My Macro Journey to Fitness – Part 2

Feed me, Julia!

But how?

Prescription Food

In the Fall of 2009, I started my program in Massage Therapy at The Swedish Institute. Along with foundational coursework like Anatomy & Physiology, I was given an education in Eastern medicine. In my introductory class, we discussed the 5 Element theory to diagnosing and treating imbalances in the body. It broke down the acupressure point meridians and the paired organs that represented diagnostic elements. Dysfunction in these paired organs manifested physically and emotionally in the body. Treatments included bodywork, acupuncture, herbs and nutrition. There were foods to avoid and foods to promote the function of these pairs depending on the diagnosis given. Each element itself was associated with certain tastes and manners of eating.

My mind was officially blown!

Food as a healing prescription instead of an anxiety inducing activity resonated with me. I wasn’t at the point yet where I even liked to eat. All I knew was that I had to eat.

Maybe those cravings for lamb burgers were more than just cravings!

I soon learned that eating disorders like my Anorexia stemmed from imbalances in the paired organ relationship of Stomach and Spleen. Makes sense, right? Food goes into the Stomach and then is transformed and assimilated as energy or Qi that gets stored in the Spleen. Depleting my body of nutrients meant I had very little stored energy. People with Stomach and Spleen deficiencies experience a loss of appetite, digestive issues, difficulty putting on muscle, general weakness and lack of tone in their limbs, metabolic imbalances and irregular menstrual cycles. The emotional/spiritual manifestation of their imbalance is anxiety, worry, excessive thinking, pensiveness, obsessiveness, remorse, regret, obsessions, and self-doubt.

Pretty much summed me up.

I bought and borrowed every book I could find on TCM (i.e. Traditional Chinese Medicine) and Eastern theory. One of my class exercises was to create a 3 Day menu for an element of our choice. You know which one I chose. I ended up implementing this menu in my own life. In the first few months of 2010, I started to see muscle definition and an increase in my strength. My program was a mostly strength based workout with my trainer 2x per week and 2 days of some kind of cardio endurance training on my own.

But by March, I found myself overcome with a strange new craving after my cardio workouts and it scared the crap out of me.

SUGAR!

Not your optimal post workout nutrition

Even though it was scary, this powerful urge for sweet made a lot of sense. Metabolically, I was depleting my energy reserves with the duration of my cardio activities. It was my brain telling my body you need the quickest form of energy available or you’ll crash. This energy is glucose. We derive glucose from consuming carbohydrates. The sugars in carbs are broken down to synthesize glucose which goes directly into the blood stream, also known as our “blood sugar.” From these same carbs, we also manufacture glycogen, a more complex sugar which is stored in our muscles and the liver. When blood sugar is depleted, a chemical messenger gets released that signals the glycogen stores to be broken down to glucose, which then gets sent into the blood stream to replenish our levels.

My, then, boyfriend was all too happy to entertain this new craving and together we indulged it. Maybe I felt safer to consume sweets in his presence because it took the edge off of the guilt I felt. Sugar in any form was something I avoided and restricted. It caused me to have anxiety and made me moody. My periods were more painful. And the worst result of all was an increase in my body fat percentage by the year’s end because I wasn’t careful with my portions.

This habit could not continue.

I clearly had to change the way I was working out on my own and what I was consuming afterward. I didn’t want all my hard work to be for nought.

The science of snacking, post workout

I looked into the chapters on nutrition in a few different Exercise Science textbooks. Many of them spoke about consuming a high glycemic index carb within a half hour to an hour of endurance workouts in order to replenish blood sugar levels and prevent the muscles from being targeted for glycogen breakdown. Muscles need that energy to repair themselves, not to keep you from fainting after your workout. Also recommended for muscle repair and recovery was a protein, preferably from the 8 essential aminos family and especially high lucein in nature, along with a source of Omega 3 fatty acid. The above macro-nutrients were recommended to be eaten within 90 mins post workout. If I could create a snack that encompassed all the macros I needed, I would not only be doing my body good, but would also be shutting the sugar cravings down for good.

Box Jumps – an advanced exercise in this High Intensity Interval Training routine

I discovered High Intensity Interval Training or HIIT while watching a documentary on obesity in the UK in 2011. I learned that 20 minutes of intense activity done in short intervals using 90% of my max energy level with even shorter rests in between accomplished more than any of my 90 min cardio benders.

