The Evolving Science of Hydration

On a hot and humid summer day of 1904, thirty-two runners started a 24.85-mile course in St. Louis where water was provided at just two stations. The current thinking was that drinking during exercise was unnecessary. In fact, to compete without nourishment was a worthy achievement.

The high metabolic heat produced during exercise causes our core temperature to rise to dangerous levels (normal core or internal temperature is 98-100 degrees). The body’s counter measure is to increase the heart rate so that blood flow is maintained to the exercising muscles and the skin to allow for the dissipation of heat through sweating. When sweating becomes the primary means of heat dissipation, however, sweat loss must be matched by fluid consumption to avoid dehydration.

By 1923, the topic of exercise physiology was advanced by studies that emphasized the risks of dehydration during exercise. This research was the primary impetus for the “cardiovascular” model of physiology and thermoregulation, which predicts that there is a point at which increases in heart rate can no longer compensate, leading to reduced blood flow to the skin, an increase of core temperature, risk of heat stroke, or myocardial infarction (heart attack).

For decades, substantial research into hydration and performance supported the position that exercise performance is impaired when a level of dehydration due to sweating reaches about 2% body mass loss. The 1996 position stand of the American College of Sports Medicine (ACSM) stated, “Even a small amount of dehydration (1% body weight) can increase cardiovascular strain as indicated by a disproportionate elevation of heart rate during exercise, and limit the ability of the body to transfer heat from contracting muscles to the skin surface where heat can be dissipated to the environment.”

But these recommendations famously ignored evidence that some of the fastest marathon runners had incurred a water deficit exceeding 4%. Using data from a review of these marathon runners, when the relationship between running speed and percentage dehydration was plotted, the best-performing runner was dehydrated by some 8%, while the only runner to prevent body mass loss of >2% was the slowest (Fig. 1). The data suggests the effect of dehydration in excess of 2% did not impair performance significantly.

Figure 1: American College of Sports Medicine

By 2007 ACSM’s revised consensus statement regarding fluid consumption during exercise reflected the new thinking that preventing all dehydration may be unnecessary, and that there may exist a level of “tolerable dehydration“.

It’s important that athletes maintain adequate hydration levels before and after training as well. Any fluid that doesn’t contain alcohol can hydrate. Food counts too!

New research has suggested that it is whole-body hyperthermia (defined as core body temperature exceeding 40°C; 104°F) that impairs performance rather than dehydration levels per se. In one study (Trangmar SJ, Chiesa ST, Kalsi KK, et al.), participants were placed under sufficient heat stress to either raise skin temperature or to raise skin temperature and core temperature. The participants with elevated skin temperature did not experience impaired exercise performance, whereas participants with an increase in whole body temperature did. This suggests a high sweat rate prevents a rise in core temperature (hyperthermia) even though it also results in a water deficit (dehydration). The higher sweat rate allowed the faster athletes to run faster than the slower runners because they were able to dissipate more core heat through sweating. We began to see that the best hydration strategy could only be determined by the athlete’s individual requirements rather than a one-size-fits-all recommendation.

The latest position (2016) of the ACSM: ”Dehydration/hypohydration can increase the perception of effort and impair exercise performance; thus, appropriate fluid intake before, during, and after exercise is important for health and optimal performance. The goal of drinking during exercise is to address sweat losses which occur to assist thermoregulation. Individualized fluid plans should be developed to use the opportunities to drink during a workout or competitive event to replace as much of the sweat loss as is practical; neither drinking in excess of sweat rate nor allowing dehydration to reach problematic levels.”

Hydration theories have taken many turns. For example, we now know that a mixture of glucose, maltodextrin, fructose, sucrose and galactose – in other words, carbohydrates (also written as CHO), improves endurance performance by maintaining blood glucose and muscle glycogen stores, resulting in a levelling-off in core temperature. And so it was, with a mixture of sugar, salts and lemonade, the first sports drink was born.

Lucozade – basically citrus flavored sugar water – launched in 1927 and was the earliest traceable ancestor of the sport drink. Owned by the Beecham Company, they merged with SmithKline many years later. Gatorade launched its first product in 1967.
Photo Courtesy: Precision Hydration where you can get more info on sports drinks and take a free online sweat test.

The problem with these early sports drinks and gels is that our stomachs don’t always do well with high concentrations of sugar. Frequent GI distress prevailed over the next few decades of running.

A more recent innovation for providing fluid and CHO during exercise is the use of alginate. Alginate is a naturally occurring anionic polymer typically derived from seaweed and commonly used in oral drug delivery, wound healing, and tissue engineering.

Maurten is one such company delivering gels that are a combination of Alginate (extracted from the cell walls of brown algae) and Pectin (found in apples, lemons, carrots, tomatoes, etc.). When mixed with water, the resulting ‘sports drink’ converts to hydrogel in the acidity of the stomach, encapsulating the carbohydrates. Athletes that experience gastric (GI) distress from sugary sports drinks will appreciate that there were no reports of GI distress with any drink including the alginate hydrogel. And because it is engineered to encapsulate the carbs with the process beginning only when contact is made in the stomach, it is also better in terms of dental health.

