A few years ago my husband gave me a choice of getting a new Jeep, or a facelift. Not the everyday, run-of-the-mill decision. The conversation was prompted by his proprietary spreadsheet, which plots out the timing of our major financial decisions. The spreadsheet had told him it was the prime time to replace the Jeep. Or, alternatively, we could take care of a few wrinkles here and there. I wasn’t at all unhappy with the Jeep.
My husband found it at a dealership in Atlanta, and negotiated the deal by phone during our last few weeks living in Ecuador. When the day came to move back to the U.S., we drove from Cuenca to Quito with our four dogs for a midnight flight to Atlanta. Our first chore after landing the next morning was to pick up my Jeep. I didn’t take it for a test drive. It was perfect, and me and that Jeep have weathered some wonderful years together.
This year seemed like the right time to finally make a change though, and we’ve retired the Jeep for good. My husband cleaned the glove compartment a few days ago, and I thought we might get a kick out of what he found. These contents seem to tell the story of the last 6 years.
Every good EMT is taught to keep a pair of latex gloves on hand in case of an emergency, and there’s a tube of lipstick that may or may not have been used in several years. Same with the sunglasses, which were last used during kayaking class in 2014.
Occasionally I’ve taken private lessons from my Kung Fu Sifu using a favorite weapon, one of which is the knife. And the dog collar was around Bentley’s neck when I brought him home (in the Jeep).
My husband insisted on buying the Mace pepper spray to attach to my waistband on long runs. Dogs are plentiful and run free on the quiet back roads of these mountains, and they scare the living bejesus out of me – I never did wear that Mace on my waistband though.
You never know when you might need a pair of gloves, or what degree of thickness may be warranted. And if it was an especially cold or windy run, I’d tie a bandana around my neck. There’s never too much chapstick, and I’d be really mad with myself if there was a little niggle that I had forgotten to tape. Mad money was a staple, whether a couple of dollars or a twenty-dollar bill.
I have to remind myself not to wave at every Jeep I encounter these days – there is a protocol for that you know. And, by the way, I didn’t get a facelift either. You never know though, that spreadsheet could decide some day that it’s the prime time.
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.
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“.
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 latestposition (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.
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.
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.
It’s been almost a year since we began renovations on this little cottage. After it spent several decades in a 1970’s decor, it has been fairly receptive to our suggestions both inside and out. Two new porches and a metal roof were added earlier this year, but it was this summer that the side yard got a total make-over, including a koi pond, stone steps, a raised flower bed, and lots of plants.
September 25, 2017: the side yard day one.
May 1, 2018
We covered a hundred years of roots (and ivy) with mulch instead of grass. I have never planted so many plants straight up in mulch rather than dirt.
July 20, 2018
There was an awkward slope up from the front of the house, and I thought it would be helpful to have a couple of steps.
September 10, 2018
A koi pond fit perfectly in the corner, and we added five goldfish that I’ve worried over every day.
We visited the discount rack at the Lowe’s garden center after lunch most days. If there was a perennial there, we brought it home – most of them just $1 each.
And I convinced my husband to rip off the lower boards of the front porch so we could crawl underneath and dig out the ferns that had been trapped there since the remodel began. Anything for a fern.
The flower bed was my idea for covering a set of concrete steps from a kitchen door that was closed off during the renovations. It was either build over them or take them out, and none of us seemed to want to take on that chore. Lewis did most of the carpentry work during the renovation and all of the stone work. He filled the flower bed with mulch, and I filled it with herbs.
After a year of debating whether to paint the living room paneling, we compromised and painted one wall. Then I played musical chairs with several rooms of drapes back at home so I could move a brighter pair to the cottage, which complements a new rug. The result is a significantly brighter living room.
September 10, 2018
We’ve also swapped out the too-small-queen-size-bed for a beautiful king bed, there’s a new fig tree – barely visible to the far right of the picture below, and plans are in the works for the next phase of construction. . . which will entirely change this little cottage yet again.
The topic of the next anatomy of a runner post is muscle. It’s not that we haven’t covered various muscles in previous posts, but their generic characteristics are fascinating as it relates to running and seem to warrant a separate conversation. After all, the brain and muscle are the most malleable of all the anatomical components. In other words, they can be trained.