This was a more efficient way of getting my cardio in no matter what my schedule was like. I started with beginner level intervals and within a year, made it to more advanced routines. I already had a good cardio base to work with and I was careful not to do movements where I felt my form was anything short of perfect.

MAJOR NOTE: HIIT is something to work up to. You cannot go from a sedentary lifestyle right into this kind of exercise. You need a strong cardio vascular system and a keen understanding of form before going “balls to the wall” – seek out a trainer that can get you there!

It may have taken almost 7 years, but I had finally found the fitness formula that worked best for me – a combination of strength training and HIIT along with proper nutrition to support my activity levels.

And an amazing thing happened. I started to like eating.

My Macro Go To’s

I make my own post workout snacks on the days where I was not running to work after training. I’m not anal about measuring out the exact proportions of high glycemic carb, protein and fat, but I more or less estimate a portion size that my body responds well to (i.e. no cramping, stitches or bloating after eating)

One of my favorite post workout snacks is a cup of full fat Greek yogurt, with 3 Medjool dates, a tsp of Greek honey and 2 tsps of tahini.

I also created a shake recipe that tastes a lot like lemon cake batter. I blend 1 cup of Kefir (a fermented milk drink similar to yogurt that is a great source of probiotic strains for your GI), 1 frozen banana, 10 blueberries, 1 tsp almond butter and 2 tsps ProOmega D-Xtra liquid from Nordic Naturals (a great source of Omega 3 fatty acid).

Lemon flavored source of Vitamin D3 and Omega 3 fatty acid

Lastly, when I’m in need of a snack on the go between clients, I prefer the  Go Macro macro-nutrient bar along with some kind of fruit. My favorite combo to date is the cashew butter macrobar “sweet rejuvenation” (pictured below) with a medium sized ripe apricot.

 

ADDITIONAL SOURCES and READING:

Journal of Applied Physiologyhttp://jap.physiology.org/content/89/5/1845.full

Muscle Glycogen Synthesis Before and After Exercisehttps://www.ncbi.nlm.nih.gov/pubmed/2011684

Haff, Gregory G and Triplett, Travis N. “Essentials of Strength Training and Conditioning, 4th Edition” (NSCA, USA)

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My Macro Journey to Fitness – Part 1

Redefining my relationship with food was one of the hardest challenges I overcame in my recovery from Anorexia. It’s been a decade plus journey with plenty of weak moments and falling off of the wagon. In an effort to hold myself accountable and practice what I preach, to both my clients and loved ones, I’d like to tell you a bit about the role nutrition played in getting me to where I am today.

The Miseducation of Julia Fragias…

The body is a wonderfully efficient machine.

Starve and abuse it, but in a continuous loop of feedback mechanisms, the brain catches wind of what you’re doing and tweaks every cell in the body to maintain your existence. When I started to eat again, my brain clearly didn’t trust me. It adjusted my metabolism to a lower rate in order to make sure the calories I put into my body wouldn’t disappear.

It took a while to earn that trust back.

The image you see above from 2007 is a softer, fuller girl almost 2 years into recovery from Anorexia. I didn’t know how to exercise properly. I didn’t know how to like food, much less understand now-common concepts like macronutrients. I was instructed by my then counselor not to restrict food and was assured my metabolism would normalize. Eventually.

But, of course, I was still afraid to eat.

I categorized foods into “safe” and “off limits.” How did I decide what made them safe? They were low in fat or fat free. Vegetables or fruit were safe, as long as they didn’t bloat me. Liquids were safer than solids. It also helped if they were low in calories per serving. I ate my “safe foods” repetitively and copiously.

My criteria for safe were so far off the mark that they actually contributed to my rapid weight gain. As my body continued to expand, I had to fight the urge to restrict my eating. I wanted someone to give me a magic menu or list of foods that I could eat without anxiety.

I wanted safety, but I needed education.

Through therapy, I was getting served a whole lot of how to eat through mindfulness, which was helpful – chew your food well, eat slowly, savor the flavors, be grateful for the nourishment – but nobody was telling me what to eat.

How could I begin to structure balanced meals that would fuel my body efficiently?