Dental health is an important issue with CHO-based sports drinks. A survey at the London 2012 Olympic Games found that 18% of athletes reported that their oral health had a negative impact on their performance and 46.5% had not been to a dentist in the past year. (The latest ACSM position statement also addresses oral health in the wider culture of sports health care and health promotion.)

The next evolution in hydration began in 2014 when the Brazilian National Football Team asked Gatorade to help them prepare for the World Cup. The team didn’t end up winning the World Cup, but the pilot opened new doors for collaboration and innovation at Gatorade.

Smart Design worked with the Gatorade Sports Science Institute (GSSI) to research heat stress and dehydration during exercise. A systemized approach was developed to test and analyze how each athlete sweats—how fast, how much and in what concentration. The resulting product was a hydration platform – a bottle with a “smart cap” that’s built on the hypothesis that personalization is the next frontier of improving athletic performance.

The new Gatorade squeeze bottle utilizes Drinkfinity beverage pods, allowing quick delivery of sport-specific or individualized player formulas. Courtesy: PepsiCo
Courtesy Gatorade

Today’s consensus is that drinking to thirst is the body’s best hydration strategy, and in most cases will protect athletes from the hazards of over and under drinking by providing real-time feedback. It’s important to research and practice various hydration approaches during training runs to understand your specific needs, and to develop a personal strategy. Some athletes are less aware of their hydration requirements and may benefit from technology, such as a fluid calculator. But the quantity, amount, or combinations of food and/or fluid consumed while exercising should always be guided by your individual palatability and tolerance.

There is still a widespread misconception that you should ‘stay ahead’ of your thirst. Drink early and often was the advice we were given years ago; advice too many runners still follow.

Slower runners generally sweat less, but have been told to drink copiously. If you ingest more fluid than you lose through sweating or urination, however, you dilute your blood’s sodium levels – a condition called hyponatremia, or water intoxication, caused by drinking too much. Osmosis then draws water from the blood into body cells to equalize sodium levels, and those cells swell. If the cellular bloating occurs in the brain, it can be fatal.

The latest position statement from the International Marathon Medical Directors Association (2006) included a Final Word:

“There are no shortcuts toward great achievement, and marathon running is no exception. Clinicians and scientists must resist handing out unrealistic ‘‘blanket advice’’ to individuals seeking simple answers, but rather should encourage athletes to explore, understand and be flexible toward their own needs. By providing guidelines and advice on how to appropriately understand individual fluid replacement needs, we can eliminate future fluid balance problems by avoiding the temptation to generalize one rule for every situation and every athlete.”

My husband believes this more individualized protocol of hydration will serve to open up the sport to runners that may have otherwise found it too uncomfortable or difficult to participate. That in some way, having technology that explains how to hydrate will win them over to the sport. Maybe it’s even a marketing ploy on behalf of the corporations involved. I’m not sure I disagree.

To a seasoned runner, technological advancements may seem unnecessary. To a new runner, they may provide much needed guidance in a world of overwhelming challenges. It may or may not make you a better runner. Some would say technology is most useful at the far ends of the spectrum – in this case, for new runners and elite runners.

Many years ago I wore a special shoe with a piece of plastic in the bottom that could tell me how far I’d gone and at what pace. Some of you may have worn those same shoes. I suppose it helped me learn to pace myself better, but mostly it was new and fun.

When I ran in Kenya, a group of runners were heading out on a 40k training run. Knowing water was not easy to come by, I asked the runner I was with how often they would drink. He smiled and told me, “When they’re finished.” I used to never drink on a training run of any length. But there also came a time that I hid extra water bottles on my route and ate a peanut butter sandwich along the way. My main hydration strategy for race day was to try to avoid having to stop at the port-a-potty.

These new guidelines, and even more recent studies, emphasize that we are all unique and our hydration strategies will be equally unique. This left my husband feeling empty. He wanted something more absolute. I told him that now there’s an app for that.

 

Additional Reading:

The Best Hydration Plan Is to Drink When You’re Thirsty, Sweat Science at OutsideOnline.com 

Don’t Ring The Bell

This was the week that we learned Washington Wizards’ point guard and five-time All-Star John Wall will have season-ending surgery to address bone spurs in his left heel. Wall had secretly suffered through several seasons in pain before consulting with a specialist who recommended surgery. I’ve been following Wall’s condition closely since a bony heel protrusion showed up on my own right foot this past summer.

It’s called Haglund’s deformity. Mine and John Wall’s. A bony englargement on the back of the heel, or essentially a bone spur on the heel. I will only say that if you’ve got one, you’ll feel it every day forever. The last thing the doctor told me was that it would never go away. Given John Wall’s level of play, his doctor warned that the stress from the spur could eventually rupture the Achilles’ tendon. Thus the surgery, and six to eight months’ recovery.

