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.
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).
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.
This post reviews generic muscle characteristics and how they relate to runners, including muscle contractions, muscle/tendon/ligament injuries and treatment, muscle cramps and remedies, lactate, strength vs mass, slow vs fast, muscle fuel, endurance and loss, flexibility vs inflexibility, stretching and fatigue.
In a future post, we’ll look at how specific training methodologies affect each of these areas for short-, medium- and long-distance runners.
Key points from this post:
Muscle is a result of three factors that overlap: physiological strength (muscle size and responses to training), neurological strength (how strong or weak the brain’s signal telling the muscle to contract), and mechanical strength (the muscle’s force, leverage, joint capabilities).
The most common muscle injuries occur during eccentric loading and usually involve muscles that cross two joints, although the hip abductor muscles are also commonly affected even though they only cross the hip joint.
A stretched tendon can cause muscle spasms, but will typically resolve on its own. Ligament injuries can destabilize the associated joint and require many months, and sometimes surgery, to heal.
Eccentric training, such as downhill running, is the most effective in strengthening muscle and connective tissues, is effective for increasing flexibility, and can increase hip and joint range-of-motion, but is also known for causing muscle soreness (DOMS). Muscle rapidly adapts to the damage caused by eccentric training, however, and protects from the future damage of long distances.
Although the brain is responsible for creating strength (i.e., muscle recruitment), increased size or muscle mass (muscle hypertrophy) happens within the muscle. Following a period of inactivity, it is initially the brain’s ability to excite the muscle that declines in correlation with the muscle’s decrease in strength, rather than a physiological change in muscle size.
Our diets provide three sources of fuel: carbs, fat and protein. The body always uses a combination of carbohydrates and fat for fuel depending on the intensity of exercise. Low intensities use more fat, but by the time you’re gasping for air the proportions have flipped to mostly carbs.
Carb-free diets have become a popular way of encouraging fat burning, but there are trade-offs with this approach.
Lactate is an important source of energy, and is produced in muscles even at rest. The use of lactate as fuel varies with how well a person’s endurance muscle fibers are trained aerobically. Highly trained athletes use lactate more efficiently, which prevents it from accumulating to high levels in the muscle.
Protein is used as an energy source if calories are insufficient, although with sufficient calories, protein contributes only minimally to the total amount of energy used by working muscles.
In addition to strengthening teeth and bone, calcium also helps with muscle contraction. If a person’s diet provides too little calcium or too much phosphorus, their body siphons calcium out of teeth and bones and stops providing it to the muscles.
Exercise-induced muscle cramps have long been misunderstood to be caused by ”dehydration” and “electrolyte depletion” (water-salt imbalance). Muscle injury or muscle damage, resulting from fatiguing exercise causes a reflex ‘‘spasm’’, resulting in a sustained involuntary contraction, or cramp. Stretching is the most effective way to resolve cramps.
We break down and rebuild 1 to 2 percent of our muscle each day, meaning that you completely rebuild yourself every two to three months. The research shows you literally are what you just ate.
Studies show adults ages 50 and up with low muscle strength were more than twice as likely to die in follow-up periods of studies than those with normal muscle strength. Having low muscle mass (vs strength) didn’t seem to matter as much. The best outcomes of all were those adults who met the aerobic and strength-training guidelines: at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week and performing a “strength-promoting exercise” at least twice a week.
When running frequency increases past 4 days a week or the intensity of endurance exercise increases above 80% VO2max, endurance exercise prevents the increase in muscle mass and strength typically associated with strength training.
Being inflexible creates greater elastic energy in the stretch shortening cycle. In fact, as much as 40-50% of the energy needed for distance running can be obtained from the elastic ability of skeletal muscle. Being less flexible is not as valuable for sprinters.
Static stretches before running caused a decrease in running distance, increased ground contact time during a 1-mile uphill run, increased muscle activation, and resulted in an approximately 8% decrease in performance.
In women, the variables related with muscle mass are generally 60-75% of the exercise physiology values recorded in men. When measured in terms of strength per square centimeter, however, the female muscle can achieve the same force of contraction as that of a male.