Count your macros…

My self education was to obsessively watch fitness channels on Youtube. This was when I first came across the term macronutrient. The body builders and fitness professionals I was taking notes from all shared the same advice – count your macros. It’s a catchy word, especially when repeated like a mantra, but what exactly are they?

Carbohydrates, Proteins and Fats: compounds we derive the most energy from and that make up the bulk of our diets as humans. Our cells need these nutrients to grow and develop properly.

Finally, I had something specific to focus on. I concentrated on the ratios of these compounds that the fitness community recommended were optimal for fitness and good health. I constructed a daily diet that consisted of ready made and home made protein powder based shakes, protein bars, bags of nuts, bananas for my pre-workout, and cans of water packed tuna for dinner.

Finally, I had a new “safe” list!

Problem was, it was even more restricted than my previous one.

My workouts were cardio endurance based only and lasted between 60 and 90 minutes to the point of utter exhaustion. There are a number of reasons why this is not the fitness route you want to go down, but I will get into that in my next post. I dropped about ten pounds, but I was constipated, had started to develop eczema patches all over my body and odd outbreaks of hives, had terrible insomnia and brain fog. As if that weren’t all bad enough, I put on virtually no muscle tone.

At the end of 2007, my annual blood test indicated I was deficient in many vitamins and borderline anemic. Essentially, I was malnourished. My doctor didn’t help matters either by telling me I needed to lose a few pounds. He came to this conclusion based on a chart of height and weight ranges of which I was at the high end of normal. FYI – this chart also said I was a normal weight when I had full blown anorexia. Scary, truly.

Here’s an example of a Height to Weight Chart, like the one my doctor used to determine I needed to lose weight. These things are AWFUL!

I left the doctor’s office terrified.

I abandoned my diet and let my body’s cravings guide my food choices. This was recommended by a therapist who believed the body intuitively knows what it needs. She was also trying to prevent my patterns of restriction and categorizing food. I remember meeting up with an old friend, who had struggled with childhood obesity and was now super fit. I asked him how he learned to eat properly. He laughed at me and said, “Julia. NO ONE eats properly. It’s how you exercise that counts.”

Working with a trainer, he put on lean muscle that raised his metabolism and allowed his body to burn off more calories at rest.

And he noticed something interesting.

The fitter he became, the less he craved the fried pork chops, plantain chips and soda of his youth. Remember what I said about the wonderful efficiency of the body? As his body grew healthier and stronger, so did his food choices.

He strongly urged me to contact his trainer. After I got over myself (my bad experience with personal trainers was documented in my post A Body Is A Terrible Thing To Waste) I set up my first session in August of 2008.

I started on the strength-training program the trainer designed for me. It was around the 6 week mark that I started to feel something I never expected to feel again. Hunger.

I was hungry all the time.

To actually feel my stomach rumbling and experience the weakness of NOT attending to that hunger was frightening to me, but also a huge step forward. Hunger was a sensation I had psychologically dulled for years with my disordered eating habits. So, for the first time since my recovery began, I ate when I was actually hungry.

This. Was. A. Game changer.

I was most ravenous within an hour of my workouts. I found myself craving meat, which was shocking because I had been a vegetarian for 7 years and the thought of animal protein in my mouth used to nauseate me. This hunger and these new cravings were my body’s call to action.

FEED ME, JULIA!!!

But how?

Stay tuned for Part 2…

 

 

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How to be mindful with a mind that’s full in 2017

Welcome to the end of the first week of the New Year. I am not alone in saying that 2016 presented its fair share of obstacles, life altering experiences and game changing events. None of us want a repeater in 2017. Last week, I set out to create an image of how I wanted this year to unfold. Within this image was a list of intentions to guide me along the process. Why not resolutions, you ask? There is a huge difference between resolving something and intending to act. The former implies that there is something wrong; that there is unfinished business hindering you from getting to where you want to be. To make such a list drives into your consciousness all the failures, road blocks and let downs of years’ past. Intentions are purposeful actions. I intend to hug strangers, eat broccoli, travel to Cuba and so on. Intentions allow you to be mindful even if the rest of your brain is locked up in the junk of 2016.

