and 3 consecutive days off. My schedule was crazier than usual this week and a Friday night wedding in New York City with 13 hours of driving in 24 hours meant that running got pushed to the back burner. So I’m calling it a cutback week and moving on!

Monday: 8 mile run with 6 by 90 seconds hard on the UVM bike path uphill. 90 seconds was exactly 400 meters, so I’m thrilled to be moving that well uphill and in snow. Legs after. Hiked up Cochran’s a bunch of times in the afternoon for the race.

Tuesday: 5 mile recovery run.

Wednesday: 9 mile midweek longer run. Skied with the team for 45 minutes after.

Thursday: Skied with the team for an hour.

Friday: Lifted arms and legs before we left for New York at 7 am.

Saturday: Nada.

Sunday: 14.25 mile long run with LT, Amy, Ryan, Erin and Laurel. Besides some major GI issues halfway through, I felt great. Probably the three days off…

Total Miles: 36.32

2 legs, 1 arms and lots of skiing this week.

Storm coming in tonight means I’ll likely be inside for my workout tomorrow. Might head to the track with my spikes to work on speed and hoping for two workouts this week. It seems like I need to get up earlier (ugh) and just get my run in before cases or I find myself dealing with too much test anxiety by the end of the day.

How do you make sure you get your runs in? Get up early? Push dinnertime? Treadmill at home?

No More Knee Pain!

Apparently it’s body overhaul week everywhere! I’ve never (knock on wood) had knee issues save for one small flare of IT band syndrome in high school, when like every other 15 year old girl, my hips weren’t strong enough to support lots of running. However, knee valgus (colloquialism: knock kneed) is incredibly common and causes a ton of problems for men and women alike. Sometimes it’s an anatomical issue; rotated femurs aren’t an unusual finding. More commonly, it’s a functional issue. As with any muscle group, we tend to use our largest hip muscles and ignore firing the smaller ones that are critical for effective motion. One of my goals for this Spring is to get my left leg back on line. After two surgeries that required no weight bearing for a period of time, it’s gotten a little lazy and loves to roll inward.

James owns Body Resolution, a gym here in town, and I was psyched to read his post on preventing knee pain. I don’t know James personally but really admire both his facility and his strong use of science. As you’ll see in his post, the exercises are simple enough for almost anyone to do but also extremely effective tools for improving functional knee valgus. I’ll share my leg routine tomorrow, which has many similar movements to James’, but am definitely considering adding some of his moves in, especially the ball squat with abduction and glute bridge on foam roller.

What parts of your form need the most work?

The #1 Exercise for Runners

If you only have time for one “extra” in your routine, this is your pick. Bold claim, I know, but I’m good at reading science and Will is even better and over the past few years, we’ve spent an enormous amount of time reviewing literature on what makes the perfect runner. Sure, you have to have some genetic predisposition and big lungs, but you also have to have a stable foot and hip/knee drive. The exercise that comes up over and over again to facilitate the development of the best stride possible for each runner are step-ups. Anecdotally, when I do my step-ups regularly, my form is significantly better. When I don’t, it’s right back to shuffle city.

Don’t mind the banner in the back. It was borrowed from Terre Haute some years back.

Earlier this fall, Will built us a step-up box (you can buy them too, but they are surprisingly expensive). Ours is 18″ but anything between 12 and 20 inches should do the trick. If you want an even cheaper version, try using 2 or 3 stairs. Just be careful when you’re coming back down not to catch your foot.

As you can see from the pictures above, I still need work. In one picture, I’m looking down at my foot when I should be looking ahead. In the bottom picture, I’m collapsing towards my loaded foot. With continued lifting and drills, however, this should improve.

How do you incorporate step-ups into your life? Start with 5 on a side (so 10 total per set) with a goal of 3 sets. Eventually you want to get up to 10 on a side.These are best done after your harder runs; how else will you learn to improve form when you’re tired?! I generally do these three times a week with the rest of my leg work.

Later in the week, I’ll share my 20 minute leg and 20 minute arm workouts that really can fit in your day and are runner-specific. No future in Cross Fit with these routines, but done regularly, they’ll improve form and help you in the latter stages of runs and races.

Week in Review: 1/5/15 to 1/11/15

Despite an arctic blast that had us at -11 F (and -35 F “feels like”) and a cold that made me (and everyone around me) miserable, it was a great week of running!

Monday am: Super early 5.1 miler plus striders before case discussion at 7:30. Arms afterward.