In retrospect, I can see that I floundered a bit during the second half of 2018. Previous injuries could always be resolved with rest. Give it enough time, and whatever ailed me would get better. This time the injury turned out to be permanent, and it changed everything in life as I knew it.

Running has defined nearly half my life. Years before I even acknowledged myself to be a runner, I ran five miles every day. I didn’t take rest days because I didn’t realize you needed rest days. Memories of every place I’ve lived revolve around the running routes associated with that city. Life revolved around running, and I’ve loved every minute.

Once your mind and body have adapted to not working out, however, it’s pretty easy to convince yourself to give up on your previous level of exercise altogether. It has taken me awhile to come up with a plan.

The most common thread among athletes of all rank is injury, but it’s a short list of athletes that make a come-back from catastrophic injury. Peyton Manning had multiple neck surgeries, Serena Williams had pregnancy complications, Kobe Bryant’s shredded knees, and Ben Hogan’s serious car accident. Then there’s Tiger.

A list of Woods’ surgeries prior to his second microdiscectomy operation in Sept. 2015. 
photo courtesy: abcnews.

It’s easy to quit. It takes courage – and a plan – to stay in the game. And if you’re not moving forward, you’re losing ground.

How you plan forward momentum is dictated by your present condition, but your present condition should never prevent you from moving forward.

My husband and I have researched my injury from every direction. I’ve tried every homeopathic solution ever mentioned – he discovered a new one just yesterday that’s already on order. He also bought me a pair of minimalist shoes with the thought that they would help strengthen the muscles and tendons of my foot and ankle over time. So far so good.

I stopped running (again) in November in favor of walking. Since then I’ve focused on a strengthening routine and increased my walks to an hour, six days a week – roughly 4 miles each. By February, I hope to incorporate a few days of running, and plan my next steps from there. Surgery may still be in my future, but we’ll try every other avenue first. It’s a process.

I’m reminded of my first lessons in Kung Fu and Wing Chun. The translation of Kung Fu is time and effort. There are no short cuts. The foundation of Wing Chun is to always move forward and aim for the center.

Naval Admiral William H. McRaven, ninth commander of U.S. Special Operations Command, gave an amazing and powerful 20-minute commencement speech at the University-wide Commencement of The University of Texas at Austin in 2014. The speech was about the lessons McRaven had learned from Navy Seal training, “To me basic SEAL training was a life time of challenges crammed into six months.” A few of the key points from his speech seem to provide a nice conclusion to my thoughts. (Read the full transcript here.)

Don’t Be Afraid of the Circus. Every day during training you were challenged with multiple physical events—long runs, long swims, obstacle courses, hours of calisthenics—something designed to test your mettle. Every event had standards—times you had to meet. If you failed to meet those standards your name was posted on a list and at the end of the day those on the list were invited to—a “circus”. A circus was two hours of additional calisthenics—designed to wear you down, to break your spirit, to force you to quit. No one wanted a circus.

But an interesting thing happened to those who were constantly on the list.  Over time those students-—who did two hours of extra calisthenics—got stronger and stronger. The pain of the circuses built inner strength-built physical resiliency. Life is filled with circuses.

Get Over Being A Sugar Cookie And Keep Moving Forward. Several times a week, the instructors would line up the class and do a uniform inspection.  It was exceptionally thorough. Your hat had to be perfectly starched, your uniform immaculately pressed and your belt buckle shiny and void of any smudges. But it seemed that no matter how much effort you put into starching your hat, or pressing your uniform or polishing your belt buckle—- it just wasn’t good enough. The instructors would find “something” wrong. For failing the uniform inspection, the student had to run, fully clothed into the surf and then, wet from head to toe, roll around on the beach until every part of your body was covered with sand. The effect was known as a “sugar cookie.” You stayed in that uniform the rest of the day—cold, wet and sandy.

There were many a student who just couldn’t accept the fact that all their effort was in vain.  That no matter how hard they tried to get the uniform right—it was unappreciated. Those students didn’t make it through training. Those students didn’t understand the purpose of the drill.  You were never going to succeed.  You were never going to have a perfect uniform. Sometimes no matter how well you prepare or how well you perform you still end up as a sugar cookie. It’s just the way life is sometimes.

If You Want To Change The World Don’t Ever, Ever Ring The Bell. Finally, in SEAL training there is a bell.  A brass bell that hangs in the center of the compound for all the students to see. All you have to do to quit—is ring the bell.  Ring the bell and you no longer have to wake up at 5 o’clock.  Ring the bell and you no longer have to do the freezing cold swims. Ring the bell and you no longer have to do the runs, the obstacle course, the PT—and you no longer have to endure the hardships of training. Just ring the bell. If you want to change the world don’t ever, ever ring the bell.

The 2019 Plan

Another remodeling project is taking shape. It’s like being in the early days of training for a marathon; you choose a training plan, and begin to work your way through the program that will culminate in a magical place – although finding yourself at the finish line seems so far away that it’s impossible to believe it will ever happen at all.