There are THREE TYPES OF MUSCLE in the body: 1) Smooth, involuntary muscles, 2) Cardiac heart muscle, and 3) Skeletal, or voluntary muscles that move the body, arms and legs. This post will focus on Skeletal muscle.
Muscle is a result of THREE FACTORS THAT OVERLAP: physiological strength (muscle size and responses to training), neurological strength (how strong or weak the brain’s signal telling the muscle to contract), and mechanical strength (the muscle’s force, leverage, joint capabilities).
Muscle tissue has THREE CHARACTERISTICS THAT GOVERN EXERCISE:
Contractility – Ability to shorten
Extensibility – Ability to stretch without damage
Elasticity – Ability to return to original shape after extension
The fundamental behavior of skeletal muscle is shortening, which produces joint motion and allows the body to move. Skeletal muscles attach to bones via tendons and often appear in antagonistic pairs, so that when one muscle contracts, the other lengthens.
THREE TYPES OF MUSCLE CONTRACTIONS:
Concentric contractions: muscle shortens, or contracts, pulling on the bone causing the joint to move. A reciprocal muscle on the other side of the joint contracts and shortens to return the joint to its original position. Muscles don’t push joints, they only shorten and pull.
Eccentric contractions: muscle shortens and lengthens at the same time, resulting in a resisting force to decelerate the lengthening movement. By opposing the downward force, a joint is safely repositioned and tissue is protected. Examples of eccentric contractions include walking down stairs, running downhill, lowering weights, and the downward motion of squats, push ups or pull ups.
Note: Eccentric training is effective for increasing flexibility, can increase hip and joint range-of-motion, and has been used as a form of training for several pathological conditions such as Parkinson disease (Dibble et al. 2006), and older cancer survivors (LaStayo et al. 2010),
The last form of muscle contraction is an isometric contraction where the muscle is activated but is held at a constant length rather than lengthened or shortened – there is no movement.
WHY IT HURTS
Muscle injuries commonly occur during eccentric loading of the muscle; that is, when the muscle is contracting while it is also elongating. Muscles that cross two joints, such as the hamstrings (the hip and knee joints), the calf (the knee and ankle joints), and the quadriceps (the hip and knee joints) are the most susceptible to injury. The hip abductor muscles are also commonly affected, though they only cross the hip joint. (Click here to discover more information about specific muscle injuries in other anatomy of a runner posts.)
Although exercises that involve eccentric contractions are the most effective in strengthening muscle, they are also the cause of muscle soreness. All forms of vigorous exercise can become painful, but only eccentric exercise causes delayed onset muscles soreness (DOMS). Muscles are very adaptable to eccentric exercises, however, and rapidly adapt to the damage, resulting in less muscle stiffness or soreness during a second bout of eccentric exercise.
When muscle is initially injured, significant inflammation and swelling occurs. Following the inflammatory phase, muscle begins to heal by regenerating muscle fibers from stem cells that live around the area of injury. However, a significant amount of scar tissue also forms where the muscle was injured. Over time, this scar tissue remodels, but the muscle never fully regenerates. This is thought to make injured muscle more prone to subsequent injury. Other factors that can predispose an athlete to injury include older age, less flexibility, lack of strength in the muscle, and fatigue.
Muscle (and tendon) injuries can be categorized into three grades ranging from mild damage to individual muscle fibers (less than 5%), causing minimal loss of strength and motion, to a complete rupture of the muscle or tendon.
Treatment and Recovery
The majority of acute muscle injuries are partial thickness tears. These can usually be treated successfully with rest, ice, compression, elevation (also known as RICE), and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. This will be done for the first week, followed by progressive functional physical therapy, as needed. A return to full activity is usually possible when you are pain free, and when full range of motion and full strength is restored.
Recovery can be 2-3 weeks for Grade 1 injuries, or 2-3 months for Grade 2. The most severe injuries may require surgery to reattach damaged muscle and tendon. The resulting scar tissue of each injury makes athletes more susceptible to subsequent injuries at the same location.