Doing for ME above all others…

One of the most powerful intentions I put on that list, which set the tone for all the others that followed was doing for ME above all others. This is huge! I am an empath and a nurturer. My profession by definition draws on both these qualities, sometimes to depletion point. Oftentimes, I forget myself and my own needs. Therefore, placing ME at the top of my intentions keeps me mindful of number 1. Channeling that nurture inward allows my higher self to steer me forward. She’s the one with the clear voice and my best intentions in mind. Her judgement of situations and people is never cloudy. She is my gut and she is always spot on. If this is too woo-woo for some of you, let me rephrase it as learning to put your needs first. If it puts you last on the list, just say NO.

Walk away from other people’s tornadoes…

You cannot take on or personalize other people’s struggles in this life. Once again, the empathic nurturing self wants to provide solutions, love the pain away, walk alongside them in their process. What you need to realize is that it is their process, not yours and trying to invite yourself into the tornado leaves a destructive path in its wake. As my post on unconditional love explored, it’s okay to walk away.

Any kind of day can be made better by working out…

I told myself whenever I was feeling off in some way or another, I would do a quick workout and then re-evaluate how I was feeling. Being in your physical body prevents you from ruminating and that form of distraction can reset your nervous system in profound ways. Feel good hormones called endorphins surge through your system every time you exercise. Why not take advantage of nature’s mood elevators? Who here has 15-20 minutes a day to feel good? I DO!!

Fantasize like a 5-year old…

Small children fantasize 24/7. Their play incorporates a ton of make believe and they love telling long drawn out stories of what they envision their future/fantasy selves to be like. My niece is always telling me her I want to be a princess fantasy complete with what her hair will look like and the types of rooms in her home. Why is it so hard for us adults to do the same? The inability to fantasize about certain things I desire for myself is like telling my inner 5 year old not to dream because I don’t believe it will come true.  There is power in falling in love with that story or as a close friend put it watching the movie of your life play out all the while rooting for the heroine – YOU. I intend to tell myself elaborate stories of future me with as many details as possible and enjoy the vision in progress.

As my list took form, I felt an energetic shift within myself. The first week of the New Year has been an optimistic one not because anything profound has actually happened, but because I feel more at home within myself than ever before. Let the above intentions guide you in making a list of your own. See what shifts occur within you. This is YOUR year.

What’s my age again?

How old would you be, if you didn’t know how old you were?

There are some days where I feel about 100 years old. My body moves like it’s made of lead and all my senses are dulled. Thank god those days are few and far between. Most of the time, I marvel at the amount of physical work I am capable of; something my unhealthy 25 year old self would have fallen over just thinking about. There is  a lot to be said about the statement, “You’re as old as you feel” which ties into the question that opened this post. With proper exercise, nutrition and stress reduction and/or mediation coupled with good genetics, a person can certainly look and act a lot younger than their chronological age. Our functional age is based on how capable we are to carry out physical tasks in daily life and also encompasses psychological, environmental and physiological factors. This is especially important amongst the elderly population, where their ability to function at a younger level helps maintain their vitality.

How old do you think she is?

Behold, Edna, a woman approaching 100 years old, who happily works with her trainers at the gym doing a medley of exercises in her adorable leopard print leggings. Energy, strength and personality exude from her tiny frame. Her mantra? “Don’t let yourself get weak.” We could all grab some inspiration from her, as excerpted below from a Women’s Health Article published in March 2014.

http://www.womenshealthmag.com/fitness/97-year-old-woman-doing-squats

Edna’s positive and motivated mental state counters the physiological reality of her age and its limitations. As we age, we lose muscle mass (sarcopoenia), bone density (osteopoenia) and collagen, which weakens our connective tissues. It takes more effort to do a lot of the activities of daily living in addition to the fun stuff like working out, chasing your grand-kids or climbing a trail.  The psychophysiological relationship is fascinating to me because it essentially shows that a good attitude, social interaction and familial/community support can override a lot of what would limit you physiologically. It can also do the opposite when the above three things are non-existent. Even as a young person, a negative attitude (I can’t do that) mixed with social isolation (Leave me alone) and no sense of community around you (I have no friends) can have drastic affects on how you function. Ask that person how old they feel and the answer probably will not match their chronological age; nor will it be for the better.