Most of the remodeling of our little cottage was completed in 2018. The kitchen finally escaped the 1970s, the master bath stole enough square footage from the center hall for a shower and two sink cabinets, and we converted the 2nd bedroom into a proper walk-in closet.

The next projects on our list include the addition of a 300 square foot conservatory (with all its required excavation), remodeling the hall bath, updating kitchen appliances, adding an attached carport and a she-shed for yours truly.

If you’ve tuned into The Fartlek for these occasional design and renovating stories, this could be a plentiful year. And if you’re a runner, please don’t despair. The year will be more about running than it may currently appear!

Conservatory

The 19th century was the golden age of conservatory building, primarily in England. In a residence, a conservatory would typically be attached to the house on only one side, and by definition must have more than 50% of its wall surface glazed. Our new room does not technically meet the ‘conservatory’ standard, but it’s the aesthetic we’re going for.

The conservatory will connect to the rear of the cottage through an existing closet. A vaulted ceiling, 6’ windows, a wall of bookshelves and two closets make it the most functional 300 square feet we’ve ever added to a home (a third new closet is accessible from the master bath). It will lack the feel of a full conservatory because of the wall of bookshelves, however, that side of the room only looks onto the neighbor’s house. Bookshelves are more practical. French doors at the back of the room lead to the she-shed and a view of the back garden.

Carport

originating from the French term “porte-cochère“, referring to a covered portal, renowned architect Frank Lloyd Wright coined the term when he used a carport in the first of his “Usonian” home designs: the house of Herbert Jacobs, built in MadisonWisconsin, in 1936 (Wikipedia).

The driveway encroaches the property’s setback restrictions on our left side, which precludes the construction of a garage. A carport complements the little cottage perfectly anyway.

Excavation

In the early 1900s, Lake Junaluska’s Epworth Lodge was built where our house now resides. I admit that I’m secretly hoping a buried treasure or rare artifact from our property’s historic past will be unearthed during excavation.

Another dozen trees were removed a few weeks ago and the excavator is scheduled for the first of the year. The plan is to tear out the tree stumps and dig out the hill to render the whole area level (i.e., flat/perfect/divine). 

A french drain will probably be required near the conservatory, but the excavator has promised to fill in with gravel throughout the yard to prevent any issues in the meantime. . . my husband was completely unsympathetic to the plight of my future garden being full of gravel.

A bucket truck was used to cut sections off the tops of the trees until they reached a manageable height, although sometimes the guys just climbed the tree to reach the top (notice the man in a yellow shirt barely visible at the top of the tree to the right).
What the back yard looks like at the moment (a.k.a. a mess).

She-Shed

We’ve decided on a combination greenhouse/shed that provides enough space for my bicycle(s) and a Kung Fu wooden dummy. We prepare the foundation and the prefabricated structure comes ready to assemble, supposedly in just two days – given the right amount of help I assume.

I have big plans for this little building.

The Kitchen

As fate would have it, Paul has helped us install tile every November for the past three years in whatever house we were remodeling at the time. This November he installed a marble backsplash in the cottage kitchen. We’re choosing black appliances to finish things off.

Space is limited so we decided to use dishwasher drawers to avoid a door that drops down into the room. The Fisher Paykel version is about the only one on the market, except they don’t come with a certified installer in our area. We’re waiting on an installer to drop by from Asheville after the holidays. Once we see the true ‘black’ of the dishwasher finish, we’ll choose the most exotic matching stove and refrigerator.

We’ve decided on the Hallman stove in either glossy or matte black to go with the Fisher Paykel double-drawer dishwasher. My new favorite refrigerator is a Gaggenau unit with antique finishes added by Italian firm, Restart Srl. . .  although at a starting price of $10,000 USD, maybe we’ll keep shopping. 🙂

A Tumultuous Downsizing Project

By late October our life had taken a nose-dive toward the uninhabitable center of the earth. We decided to put our house on the market for only the month of October to let fate determine whether we’d finally downsize to our little cottage. Fate decided. We downsized.

For three weeks in November we were betwixt and between two houses; not fully settled into one, not fully moved out of the other. Some people find the whole process invigorating (me) while others find it quite miserable (my husband).

It’s difficult to describe the amount of purging required to fit ourselves into 975 square feet of space. To make matters worse, those 975 square feet had already been furnished for the vacation rental market so there were two houses to clear out instead of just one. We dealt with the furniture first.

My sister was fortunately in the position to take several entire rooms – accessories, art and furniture. Julie, our friend and dearest of all realtors, took another significant portion of furniture and a variety of other things for the very extraordinary vacation rental properties she’s renovating. The two of them saved the day. We kept four rooms of furniture and sent the rest to consignment stores all across town. Then for the next two weeks we dealt with stuff.

For almost everyone I know (except maybe our friends the Markham’s), we accumulate stuff we don’t need. We had buckets of old photos, candles of every color and size, four hammers, three ladders, too many bottles of glue. I had several dozen pairs of shoes, purses I didn’t use, and a matching robe for every pair of pajamas.