In a study that examined professional football players with severe hamstring tears with palpable defects, an intramuscular cortisone injection led to a return to full activity time of 7.6 days, and 85% of the players did not miss a single game. However, the use of cortisone injections in the recreational athlete should be reserved for chronic or lingering injuries since there is a chance of weakening the remaining muscle and increasing the severity of the injury.
Several new therapies are in the investigational phase, including platelet-rich plasma (or PRP) which requires blood to be drawn and then spun in a centrifuge to concentrate the platelets and injected into the site of the injury. These platelets contain several growth factors that may stimulate healing and muscle regeneration, and limit the amount of scar tissue that forms. There are currently no reliable scientific studies that show if this therapy works. Antihypertensive medications have been shown to reduce scar tissue formation and improve healing in experimental models.
Tendon & Ligament Injuries
Tendons connect muscle to bone and ligaments connect bones to other bones. Tendons allow muscles to move bones, whereas ligaments stabilize joints. When tendons and ligaments are stretched beyond their basic capacity, they become damaged. For tendons, this can result in tendonitis, which occurs when the tendon becomes torn. This damage causes the tissue of the tendon to inflame while it heals; as a result, tendonitis causes swelling and soreness, as well as temporary loss of muscle function. Ligament injuries weaken the joint and threaten its integrity. A common ligament injury among athletes involves the ACL, or the anterior cruciate ligament in a person’s knee.
A stretched tendon can cause muscle spasms, but will typically resolve on its own. Ligament injuries can destabilize the associated joint and require many months, and sometimes surgery, to heal.
Tendonitis is inflammation of the tendon (the suffix “itis” indicates inflammation). Achilles tendonitis tends to be an acute (or quick-onset) condition lasting 6 weeks or less, although some view this diagnosis as the first in a continuum of tendon injuries that subsequently increase in severity.
Tendinosis is a non-inflammatory degeneration of the tendon which typically occurs from long-term overuse of the tendon leading to weakening of the tendon fibers. Unlike tendonitis, which can often be successfully treated within several weeks, tendinosis can take several months to treat.
Paratenonitis is inflammation of the tissue surrounding the tendon, which may thicken and adhere to the tendon. This diagnosis is controversial, as some practitioners do not believe paratenonitis is a separate condition from tendonitis.
Tendinopathy: The suffix “pathy” is derived from Greek and indicates a disease or disorder, in this case of a tendon. The term is 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.
SLOW VS FAST
Every muscle contains some combination of three basic types of fibers or motor units: slow twitch, intermediate, and fast twitch.
Slow-twitch fibers (Type I or Red Muscle) – are smaller, develop force slowly, maintain contractions longer, and have higher aerobic capacity that is well suited to long-distance/marathon oriented running. Red fibers are easier to target with exercise. For example, any repetitive, weight-bearing action above your accustomed-level intensity produces red muscle adaptations such as growth and increased endurance.
Fast-twitch fibers (Type IIx or White Muscle) – are larger, capable of developing greater forces, contract faster and have greater anaerobic capacity – better for sprinting or <400m races). White muscle specializes in high-intensity actions lasting fewer than 30 seconds and responds well to heavy resistance training and ballistic exercise such as fast, yet controlled, weightlifting, or plyometric training.
Intermediate fibers (Type IIa) – intermediate in size, speed, power, and susceptibility to fatigue such as those needed for prolonged fast running; the kind demanded for 800m and 1500m races.
Not all runners inherently have the same percentage of each type of muscle fiber. Elite distance runners have high percentages of slow-twitch and intermediate fibers, and as expected, sprinters have more fast-twitch. Since genetics determine our individual percentages, you may find you are more successful in sports that complement your specific muscle configuration. Finding your muscle type can be as simple as defining your preferences: Do you prefer long interval and tempo training (slow-twitch) or short, fast workouts (fast-twitch)? Despite genetic disposition, it has been suggested that training can cause type II fibers to take on the properties of slow-twitch type I fibers. (Specific training considerations will be covered in a future post.)