The purpose of the paper is to illustrate the link between an athlete’s physiology and success in distance running. “The maximal oxygen (O2) uptake, O2 cost of running at sub-maximal speeds (running economy), and blood lactate response to exercise can all be determined using standard physiology laboratory exercise tests and the results used to track changes in ‘fitness’ and to make recommendations for future training,” Jones writes in the introduction.
Once or twice a year Radcliffe was given a physiological assessment that measured height, body mass, body composition (through skinfold thicknesses), haemoglobin concentration ([Hb]), pulmonary function, vertical jump height, a sit-and-reach test, and a multi-stage incremental treadmill test. The resulting data from these tests demonstrate how 15 years of directed training created the ‘complete’ female distance runner and a World champion.
Radcliffe committed herself to many years of hard training and used these yearly assessments to objectively analyze her progress and to inform her training. The data also accurately predicted actual finishing race times within 0.2-0.4% over a variety of distances.
Training consisted of “steady” continuous running, tempo runs, 1-2 higher intensity sessions at 95-100% V’02 max, interval or repetition sessions at the track or cross-country, and two weight training sessions weekly. Total mileage increased considerably over her career from less than 25-30 miles initially to 120-160 miles per week during full marathon training in the final years.
It’s difficult to pinpoint one thing that specifically creates an exceptional athlete although running economy, or enhanced exercise economy, is considered by many to be a critical component of success. Running economy is defined as the oxygen (O2) cost of running at a certain speed, or the O2 cost of running a certain distance. The more efficient we become the less oxygen we use, which means we can run further or faster with the same effort.
Radcliffe’s data demonstrate a 15% improvement in running economy between 1992 and 2003 suggesting that improvements in this parameter are very important in allowing a distance runner to continue to improve their performance over the longer-term.
There is evidence that explosive strength training can improve running economy. Studies of runners that participated in strength training decreased their running pace by 4% as compared to runners who did no strengthening exercises even though there were no significant changes in their maximum aerobic capacity, blood lactate accumulation, body mass, or body fat percentage. This is an important finding because it suggests that the improvements in running economy come from a mechanism other than cardiovascular or metabolic changes. A possible explanation is enhanced mechanical efficiency and muscle recruitment patterns – both of which are a result of the neuromuscular adaptations achieved from strength training.
As Radcliffe’s weight training program became more sophisticated her leg strength and power improved. Her vertical jump test performance improved from 29 cm in 1996 to 38 cm in 2003 while lower body “flexibility” declined slightly. This corresponds to a suggestion that “stiffer” muscle-tendon structures might improve running economy by allowing a greater storage and return of elastic energy (something we’ll pursue further in the upcoming post).
Exercise economy is influenced by a wide variety of factors so it’s not easy to say this or that is directly responsible for the improved running economy experienced by Radcliffe over her career.
One suggested explanation offered by Jones is that our type I (slow-twitch) muscle fibres are more efficient than type II (fast-twitch) muscle fibres; that is, compared to type II fibres, type I fibres consume less O2 for a given amount of muscle work, and if endurance training causes a reduction in type II fibres being recruited, this would reduce the cost of O2 and, therefore, improve running economy. Alternative studies also suggest that, with chronic endurance training, type II fibres take on some of the same properties of type I fibres, or that this same training results in a transformation of type II fibres into type I fibres.
You might ask, do we care? Depending on your running goals, the answer would be yes since the type and quantity of training causes a definitive change to the muscle structure and can affect performance across the spectrum of distances.
The distinction is made in this paper that while a high V ̇O2 max is a prerequisite for success at the highest levels of elite runners, and Paula Radcliffe certainly had this, factors such as running economy and a delayed accumulation of lactate in the blood are also important and can be positively affected by our training.
Mr. Jones concluded the paper by saying,
“Study of the great human athletes therefore continues to provide insights into the ultimate limits to exercise performance. Through determination, commitment, and consistently hard training, PR has achieved her athletic potential and become one of the greatest endurance athletes of all time. I have been greatly honoured to have been associated with her.”
The upcoming post about muscle will include a behind-the-scenes kind of look at the types of training that create the most improvements for runners, strength vs mass, slow vs fast, elastic energy or active stretch, fatigue and endurance.
There would be no fartlek through the woods. No peaceful run down the mountain, and definitely none of those mind-numbing sprints around the track. In fact, there may be no substantive running at all this year. It’s shocking to the core.
If you’ve ever talked at length to a runner, chances are the discussion evolved into the topic of injuries. There’s not a single memory of an injury from the nearly 20 years of competitive tennis in my earlier years, but I can’t even put a number to all the running injuries.