Our gym upstairs housed three different types of stationary bikes, a treadmill and a full set of free weights. There were towels in every bathroom, multiple sets of linens for every bedroom, 25-year old Christmas ornaments, a music box my parents gave me 50 years ago, and every medal, racing bib and trophy from the past 11 years of road racing.

There was no chance I would throw everything down to the curb for it to end up in a landfill, so I sorted everything and tried to find the appropriate home for all of it. More than likely I’ve touched everything I own a half-dozen times each.

Eventually the purge ended, and we left our house with barely a whispered goodbye. We were exhausted.

The first week that we lived in the cottage our neighbor across the street walked out of his house and had a massive heart attack right there in the middle of the road. Another neighbor and I reached him about the same time while my husband dialed 911. The neighbor and I performed CPR until the paramedics arrived, and then they worked on him for some time before he was pronounced dead at the scene. It was upsetting for the neighborhood as a whole. I had trouble sleeping for several weeks.

Sunday before last was a beautiful warm day. I spent the afternoon working in the yard and decorating the cottage for Christmas. The man’s widow was out walking their two dogs so I worked my way across the street to offer condolences. The dogs were on especially long leashes and reached me first. Still wearing my gardening gloves, I reached out to let them smell my hands and instinctively bent over to say hello. One of the dogs jumped up and bit right through my nose. A trip to the E.R., a visit to a plastic surgeon, and eleven stitches later I was glad to still have something that resembled a nose on my face. Three days later my son arrived from Texas with his new wife and their two dogs.

We had planned their trip months before we sold the house that had extra bedrooms and plenty of bathrooms, so we booked them into an Airbnb down the street and kept their two dogs at the cottage – along with our three. It was a full house: five dogs, four people, and also love and fun all around. Their trip ended with a freak snow storm that hit Western North Carolina over the weekend leaving us with oodles of snow and only a generator for power.

Ours has been a tumultuous transition, but we do enjoy life at our little cottage – and for the first time since October, there’s nothing to pack, move or get rid of, nothing on our schedule, and enough time in every day for a run. Life is good.

The Anatomy of a Runner: flow (the runner’s high)

A burglar is likely to experience flow, as is a con artist or an assassin. Flow is considered in the development of video games, sport psychology, computer programming, the design of playgrounds, the formation of business leaders, stand-up comedy, and in the high development training activities of Outdoor Leaders. Athletes, artists, musicians and Formula One drivers also experience flow.

Every activity in life may engender flow, but no activity can sustain it for long unless both the challenges and the skills become more complex.

flow: a level of involvement such that consciousness at hand and the doing of it blend; where action and awareness become indistinguishable.

In positive psychology, Flow, also known as Zone, is the mental state of operation in which a person performing an activity is fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of the activity…. complete absorption in what is doing.

Some runners report achieving flow, or in this case ‘the runner’s high,’ during a race or a tempo run – a run slightly below 10k race pace that is sufficiently taxing on the system but not an all-out effort.

Somewhere in this ideal zone runners lose themselves and reach a state where mind and body become one – the consciousness of running and the doing of it become indistinguishable.

According to Mihály Csikszentmihalyi (pronounced “CHICK-sent-me-high-ee”) who gave it the name, flow is completely focused motivation; a deep focus on nothing but the activity – not even oneself or one’s emotions. ”The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you’re using your skills to the utmost.”

Csikszentmihalyi and his fellow researchers began researching flow after Csikszentmihalyi became fascinated by artists who would essentially get lost in their work. Artists, especially painters, become so immersed in their work that they disregard their need for food, water and even sleep.

He realized that it was the activity itself – the work of painting – that so enthralled his subjects and not, as he had expected, the anticipation of its outcome or extrinsic rewards. In Csikszentmihalyi’s initial 1975 studies, people described their experiences using the metaphor of a water current carrying them along – and thus his source for the name flow.

Research has shown that performers in a flow state have a heightened quality of performance. In a study performed with professional classical pianists, heart rate and blood pressure decreased and the major facial muscles relaxed while the pianists were in the flow state. This study emphasized that flow is a state of effortless attention. In spite of this effortlessness and overall relaxation of the body, the performance of the pianist improved during the flow state.

Drummers experience a state of flow when they sense a collective energy that drives the beat, something they refer to as getting into the groove or entrainment. Bass guitarists often describe a state of flow as being in the pocket. Surfers call it the surfer’s high.

Historical sources hint that Michelangelo may have painted the ceiling of the Vatican’s Sistine Chapel while in a flow state. Winning coach Jimmy Johnson credited flow with helping him and his Dallas Cowboys prepare for the 1993 Superbowl.

Each of these flow-producing activities requires an initial investment of attention and skills development before it can be enjoyable. If a person lacks the discipline to overcome this initial obstacle, he or she may find the state of flow impossible to achieve.

SOME CAN FLOW MORE THAN OTHERS….