How old does this toddler feel if she’s conked out while standing?

So, take a moment to do a little metal inventory and ask yourself the opening question. What are the factors that made you answer the way you did? Are you doing too much? Too little? Have you not seen a friend or family member in a while because of a hectic schedule? Are you surrounded by energy vampires? This self searching will allow you to pinpoint what needs to change in this moment in order to feel more like the number you deserve to be. Life is already too short as it is. Make every year count!

Metabolic Obesity: Redefining Fat

When many of us think of fat, we picture folds and rolls that jiggle. The fat that the health and beauty industries market toward is that which is under the skin, otherwise known as subcutaneous fat. It’s the same fat that puckers through weak connective tissue grids creating what we call cellulite. While this fat is concerning from both an aesthetic and health oriented perspective, there is a far more insidious kind of fat not always visible on the outside who is responsible for a host of diseases in the long term. This fat is not assessed by volume like those caliper pinching tools used to tell you your overall body fat %, but by location. This is your deeper fat reserve – your visceral fat.

The how to of measuring one kind of fat…caliper in action

Visceral fat (also known as brown fat or metabolic fat) gets its name because of where you find it – nestled deep in the abdominal cavity surrounding organs (i.e. viscera) like the liver, intestines, pancreas and kidneys. It’s there as an energy back up for your vital organs as well as to cushion and protect them. Your body is hardwired to maintain this fat, unless there is a deficit (i.e. starvation or intense exercise). In fact, even when not starving, this fat produces substances that affect insulin levels and communicate with the liver to influence blood fat content ensuring that the vital organs always get fed. In a famine, this fat will be the first to go before your body resorts to breaking down surface fat, muscles and organs for fuel. Now, imagine that you have more than what you need of this highly active fat? It pumps out pro-inflammatory cells into your blood stream, since it has a tight relationship with a major blood vessel to the liver and heart. These cells cause insulin resistance which is the precursor to Type II diabetes as well as promote the development of heart disease, atherosclerosis (hardening of the arteries) and cancer of the bowel. Research even suggests that visceral fat increases production of the stress hormone, cortisol, and reduces levels of feel-good endorphins, leaving you feeling low on so many levels.

Being that it is so metabolically active, plentiful visceral fat is not the easiest to get rid of. This is also why people who have excess are now being termed metabolically obese regardless of whether they look lean or large. The tell tale sign of this excess in most people is the gut. While the gut is more prevalent in men who tend to have more fat stores in their belly region due to their hormones, menopausal women can also display this type of distention. Waist circumference will give you an inkling as to whether visceral fat is high; 35 inches or more in women and 40 inches and above for men. Another factor that affects visceral fat accumulation beyond gender and hormones is heredity/ethnic background. If people in your family tend to be apple shaped, meaning that more of their fat resides in the upper body, chances are your visceral fat is going to be higher. Following patterns amongst ethnic groups, it was found that excess visceral fat pops up in white men, African American women, Asian Indian and Japanese men and women most often. In addition, certain environmental factors play a role such as smoking and the consumption of compounds in food that mimic estrogen. Known as xenoestrogen or “foreign estrogen” they enter the body through the eating of plants and meats that have been exposed to or naturally contain these compounds and wreak havoc on hormonal levels which mess with visceral fat accumulation. However, many people suffer from metabolic obesity, as I noted earlier, without any outward sign of a large tummy. In fact, they might look pretty lean to the naked eye and register BMI’s that are in normal range.  The only way they find out their visceral fat is high is through an MRI or CT like scan, where the fat’s location can be clearly seen, as demonstrated in the below image. Of course, this is a costly test that is not always accessible or covered by insurance.

MRI Scan done in Britain of an outwardly thin person, who clearly has a large amount of visceral fat, as seen in the white regions of his abdomen (http://www.telegraph.co.uk/news/uknews/1536556/Get-in-touch-with-your-inner-fat.html)

 

So now that your perception of fat is altered, what can you do to reduce excess visceral fat? A 2007 study indicated that High-Intesity exercise was most effective when done at least 4-5 hours a week. Another added bonus for some of the individuals taking part in this study, when combined with dietary tweaking, was an overall reduction of their subcutaneous fat % thus putting BMI levels in normal range. I can’t think of a better prescription than food and exercise. Of course, the best people to consult with for said script would be a nutritionist or registered dietician and a personal trainer. The former for an overhaul of your diet and eating habits and the latter for the right training regimen. My personal feeling with respect to trainers is to do your research and look for someone who has a strong background (cumulative experience and/or degree) in exercise physiology or kinesiology to construct a program of exercise that best suits your body, fitness level and individual goals. Physical therapists and doctors that specialize in sports medicine can be great sources for referrals of this kind.