Muscles are recruited by the brain according to the Size Principle. Muscles with fewer slow-twitch muscle fibers are recruited first and, as more force is demanded by an activity, progressively larger, fast-twitch units are recruited. As the intensity of exercise increases in any muscle, the contribution of fast fibers also increases.
Top athletes in explosive sports like Olympic weightlifting or the high jump appear to have the ability to recruit nearly all of their motor units in a simultaneous or synchronous fashion. In contrast, the firing pattern of endurance athletes becomes more asynchronous. During continuous muscle contractions, some units are firing while others recover.
Initially we might maintain the desired pace/duration with no involvement from fast motor units. As these slow units become fatigued, however, the brain will recruit more motor units in an attempt to maintain pace. Recruiting these additional motor units brings in the fast, but easily fatiguable units. This explains why fatigue is accelerated at the end of a long or intense run.
Lactate is an important source of energy, and is produced in muscles even at rest – something that has been previously misunderstood. Lactate is sent to the brain and heart for fuel, or to active and inactive muscles for energy.
During exercise, we breathe faster to supply more oxygen to working muscles which also clears excess lactate. If exercise intensity increases beyond our ability to supply required oxygen, the muscles continue energy production, but in an anaerobic condition (without oxygen). The muscles produce energy in this anaerobic condition for only one to three minutes, during which time lactate can accumulate to high levels.
The potential for lactate accumulation varies by muscle type with fast-twitch muscles having the highest potential because of their maximum oxygen delivery requirements. “Producer” cells make lactate which is used by “consumer” cells. In muscle tissue, for example, the white, or “fast twitch,” muscle cells convert glycogen and glucose into lactate and excrete it as fuel for neighboring red, or “slow twitch,” muscle cells. Type II muscle fibers are highly glycolytic (they use lots of glucose) which results in the production of high amounts of lactate.
We’ve always associated these high levels of lactate with the burning sensation of muscle fatigue that ultimately causes us to stop exercise – a process that is thought to prevent muscle damage – although lactate may not actually be the cause of the burn. (Continuing research indicates muscle fatigue may be caused by other factors.) Lactate production is a strain response; it’s there to compensate for the metabolic stress of high intensity exercise. The deep breaths we take post-exercise helps clear excess lactate from muscles and restores balance.
The use of lactate as fuel within the muscle varies with how well a person’s endurance muscle fibers are trained aerobically. Highly trained athletes use lactate more efficiently as energy preventing it from accumulating to high levels. Conditioning in sports is all about getting the body to produce a larger mitochondrial reticulum in cells to use the lactate and thus perform better.
The muscles of untrained athletes, and also bodybuilders, produce energy without oxygen; a condition that produces high lactate levels in the muscles. At the same time, muscles begin to fatigue and the muscles feel “heavy”. This is considered an anaerobic training process (without oxygen) as compared to marathon training, for example, which is an aerobic (with oxygen) process.
Endurance training changes the metabolism of muscles by stimulating the production of a protein, PGC-1a. Trained mice that developed a high PGC-1a maintained their performance levels, and their lactate levels remained low despite a high training load. Endurance training programs, such as for the marathon, reduces the formation of lactate, while the remaining lactate in the muscle is converted and used immediately as energy substrate.
The energy drink, Cytomax, is based on research that indicates lactate is the body’s primary fuel. The combination of lactate, glucose, and fructose takes advantage of the different ways the body uses fuel: lactate can get into the blood twice as fast as glucose – peaking in just 15 compared to 30 minutes after drinking. Most sports drinks contain only glucose and fructose. (This reference is not an endorsement of the Cytomax product.)
1) High lactate levels are also seen in the blood during illness or after injury, such as severe head trauma, and are a key part of the body’s repair process. Lactate is now being used to help control blood sugar after injury, to treat inflammation and swelling, for resuscitation in pancreatitis, hepatitis and dengue infection, to fuel the heart after myocardial infarction and to manage sepsis.
2) Disturbances in lactate metabolism are common in obese and diabetic patients. The stimulation of PGC-1α achieved by endurance exercise means endurance training can be an effective approach to improve the metabolism of these groups, and could help prevent the resulting damage and progressive physical limitations caused by metabolic diseases.