Csíkszentmihályi hypothesized that people with specific personality traits may be able to achieve flow more often than the average person. These personality traits include curiosity, persistence, low self-centeredness, and a high rate of performing activities for intrinsic reasons only; known as an autotelic personality.

People with autotelic tendencies are internally driven and may also exhibit a sense of purpose and humility – this determination being different from an externally driven personality where things such as comfort, money, power, or fame are the motivating force. Autotelic personalities also learn to enjoy situations that other people consider miserable.

One researcher (Abuhamdeh, 2000) found that people with an autotelic personality have a greater preference for “high-action-opportunity, high-skills situations that stimulate them and encourage growth.” It is in such high-challenge, high-skills situations that people are most likely to enter the flow state.

THE PSYCHOLOGY. Almost any activity can produce flow, provided you find the challenge in what you are doing and then focus on doing it as best you can. Flow is not dependent on external events, but is the result of our ability to focus.

In every given moment, there is a great deal of information made available to our brain. Psychologists have found that one’s mind can attend to only a certain amount of information at a time – about 126 bits of information per second (Csikszentmihalyi’s 1956 study). Decoding speech, for example, takes about 40 bits of information per second; about 1/3 of our total capacity.

For the most part (except for innate basic bodily feelings like hunger and pain), we decide what we want to focus our attention on. When we are in the flow state, however, we are completely engrossed with the task at hand – without making the conscious decision to do so.

Awareness of all other things: time, people, distractions, and even basic bodily needs is non-existent. This occurs because our total attention is on the task at hand; there is no more attention to be allocated.

THE SCIENCE. The internet lit up in 2015 when German researchers discovered the brain’s endocannabinoid system — the same one affected by marijuana’s Δ9-tetrahydrocannabinol (THC) — may also play a role in producing the runner’s high, (Proc. Natl. Acad. Sci. USA 2015, DOI: 10.1072/pnas.1514996112).

For decades, it was hypothesized that exercise-induced endorphin release was solely responsible for a runner’s high. These researchers observed, however, that endorphins can’t pass through the blood-brain barrier. On the other hand, a lipid-soluble endocannabinoid called anandamide—also found at high levels in people’s blood after running—can travel from the blood into the brain, where it can trigger a high. Scientists agree more studies are needed since these conclusions were based on mice not humans, but it brings us a step closer to understanding the science behind the high.

HOW TO GET THERE. To achieve and maintain a flow experience, a balance is reached between the challenge of the activity and the runner’s ability.

If the challenge is greater than the ability, the activity becomes overwhelming and creates anxiety. Anxiety also occurs when the challenge exceeds our perceived skill level.

If the challenge is lower than ability, boredom ensues.

Apathy is characterized when the challenge is low, and one’s skill level is low – producing a general lack of interest.

A state of flow occurs when the challenge matches skill.

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A 1997 study by Csíkszentmihályi also determined that flow is more likely to occur when the activity at hand is a higher-than-average challenge and the individual has above-average skills.

Defined within the parameters of a runner’s high, one could then assume flow would not be achieved when:

  • pace is too slow and effortless as compared to the runner’s skill level (boredom);
  • the runner has no interest in running (apathy);
  • pace or terrain, level of difficulty is too challenging (anxiety).

FLOW CONDITIONS:

  • Knowing what to do
  • Knowing how to do it
  • Knowing how well you are doing (immediate feedback)
  • High perceived challenges
  • High perceived skills
  • Freedom from distractions

It’s important to repeat that the key to achieving flow is in one’s ability to focus.

A violinist will focus all their energy on feeling the strings or the bow with the fingers, following the notes on the score, and at the same time feel the emotional content of the music as a whole. Irrelevant thoughts, worries, or distractions no longer have a chance to appear in consciousness. There is no room. They are totally immersed and focused on the task at hand.

Similarly runners will feel a focus on running: the fluidity of the stride and the rhythm of breathing, the immediate feedback of feeling confident and comfortable in the effort – an exhilaration from performing a challenging task.

Some runners experience flow early in a run, near a 10k pace, or several hours into a long run, depending on their experience and skill level.

If there is a way to induce flow, it is by training the mind to focus. Techniques of meditation or yoga traditions train the ability to concentrate attention and limit awareness to specific goals and may be helpful in creating the conditions for flow.

THE GROWTH PRINCIPLE. Flow experiences imply a growth principle. When in a flow state, we are working to master the activity at hand. To maintain and achieve a subsequent flow state, however, we must eventually seek increasingly greater challenges. Attempting these new, difficult challenges stretches our skills and we emerge stronger, more competent, and with a greater sense of personal satisfaction.

Mihaly Csikszentmihalyi wrote a book on the subject, “Good Business: Leadership, Flow, and the Making of Meaning,” where he argues that with increased experiences of flow, people experience growth towards complexity, in which people flourish as their achievements grow.

In the long run, flow experiences in a specific activity may lead to higher performance in that activity as flow is positively correlated with a higher motivation to perform and to perform well.