Monday pm: Had a lot of reading in a review book to do, so did an hour on the bike to change it up.

Tuesday: Warmed up for my workout and realized I was much sicker than realized. Called it after 3 miles total.

Wednesday: 8 miles easy plus legs.

Thursday: Skied with the team for a bit then 5 miles indoors plus striders. Arms afterward.

Friday: One of the best workouts I’ve had in a long time! 8 miles total with warmup, then 2 by 10 at T pace and 5 minutes of cutdown plus cooldown. Legs afterward.

Saturday: 12.8 mile long run in the wind and cold on Spear Street. So grateful to have Amy, Ryan and Laurel with me!

Sunday: 6.1 mile eassssssy pace run around St. Mikes. Striders after.

Total Miles: 48

Arms: 2 times

Legs: 2 times

Striders: 3 times

I’m really thrilled with the way this week panned out, especially given my cold. I’m still totally stuffed up but feeling a lot better than I was midweek. I got my miles up another click, had a very solid workout on Friday and most importantly, did a good job of getting the extras in. I’m finding that if I go directly downstairs after my run or finish my run at the gym, I’m much better about getting lifting in. For this coming week, I’ll keep inching mileage up, hope to get two workouts in and add drills before those workouts.

How was your week?

The Endurance Mindset

When Oprah was training for her marathon, she quipped that “running is the best metaphor for life; you get out of it what you put in.” There’s an enormous amount of truth to this. Sure, freak things may happen but for the most part, what you get on race day is a sum of quality miles trained plus the benefits of all the extras like strides, core, strength, stretching etc.

When I started to prepare for Step 1, I didn’t even know where to begin. I’ve taken big exams before; after all, I managed to get into medical school which required the MCAT. The MCAT, however, was a half day test and although it ostensibly determined my entrance to medical school, a poor performance didn’t mean I could never go to medical school (I could retake) and didn’t represent an investment of over $100,000. The USMLE Step 1 exam represents two years of classroom knowledge crammed into a day long test with a total break time of an hour. The only way you can retake is to fail but the space between barely passing and being competitive for a residency is enormous. The more I thought about it, the more Step 1 resembled a marathon. You study for about 12 weeks. You start by building a knowledge base and as you get stronger, you add workouts that are more and more specific to your task. Finally, you work on the endurance to sit and focus for 8 hours. Once I framed it that way, the test preparedness paralysis lifted. I wrote a schedule the exact way I write one in running, with dates down the y-axis and specific domains across the top x-axis. I built in recovery days. I even built in a taper so that I’m fresh and ready on test day (March 2nd), not crawling to the start line.

Throughout medical school, people have asked how I keep training at a (relatively) high level, almost always incredulous that I can find the time. Some of the answer is that running is a top priority for me and I make choices that support my running ahead of many other things. I don’t belong to any student interest groups; I choose to believe that a long coaching relationship with MMU demonstrates my interests just as well. I don’t do many social things; almost all of my friends are runners, so I make that my social time. However, making running a priority isn’t the only reason I’ve kept at it during medical school. Being a runner has given me an endurance mindset and gives me a set of tools to approach any enormous challenge that life can throw at me.

How do the things you’ve learned from running carry over in your life?

Be Like Bamboo

“Bamboo is flexible, bending with the wind but never breaking, capable of adapting to any circumstance. It suggests resilience, meaning that we have the ability to bounce back even from the most difficult times.Your ability to thrive depends, in the end, on your attitude to your life circumstances. Take everything in stride with grace, putting forth energy when it is needed, yet always staying calm inwardly.”  Ping Fu

This week started beautifully. I got out the door at 5:30 on Monday and had my run, strides and lift done by 7:00 and was in my chair for class at 7:30. I got an extra hour of biking in when I had some reading to do. Sure, I had the beginnings of a cold and had sneezed through the entire day, but I didn’t feel THAT bad.

Today I feel THAT bad. Due to freezing temps, I swapped my workouts and planned to do an indoor tempo run tonight after coaching. I felt horrible while I was skiing (nauseous, dizzy) but thought it was just the temps. I headed to the gym as planned, warmed up with Joey then hit the treadmill. Where I made it exactly 8 minutes. When the display started spinning and I felt like I was going to die, I called it and came home deflated.

What I’m trying to remember is that above all else, I need to respect my body and I need to respect the weather. It’s hard, with forecasted wind chills of -40, but it is what it is and I just have to make the best of my cold and the cold this week.

Be Like Bamboo.