POST EXERCISE OXYGEN DEBT
After exercise has stopped, extra oxygen is required to metabolize lactic acid and to replace (“pay back”) any oxygen that has been borrowed from other parts of the body. This debt is paid by labored breathing that continues after exercise has stopped. Highly trained athletes are capable of greater muscular activity without increasing their lactic acid production and have lower oxygen debts, which is why they do not become short of breath as readily as untrained individuals. Eventually, muscle glycogen must also be restored. Restoration of muscle glycogen is accomplished through diet and may take several days, depending on the intensity of exercise.
EXERCISE INDUCED MUSCLE CRAMPS (EAMC)
There are two theories about the origin of EAMC. The older one is the “dehydration” and “electrolyte depletion” theory (water-salt balance), while the more recent one is the “altered neuromuscular control” theory, or a sustained, involuntary muscle contraction brought on by muscle fatigue. In 1904, muscle spasms (cramps) were reported for the first time in two men at the Episcopal Hospital and were presented as a new disorder due to exposure to intense heat, which gave us the term “heat cramps”. Except, we’ve since learned that EAMC occurs in hot conditions, moderate to cool temperatures and in extreme cold. Also, multiple studies of endurance athletes, marathoners and triathletes have shown no evidence of low salt levels or electrolyte imbalances after cramping during a race (Schwellnus et al, 2004; Sulzer et al, 2005; Schwellnus et al, 2007).
One of the first studies showing that fatiguing muscle can develop cramping in normal healthy subjects during exercise was reported in 1957, but it wasn’t until 1997 that muscle fatigue was credited as the predecessor to EAMC. Click here to read the technical details behind this theory (Part III of a 5-part series on the history of EAMC studies) or here to read the full study.
A previous history of EAMC and a positive family history of cramping are also considered risk factors for EAMC. Muscle injury or muscle damage, resulting from fatiguing exercise, are thought to cause a reflex ‘‘spasm’’, and thereby result in a sustained involuntary contraction, or cramp.
Prevention & Recovery
Prevention of EAMC primarily is use of dietary supplements and kinesio taping, massage therapy, corrective exercises that will lead to the improvement of the function of a particular group of muscles or the biomechanics of the organism itself, although stretching exercises are said to be the most effective. Post-isometric relaxation techniques, plyometric or eccentric muscle strengthening programs have also proven effective. Mustard and pickle juice are listed as the nutritional form of EAMC prevention.
Note: non-exercise related cramps include rest cramps (also known as nocturnal cramps). These may be more prevalent in older adults, but can occur at any age. Rest cramps are started by making a development that abbreviates the muscle; for example, pointing the toe downward while lying in bed, which shortens/abbreviates the calf muscle, resulting in cramping of the muscle. Rest cramps can also occur in other areas, such as the arches of the feet or abdominal muscles.
STRENGTH VS MASS
Strength: People generate more strength if they can recruit and fire 50,000 muscle fibers than if they can only recruit 25,000 fibers. Muscle recruitment is controlled by the brain, and initial improvements are achieved because the brain gets more efficient at communicating with the muscles, using more of them, and using them more efficiently. In fact, muscle recruitment is the mechanism that allows us to gain strength before our muscles even increase in size. It is only through practice, or training, that the brain improves muscle recruitment.
Mass: Although the brain is responsible for creating strength (i.e., muscle recruitment), increased size or muscle mass (muscle hypertrophy) happens within the muscle. Microscopic damage (microtears) occurs in the muscle fiber during strengthening activities, which stimulates the body’s repair response to repair the damage. This repair response causes the muscle fibres to enlarge or swell, ultimately increasing their volume and size. Once running frequency increases past 4 days a week or the intensity of endurance exercise increases above 80% VO2max, however, endurance exercise prevents the increase in muscle mass and strength that typically occurs with strength training.