Testing Trauma Naked and the Medical Touch

A little known fact of my life is that I am (still) a National Registry and Wilderness EMT. It was one of those things that seemed interesting to do at the time, four years ago, and I never gave much thought as to how or if it might become a permanent part of life.

Six months prior I had gone back to school. I spent months backpacking through the mountains, climbing the 50-ft Alpine Tower, and navigating high/low ropes courses, which, to my surprise, included jumping off the top of a 45-foot telephone pole.

Another semester was devoted to paddling rafts, kayaks and canoes in the cold, fast waters of the Nantahala. One of our early assignments was to capsize our kayaks and see how long we could force ourselves to hang upside down under water. Just before my instructor flipped my kayak, he told me the secret was to not let my mind convince me to tap out – not to panic. We could survive much longer, he warned, than our mind would lead us to believe. The point of every class was to push ourselves to our personal physical or emotional limit.

When my late teenage/early twenty-something classmates ventured out to find summer jobs that year, I wandered into my instructor’s office to decide what I would be when I grew up. I had taken the 9-day Wilderness First Responder class during spring break, so he suggested I might take the 3-week EMT class during summer break.

I’m not nearly so comfortable in a classroom. If it had been more common in the 60s and 70s, I’m pretty sure I would have been diagnosed ADHD. My mind wanders, and short-term memory is not my best attribute. I passed the class, and discovered I loved emergency medicine. Not doing, mind you, but the learning of it.

There’s a process to follow in quickly identifying life-threatening issues and stabilizing a person for transport. When testing this process, we divide the topics into three areas.

There’s a pediatric test where the students must realize that little Bobby is having an allergic reaction, safely administer an EPI pen, and the appropriate oxygen treatment. The medical test involves a patient that is having chest pain, who inevitably has a heart attack right in front of your eyes causing you to administer CPR. The third test is trauma related where students must assess a patient involved in a major and near fatal incident. There’s major bleeding to remedy, severe head trauma to diagnose and mitigate, and a requirement to immediately transport the patient correctly attached to a backboard.

I’ve been a proctor for these tests for about three years. The students come in one by one racked with nerves. I remember the feeling well. They’re overly conscious of the time limit of each test, and it cripples some of them. We keep the rooms cool. They sweat profusely. We’re not allowed to show an ounce of emotion. Their eyes beg us to encourage them, or reassure. One student out of every class will come right out and ask if they’ve passed the test. We still don’t answer, although I admit that sometimes I look deep into their eyes and attempt to pass along a smile. Some of them notice I think.

We use life-size dummies with fake blood and sort of real-to-life looking props in class and for the tests. Sometimes we use real people as patients. Students are encouraged to show respect as we ‘dress down’ the patients, searching their body for signs and symptoms. My instructors called it learning to perfect trauma naked and the medical touch. In other words, don’t be creepy.

Sometimes I think of these things I’ve learned.

Show respect if you find it necessary to ‘dress down’ another person; don’t be creepy; find a way to pass along a smile; and, if you capsize, remember that you can survive much longer than your mind would lead you to believe.

The Pump Bump and Achilles Tendinitis

She was the goddess of water in Greek mythology. Both Zeus and Poseidon loved her and did their best to win her hand in marriage until Prometheus warned them of a prophecy that her son would become greater than his father. She married a mortal king instead, and dropped their son into the river Styx to make him immortal – holding him by the heel of his foot.

I had exercised patience regarding the time required to recover from a dislodged peroneal tendon, but when the swelling subsided and I could no longer move the tendon around with my finger there was still a hard bump on the back of my heel. Even relatively easy exercise made it sore. It was time to visit the doctor.

My husband and I sat quietly while the doctor examined my heel. As he left to order the x-ray he mumbled something about a pump-bump. My husband immediately took to his phone and by the time the good doctor returned we had discovered everything there was to know about Haglund’s Heel.

Dr. Haglund was a friend of Dr. Roentgen, the inventor of the x-ray. Haglund began researching the boney anatomy of humans for his dear friend, and came up with a fairly common deviation of the heel bone, which became known as Haglund’s Heel (also Hagulund’s Syndrome or Deformity).

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This deviation is associated with decreased range of motion of the ankle and increasing age, typically hitting women in their 40s, 50s, and 60s after years of wearing high heel shoes. Jumping, running and navigating stairs can exacerbate the condition making inflammation and heel pain worse. It develops gradually, but we usually take notice when the tendon becomes inflamed. In many cases, especially with runners, Haglund’s Heel evolves into Achilles tendinitis.

Insertional Achilles Tendinitis is a common overuse injury among athletes causing stiffness in the heel especially in the morning, pain along the tendon that increases with activity and possibly swelling. A bone spur gradually develops around the tendon that can cause irritation (bone tends to generate new bone in an attempt to heal itself), and eventually the tendon may calcify and harden.

7A184A2D-7D55-4E29-9737-E6D2D4A2A7B6Note: Insertional Achilles tendinitis affects the back of the heel where the Achilles tendon inserts into the heel bone. Non-insertional Achilles Tendinitis causes pain in the lower calf, where the Achilles tendon and calf muscle meet.