You’d think it would be discouraging, but it’s not. The goal is to avoid injury, somewhat like the goal is to avoid misjudging your arrival at the airport and never miss a flight. It still happens sometimes.
This latest injury happened within the first two steps of a run when I heard a loud pop. It’s curious that I heard the pop despite music blasting into my ears, which I’ve later realized is because the pop came from inside my body. The peroneal tendon of my right foot had moved out of its groove. If it moved all the way across the ankle bone and snapped back, it‘s called Peroneal Tendon Subluxation. Treatment seems to be the same nonetheless. REST.
One authority on the subject claims this injury is one of the few running injuries that’s not a consequence of overuse. They correctly observe that some athletes experience this ailment even when we’ve followed all the proper training rules. The alternative label appears to be “repetitive use with biomechanical dysfunction” because those of us with high arches that also run excessively are more prone than others to succumb to its ill fate.
Initially it hurt to do everything. The back of my heel was swollen, the tendon was tender to the touch, and would move around slightly. It was during these early weeks that it hurt to walk, run, or even ride my bike. Some weeks I did nothing at all. It was depressing, frustrating, and every other aggravating ‘-ing’ word imaginable.
My husband told me one day that I needed to get out there and do something to exhaustion. We found a new bike route and I went for a long ride. There were the steepest hills I’ve ever climbed, nail-biting descents, and the hairiest of all hair-pin turns. I used every gear in my arsenal that day. It was exhausting.
I’ve learned something. I love running so much.
I love the long runs, and the total exhaustion that comes from a grueling race. I simply adore the daily routine of charging up my watch and following a training plan. I miss all those things that runners learn to endure over years of practice.
The advice I’d want to give to every new runner is to stick with it. It gets better. It doesn’t always hurt. Focus on training your mind, and some day you’ll be pleasantly surprised that you’ve actually enjoyed yourself.
Exactly the conversation I’ve finally had with myself about doing every other exercise besides running.
For more information about a peroneal tendon injury or the dreaded subluxation, click on one of the articles below.
The lull in anatomy ended several months ago. This only means my days have once again been filled with reading – reading books, re-reading books, and weeks of days spent delving into the far reaches of the internet in search of the latest revelations on the runner’s brain.
It would be a fair assumption to think this post will ooze facts about all the positive benefits running gives back to your brain. The benefits are countless and noteworthy, but my curiosity lies more in what the brain contributes to our running, or our capacity to keep running. In other words, has anyone confirmed whether the brain controls or limits endurance?
Early studies concluded it was the heart itself that became fatigued, which resulted in too little blood being supplied to the skeletal muscles and brain. Running all out at our fastest pace for several minutes could make us all support this theory, but the heart does not fatigue. This realization led to the idea of a governor that terminates exercise before maximal blood flow to the heart is achieved and the heart is damaged. The supporting data suggested that a governor somewhere within the body terminates exercise before the heart and skeletal muscles are forced to contract anaerobically (without oxygen). These notions persisted and evolved for a long time.
The central governor theory has ultimately come under attack with compelling arguments. One scientist observed that with the exception of combat activity, sport is perhaps the brain’s biggest challenge, requiring more cognitive skills than is often appreciated.
The ability to plan and execute performance, make corrective adjustments to behaviour (e.g., modify skill execution or pacing strategy), resist temptation, manage emotions, elevate collective obligations above myopic self-interests, and persevere despite disappointment all constitute acts of self-control (or self-regulation) implicated in successful sports performance (Friesen, Devonport, Sellars, & Lane, 2013; Hardy, Jones, & Gould, 1996; Tamminen & Crocker, 2013). This is one of the lines of thinking that gave us a new term, ego depletion, and a string of new theories about the limitations of endurance.
I’ve contemplated abandoning the brain several times. There are other anatomy posts I could churn out in an afternoon, and I’d much rather move on to the creative side of writing. Instead, the typical routine is to do my research in the late afternoon while my husband reads or watches the news. Some days, the world seems to be in total chaotic calamity in the background noise of the news – all the while I needle my way through the theories of endurance.