Note: Even with the greater muscle mass typically found in short distance runners, a sprinter cannot win a marathon. A sprinter’s specially-trained and strengthened muscles will fatigue faster than the endurance-trained muscles of a long distance runner. The research group of Prof. Christoph Handschin of the Biozentrum, University of Basel, shows that during endurance exercise the protein PGC-1α shifts the metabolic profile in the muscle.
The three basic fuel options are carbohydrate, fat and protein.
Fat is the preferred fuel for light-intensity to moderate-intensity exercise, such as slow running or hiking, cycling, and recreational swimming. However, the body always uses a combination of carbohydrates and fat depending on the intensity of exercise. Low intensities use more fat, but by the time you’re gasping for air, the proportions have flipped to mostly carbs.
Endurance (low-intensity) training teaches the body to preserve glucose and utilize more fat as fuel, but you’ll burn the same fat-carb mix at any given relative intensity. One study found that marathoners running a 2:45 pace relied on 97 percent carbohydrate fuel, while slowing to a 3:45 pace reduced the carb mix to 68 percent.
It is now believed that lactate is produced in healthy, well-oxygenated muscle and is preferentially used for energy throughout the body. In fact, about 30 percent of all glucose we use during exercise is derived from lactate “recycling” to glucose.
Carbohydrate-free diets have become popular in recent years to encourage the body to burn predominantly fat as fuel. Studies show it takes several weeks for the body to adjust to a mostly carb-free diet and that any benefits in terms of performance are mixed. In exchange for their enhanced ability to burn fat, a study of cyclists seemed to lose their ability to harness quick-burning carbohydrate for short sprints resulting in “a severe restriction on the ability of subjects to do anaerobic work.”
The conclusion among researchers is that high-fat (carb-free) diets don’t just ramp up fat burning; they actually throttle carbohydrate usage by decreasing the activity of a key enzyme called pyruvate dehydrogenase. This may or may not matter depending on your running goals. Fat burning is ideal for long distances that never require speed. Racing, on the other hand, may be enhanced by having carbohydrates in reserve for that end spurt, or for more intensive training sessions.
Protein is used as an energy source if calories are insufficient, although with sufficient calories, protein contributes only minimally to the total amount of energy used by working muscles. When a person begins a moderate endurance exercise program, they initially lose more protein than they ingest. This corrects itself within 2–3 weeks without dietary intervention. To increase muscle size and increase strength, however, athletes must ingest more protein than is lost. On the other hand, ingesting too much protein can result in dehydration, loss of urinary calcium, and will put stress on the kidneys and liver.
Luc van Loon, Professor at Maastricht University in the Netherlands, and his colleagues developed a technique to track protein as it progressed from a person’s mouth to their biceps in the hours following a meal. Just over 50 percent of the protein made it into the subjects’ circulation within five hours (the remaining protein was presumably taken up by tissues in the gut or not absorbed.) During the same period, 11 percent of the ingested protein was incorporated into new muscle. Literally, you are what you just ate. Overall, van Loon points out, we break down and rebuild 1 to 2 percent of our muscle each day, meaning that you completely rebuild yourself every two to three months.
Calcium is predominantly used by the body to strengthen teeth and bones, but also helps with muscle contraction. If a person’s diet provides too little calcium or too much phosphorus, their body siphons calcium out of teeth and bones and stops providing it to the muscles. Cola based soft drinks and some junk foods are high in phosphorous, unduly increasing the body’s need for calcium.
Fun Fact: studies in the 1960s found that people who retained more of their own teeth tended to have more muscle.
Our ability to engage in physical activity for long periods of time is thanks to efficient energy production in the mitochondria—the small “powerhouses” of our muscles. Endurance training increases the number of mitochondria and their structure, and the more we have, the longer we can exert ourselves. Endurance athletes have more than twice as many mitochondria that generate about 25% more energy as non-athletes.
During a two-week period following inactivity, it is the brain’s ability to excite the muscle that declines in correlation with the muscle’s decrease in strength, rather than a physiological change in muscle size. Getting older is another factor that causes changes within the muscle since muscles are less sensitive to protein signaling as we age. Studies show adults ages 50 and up with low muscle strength were more than twice as likely to die in follow-up periods of studies than those with normal muscle strength. Having low muscle mass (vs strength) didn’t seem to matter as much.