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Male and female athletes alike can develop insertional Achilles tendinitis with or without the underlying Haglund’s Heel, but in many cases Haglund’s Heel will trigger or evolve into insertional Achilles tendinitis.

Why it hurts: When a healthy tendon experiences an increased load, it responds by increasing its stiffness to handle the greater demand as it also increases the production of collagen cells. Researchers propose that this non-inflammatory cell response is an attempt by the tendon to increase the cross-sectional area to better handle the load. This short-term adaptation is reversible if the load is diminished or the tendon has a chance to rest before the next stress is applied. Over time a healthy tendon adapts to the stress by growing larger and stronger. An overused or diseased tendon does not recover from the stress and the injury progressively worsens.

The Progression:

Tendinitis is inflammation of the tendon (the suffix “itis” indicates inflammation), in this case of the Achilles. The condition lasts about six weeks although most practitioners view tendinitis as the first in a continuum of tendon injuries that subsequently increase in severity (you’ll also see it spelled tendonitis). If you feel pain in your heel, this is the time to take action.

Tendinosis is a non-inflammatory degeneration of a tendon that can include changes to its structure or composition. These changes often result from repetitive micro-traumas or failure of the tissue to heal and will likely require several months of treatment.

The suffix “pathy” is derived from Greek and indicates a disease or disorder. Tendinopathy is the term also applied to a chronic condition that fails to heal. For example, a runner who has suffered a hamstring tendon rupture that does not heal properly may be diagnosed with tendinopathy.

Insertional Achilles Tendinopathy is inflammation, and later, degeneration of the tendon fibers that insert on the back of the heel bone. Since the Achilles tendon connects the calf’s gastrocnemius and soleus muscles to the calcaneus, or heel bone, by the time you’ve reached the Achilles tendinopathy stage you will likely also notice reduced strength in the calf muscles.

Treatment: The Achilles’ tendon is exposed to greater amounts of strain in the dorsiflexed or upward position where the forward section of the tendon is exposed to low loads. Researchers suggest the lack of stress on this forward aspect of the tendon may cause that section to weaken and eventually fail. The treatment goal of insertional Achilles tendinitis is to strengthen the forward-most aspect of the tendon, which is accomplished through a series of eccentric exercises.

The Alfredson Protocol: The story goes that Hakan Alfredson, an orthopedic surgeon and professor of sports medicine in Sweden, developed Achilles tendon problems in the mid-1990s. When his boss refused his request for surgery because the injury was not yet advanced enough, Dr. Alfredson attempted to deliberately aggravate the injury with a series of exercises. Instead of getting worse, however, his injury disappeared.

These exercises, now known as the “Alfredson protocol” are considered the most effective first line of treatment for Achilles tendinopathy. The eccentric movements are designed to physically stimulate the cells in the tendon as they move relative to each other, causing the cells to initiate a tissue repair process.

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Stand on your toes at the edge of a step (holding onto something for balance). Slowly lower the injured foot until the heel drops below the edge of the step. Return to the starting position (on your toes) by using the non-injured foot. The injured foot should never be used to raise onto your toes.

Perform 2 sets of 20 reps with the knee straight, which strengthens the gastrocnemius muscle, and another 2 sets of 20 with the knee bent to strengthen the soleus muscle. Repeat the exercises twice daily for 12 weeks. If the effort become too easy, add weight to increase the load.

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(The original protocol called for 3 sets of 15 reps with the knee straight and another 3 sets with the knee bent for a total of 180 reps daily.)

Note: as with everything science, there is a corresponding study that found no difference when performing the heel drop using a straight knee only, and performing the exercise from both the straight and bent knee position.

Compression tack and flossing along with lacrosse ball massage to treat chronic Achilles tendinopathy

Another study published last year involves a 3-prong approach combining the eccentric exercises mentioned above with compression band therapy, or CBT, and Lacrosse Ball Management (basically massaging the tendon using a lacrosse ball).

LBM: Once daily apply firm but comfortable pressure with the lacrosse ball while rotating the ball over the tendon.

The CBT process: Firmly wrap a floss tape around the Achilles tendon as well as the gastrocnemius and soleus muscles starting at the heel (using a 75-90% stretch) and finishing just below the knee. (In the referenced study, a black Theraband© was used.) Perform a ‘flossing motion by slightly shifting weight forward and backwards over the back foot and ankle in a standard soleus stretch position. Perform 3 sets of 10 reps daily.

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I’ve followed the exercise and massage protocol for 4 weeks (although I will admit that I have performed the flossing motion without the band). After not running one step for several months (because it hurt), I ran three times last week with no pain during or after the run. My results have been similar to the results achieved by the test subject at this same interval in the study. At the study’s nine month follow-up, the test subject was exercising up to nine hours each week with no pain. It would be premature for me to claim victory over this injury, but I am cautiously optimistic.

Read more:

Athlete’s Edge: Achilles Tendinopathy