 

The Magic Number

What’s your magic number?

How many massages can you do in a day?

This is a popular question posited to me by many a new and regular client. You can never be fully honest for obvious reasons. You don’t want to seem tired and overworked, even if you are, because now the client is thinking they will get a shitty massage or feel guilty that they are number (insert double digit) of the day. If I am in the spa setting, I usually make a joke and say that I am “strong like bull” in a mock Eastern European accent and tell them not to worry. If I am in a clinical setting, I distract them back to the matter at hand – their condition, thus dismissing the question altogether. If they bring it up again, I then tell them these clinical massages are shorter and more focused, so don’t worry about me. Let’s focus on you!

The only thing a client should be focused on…

Truthfully, there is a magic number of massages a therapist can perform consecutively before burn out happens. Of course, this number is different for all of us. I weight train and exercise at least three times a week; therefore I am “strong like bull.” Despite this strength and stamina, I know that if I do 5.5 hours of consecutive massage, I am at my body’s limit for the day. I learned this from the rare times I had done 7 or even 8 hours of consecutive massages. The next day, I could barely make my hands into fists coupled with the ache in my forearms and shoulders. Now, for those of you who may say, “You work a 6 hour shift? That’s so part time.” Let me take a moment here and define what consecutive means in this context. These massages are occurring literally back to back. Once the one client is off the table, there are between 5 to 7 minutes to get the room changed over, grab a sip of water, then run to get the next guest without looking like you ran to get them. This is usually what happens in a spa setting, as the booking is done to maximize profitability; not to consider the physical demands made on the therapist. So, you see how 5.5 hours of continuous physical work plus the added cardio of running up and down stairs for guest pick up, drop off and supplies is enough of a full work day for me. You cannot compare it to a 9-5 p.m. desk job, which exhausts many in a different manner (i.e. from holding their bodies in poor sedentary posture and mentally focusing on a screen with few breaks).

Burnout of a different kind…

I recall working an event where another therapist boasted at the amount of clients they could take on in a day. Observing their body mechanics, I assessed that within a few years this therapist would surely burn out. Chronic Tendonitis is a common occurrence in any profession that requires repetitive movements over long periods of time. Taking breaks to stretch, hydrate and regroup mentally and physically allow this career to last beyond the statistical death knell of 3-5 years. I’m not ashamed or scared to say NO when asked to go above and beyond my limit at this 3 year mark of my professional career. After all, I want to be able to straddle both physical worlds – the demands of my fitness regimen with those of my profession. I feel blessed that I know what my magic number feels like, as it makes me a better practitioner for my current and future clients. As for the rest of my fellow LMT’s, may yours pop up sooner than later.

What Are You Running For?

After the runner’s high fades…ouch!

It’s marathon season in the Northeast. Thousands of people participated in the ING NYC Marathon on November 3rd . For those who may not know, the race traverses all corners of New York City’s 5 boroughs covering a distance of 26.2 miles (never forget the .2). Three years ago, I volunteered to provide post marathon massage to members of the FDNY; all of whom took part as a charity effort, competing against the NYPD‘s team. I think the firefighters made the better time that year – gotta love them!

Outside of marathon training, many New Yorkers whose favored form of exercise is running describe themselves as runners and only runners. I found this fascinating, for as much as I train in Thai kickboxing, I never call myself a kick-boxer. Other people I know who incorporate Olympic lifting into their workouts also will never call themselves Olympic Lifters. So why do people who run become so defensive about their running. When told, Oh, so you like to run? their immediate reaction is No, no…I’m a runner. I run (insert mileage/distance covered) every day, such and such times per week followed by accolades like and I’m about to do my third marathon.