A similar study of 80,000 adults found those doing any strength training were 23% less likely to die and 31% less likely to die of cancer. The best outcomes of all – a 29% reduction in mortality risk – were those adults who met the aerobic and strength-training guidelines (at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week and performing a “strength-promoting exercise” at least twice a week).
Note: A recent study led by researchers at Keele University has shown for the first time that periods of skeletal muscle growth are ‘remembered’ by the genes in the muscle, helping them to grow larger later in life.
Long-term observations of runners have shown improvements in running economy when the athletes are less flexible – being inflexible creates greater elastic energy in the stretch shortening cycle. In fact, as much as 40-50% of the energy needed for distance running can be obtained from the elastic ability of skeletal muscle. One of the reasons plyometric and resistance training improves running economy is due to an increase in muscle stiffness. Imagine a ball bouncing off a wall – if it gets softer, it bounces off more slowly, whereas a stiff ball returns quickly (golf ball vs squash ball, for example).
Being less flexible does not appear to be as advantageous in shorter distances, sprinting, or the long jump. A sprinter (i.e., events <800 m), for example, requires a greater range of motion at the hip that benefits from more flexibility as compared with a long-distance runner (i.e., events >800 m).
The sit and reach test is a common measure of flexibility, and specifically measures the flexibility of the lower back and hamstring muscles.
Researchers have sought to determine whether acute bouts of static stretching before exercise would affect running economy. (Static stretches hold a stretched or elongated position for 15 seconds or more.) Findings show runners who performed these stretches before running caused a decrease in running distance, increased ground contact time during a 1-mile uphill run, increased muscle activation, and resulted in an approximately 8% decrease in performance.
Stretching, considered an exercise, also fatigued the muscle resulting in more muscular recruitment to perform a given task. Considering that one of the adaptations to endurance training is asynchronous recruitment of the musculature, having to recruit more muscle fibers per given intensity would be counterproductive to performance for distance running.
Static stretching is helpful to increase range of motion or improve flexibility and is a useful component of an overall training program depending on your sport (i.e., for sprinters and short distance runners). If you feel a need to stretch before running, dynamic stretches use controlled movements that can make muscles more limber while also activating major muscle groups.
Fatigue was defined in a previous post as peripheral (within the muscles) or central (within the brain and spinal cord). Although fatigue produces the belief that our resources are limited, exercise generally ceases before all the muscle fibers have been activated. In fact, just 35-50% of active muscle mass is recruited during prolonged exercise. Read more here.
Limited studies show that women appear to be more resistant to fatigue than men during long efforts. A study that was published in the journal Medicine and Science in Sports and Exercise measured fatiguability of subjects completing an isometric arm contraction. Women were able to perform the task until failure almost three times longer than men, 23.5 minutes versus 8.5.
One difference between the sexes is that women have a greater number of fatigue-resistant fibers (Type I) while men have more faster-contracting fibers. Secondly, men have larger muscles that demand more blood, which makes their hearts work harder. Female endurance athletes also have a metabolic edge in moderate-intensity aerobic exercise by deriving more of their energy from fat as compared with males. In women, the variables related with muscle mass are generally 60-75% of the exercise physiology values recorded in men. When measured in terms of strength per square centimeter, however, the female muscle can achieve the same force of contraction as that of a male.
Note: Muscle fatigue is usually resolved within hours, while muscle damage can impair force generation for up to 7 days.
THE TRAINING EFFECT
Skeletal muscle has three basic performance parameters that describe its function: 1) Movement production (speed), 2) Force production (strength), and 3) Endurance. Increasing muscular strength will increase muscular power, which is the product of force (strength) and speed.
Athletic performance is ultimately limited by the amount of force and power that can be produced and sustained. The theories behind the various components of a running training program will be discussed in the next anatomy of a runner post.
American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Keele University. “Study proves ‘muscle memory’ exists at a DNA level.” ScienceDaily. ScienceDaily, 30 January 2018.