It was a breakthrough day when I came up with an outline from the 25 pages of research notes I had collected. Then I found a thesis written in 2016 by a Doctor of Philosophy student at the University of Wolverhampton. The author presented research from four studies that examined self-control in sport, and co-authored two additional studies that explored emotion as a factor in the self-regulation of endurance. The best news of this discovery was that it’s written in plain English, and presents the studies and opposing arguments of the studies already in my research notes. Even better, all of the studies’ control subjects were athletes, and in one case they were competitive endurance runners. The bad news of this discovery is that the thesis is 292 pages long. The reading phase begins again.
It’s fairly typical for me to regurgitate my research at the end of the day over a glass of wine with my husband. Sometimes it just helps to talk about it and get it out of my head, but mostly his reactions help me sort through the data. He reminded me one day how few people experience the feeling of pushing their body to the point that the brain would shut them down. And there may be fewer people still that observe this shutdown on a personal level in someone else. It’s a humbling experience on both sides, but as he said, the experience almost always leaves the athlete more confident and empowered.
I presented several questions in a previous post about the heart: Do the muscles fatigue and reduce their output because the body has reached its maximum potential to deliver oxygen? Does the heart force the muscles to reduce output because it senses a lack of blood flow (oxygen) and works to protect itself? Or, does the brain anticipate when the blood and oxygen supply to the heart is about to become inadequate and reduce the recruitment of the muscles causing exercise to diminish or cease (fatigue) before damage is incurred to the heart or skeletal muscles?
Even if we acknowledge the body’s central governor must be found in the brain, and thereby controls the mechanisms that dictate endurance, this simply raises more questions. Stress, will-power, emotion, fatigue, motivation, the placebo effect, and even personality traits originate in the brain and each one contributes to, or limits endurance. . . the brain is still under construction.
I had this idea to write a series of posts on the anatomy of a runner. So far, I’ve published several posts – chapters as my husband calls them – on various body parts and their contribution, or hindrance, to our running goals.
I had set parameters for myself from the beginning. First, each post should contain everything there was to know about the function of a particular area: how our bodies work so ingeniously, what can go wrong, why it goes wrong, and the most up-to-date remedies.
My past frustration was that every resource for this information contained one tidbit of information or another, but not everything. You may hit a dozen some odd sources before finding all you need to know about an injury – not to mention that some of these sources propagate the same gobbledygook year after year despite new research or methodologies, which leads me to my second parameter. . . that I must find the latest and most conclusive research, limiting my references to those studies completed within the past 10 years.
Surprisingly, some topics haven’t been studied in the past 10 years, even though previous studies were inconclusive, and some of the new studies raise more questions than answers leaving us nowhere.
The third parameter was that this would not be a conglomeration of anecdotal advice. If there was ever a personal reference, it should only be to offer affirmation of the scientific findings.
With this in mind, I compiled a short list of running-related anatomical topics. There’d be a post on all the obvious players – the legs, feet, lungs, heart, and the list kept growing. Researching one topic yielded fascinating facts on another topic. I’d cut and paste links to these findings into draft documents dozens of times a day. The more I researched, the more fascinated I became.
It’s not easy to read scientific studies though. They have all kinds of words I’ve never heard before. They’re complex, and, at times, boring with all that science mumbo jumbo. It’s a massive effort to sort through the data, understand it, confirm it with other sources, and figure out how to dialogue it into a post that made sense. After the second or third topic, my husband declared we should plan on these posts taking me three weeks to finish. That proclamation has proven true, and has even grown to six or seven weeks in some cases.
Then I understood we’d have to cover some parts of the body before others, otherwise things wouldn’t make sense. So there became an order to the postings, and the research. Shortly after finishing the upper and lower leg, I realized we’d better address pain, for example. The general topic of pain, even excluding chronic pain, became one of the most intense topics to date. After days of editing, my husband carefully suggested the post was long enough that it could become two topics. I had severely broken the word count bank. I took out any reference to perhaps the worst of all running pain, hitting the wall, and made it a separate post. It wasn’t the only time I split one post into two.
The next topic on my list is the brain. I had already gathered enough research to compile a formidable post when Alex Hutchinson announced his new book, Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance. I may have been first on the pre-order list, but this great book remains on the table by the sofa still awaiting my full attention. There’s been a lull in my effort.
By all accounts the brain is shaping up to be the most fascinating topic of all the running-related anatomical topics. The past decade has produced “paradigm-altering research” in the world of endurance sports, and what we once viewed as physical barriers is actually limitations created by our brain as much so by our bodies. Pain, muscle, oxygen, heat, thirst, fuel, as Hutchinson describes, involves the delicate interplay of mind and body. As does writing I have learned.