After the initial defense, to which you nod and note their determination and dedication, they begin to list their assorted musculoskeletal injuries. This is where my mind really gets blown. Is it normal for a thirty four year old non-athlete to have had multiple knee and a hip replacement surgery? Answer is no; however their injuries  are worn like metals of honor. What I have also come to realize is the more they are able to run through the pain, despite their cartilage and tendons fraying to strands, the prouder they are. The only way you would know that something was off would be by observing their running gait (professional eye helps in that department) and the appearance of their knees and hips post run.

A little self massage of the Plantar Fascia…

Since many of my clients in the last two weeks have been runners, I decided to share with you all some of the more popular injuries experienced amongst this group. Blisters, weakened toe nails and callouses aside, feet suffer from the manner in which the individual runner pounds the pavement. Plantar fasciatis is an inflammatory condition that affects the connective tissue sheath that covers the sole of the foot. This inflammation leads to heel pain that radiates to the center of the foot. We test for it by pressing a thumb into the base of the great toe and extending the entire foot.  Most clients that I have had with this condition feel it more acutely in the belly of their arch into the medial/inner side of their foot. In normal walking gait, our heel strikes the ground first followed by a rolling out of the balls of our feet from left to right to push off for the next step. Running gait sends the strike further up into the middle part of the foot. In the case of plantar fasciatis, the runner is usually putting too much roll/strike into the inner arch of the foot, which leads to the inflammation they experience and related pain pattern.

Sharply related to the bottom of the foot is another condition known as Achilles Tendinopathy. The achilles tendon is a thick band of connective tissue that anchors the calf muscle’s two heads into the heel of the foot. Constant wear and tear from activity leads to degeneration and a weakening of the tendon, which makes it vulnerable to rupture. The areas that are weakened often feel tender to the touch and the tendon itself appears thicker looking. Much like with the plantar fasciatis, it is believed that an over rolling/striking into the inner arch of the foot can cause the achilles to become over strained, thus leading to the tendinopathy. The only way to heal both of these conditions is to reduce activity to allow for the collagen fibers to rebuild/repair themselves. Also, the wearing of insoles and a correction of one’s striking gait can help. However, many runners do not allow themselves this rest and repair time. At some point, it will become impossible to take even walking steps, let alone to run.

Achilles Tendinopathy in the left foot is clearly delineated by the black marker – thicker, misshapen and you bet, painful!

Moving further up the leg we have a condition that affects both the knee and hip known as Ilio-Tibial Band Friction Syndrome. Stats say that over 10% of runners will experience this condition at some point in their running life. Much like the other two overuse conditions mentioned, this one occurs from excessive training/activity. The locus of pain is on the outside of the knee over a bony prominence where the IT Band passes over each time the knee flexes and extends. It can radiate down into the shins or up into the hip, where the IT Band originates. It is super painful during activity and for some, even at rest, depending on how aggravated that huge strip of fascia is.  Stretching the glutes, especially the sides which encompass your little kickboxing muscle behind the pelvis known as the TFL, definitely helps as well as correcting, like the other two conditions, running gait and posture. But again, these conditions stem from pushing one’s limbs to their limits. In tandem with Ilio-Tibial Band Friction Syndrome, there is also “Runner’s Knee” or Chondromalacia Patellae. This condition is an inflammation of the underside of the patella or knee cap which leads to Patellofemoral Pain Syndrome.  This area is covered by smooth cartilage that normally allows the femur to glide easily when the knee is bent. However in runners, the constant friction causes the cartilage to get irritated which leads to thinning and softening, hence the moniker chondro (cartilage) and malacia (softening). Also, if one’s gait is out of alignment, the patella will not track properly and will also irritate the cartilage. A tight IT Band also relates to this condition as do the Lateral and medial quad muscles. Knees will crackle audibly with pain often felt in the front of the knee and on the condyles of the femur slightly above the knee.

If you wear all your cartilage away, surgery is the only route you will be covering.

Outside of physiotherapy, anti-inflammatory medications and icing one’s painful parts, taking the time to properly heal tissues, which should include massage to break up adhesions (i.e. knots or stuck points in tissues), clear toxins, build up the blood supply and elongate taut fibers will extend one’s running “career.” Let’s face it. If you are going to call yourself a runner and wear your battle wounds proudly, you should also invest in the care necessary to make your mileage count!!