THE BRAIN is what makes us human. It gives us the capacity to make decisions, produce rational thoughts, or spectacular works of art. It’s responsible for our personality, storing the memories we cherish, and how we view the world. It also governs our ability to speak, eat, breathe, and move.
Disciplined, smart training is the foundation of any athletic endeavor, and proper training is also what earns us a seat at the table of endurance. Some athletes have genetic endowments and natural advantages that predispose them to sports. Maybe they respond better to training, the shape of their bodies or the genes they carry make them specifically optimized for certain athletic endeavors. Another subset of great athletes also have cultural and environmental advantages, such as the Kenyans who spend a lifetime being active at altitude. Then there are great athletes who have none of these advantages – the only common denominator between all groups of athletes being the brain.
The question of this post is not what can the human body do, but rather, what more can the human mind add to that?
The 1922 Nobel Prize in Physiology or Medicine winner, Archibald Hill, proposed in 1924 that the heart was protected from anoxia (absence of oxygen resulting in permanent damage) in strenuous exercise by the existence of a governor. Dr. Timothy Noakes, a professor of exercise and sports science at the University of Cape Town, re-introduced Hill’s governor model in 1997 on the basis of modern research. The essence of Noakes’ original central governor theory is that the brain monitors activity, predicting outcomes, and involuntarily implements an appropriate pace that prevents total exhaustion and permanent bodily damage by creating the distressing sensations we interpret as fatigue.
Physiological catastrophes can and do occur in athletes, however, that present conflicts in the governor theory. A story from the 2015 Austin Marathon serves as one example from many.
Kenyan runner, Hyvon Ngetich, had been leading most of the race. With two-tenths of a mile left to run, she began to wobble and stagger, and eventually fell down. After failed attempts to get up, Ngetich crawled to the finish line leaving her knees and elbows bloodied and hands stained from the pavement. Ngetich crossed the finish line in third place with a time of 3:04:02, and was immediately treated for dangerously low blood sugar. In a post-race interview with CNN, she said she didn’t remember finishing the race. She had continued the race despite the distressing sensations of fatigue and debilitating physiological failure.
Over time the central governor theory has been revised to include the role of psychological and motivational factors, which is where we begin to uncover the story of endurance.
muscular endurance: the ability of a muscle or group of muscles to repeatedly develop or maintain force without fatiguing.
cardiorespiratory endurance: the ability of the cardiovascular and respiratory systems to deliver blood and oxygen to working muscles, which in turn enables the working muscles to perform continuous exercise. It is an indicator of a person’s aerobic or cardiovascular fitness.
athletic endurance is defined as the ability to continue an activity despite increasing physical or psychological stress, as in the effort to perform additional numbers of muscle contractions before the onset of fatigue.
The human brain weighs about 3 pounds (1.4 kilograms). The surface area is 233-465 square inches (1500-2000 cm2), or roughly the size of one to two pages of newspaper. If we flattened the brain’s 1/4 inch thick outer layer, it would cover the size of an office desk. But to keep the brain compact enough to fit into our skull, it folds in on itself.
The simplest commands of the brain are monosynaptic (single connection), like the knee-jerk reflex. The knee-jerk response is a muscular jerk that happens quickly and does not involve the brain. There are lots of these hardwired reflexes, but as tasks become more complex, the circuitry involved is more complicated, and the brain gets involved.
The cerebellum, “little brain”, consists of both grey and white matter, and is responsible for coordinating muscle movement and controlling balance by transmitting information to the spinal cord and other parts of the brain. The cerebellum is constantly receiving updates about the body’s position and movement. It also sends instructions to our muscles that adjust our posture and keeps our body moving smoothly.
The cerebrum is the largest part of the human brain, controlling memory, movement, speech, emotions, and voluntary motor activities. With the assistance of the cerebellum, the cerebrum controls all voluntary actions in the body. Voluntary actions include running, clapping your hands, or lifting weights – things you are consciously doing.
The cerebral cortex is the outer layer of the cerebrum and consists of gray matter. This is where our conscious thoughts and actions take place; many of the signals our brain receives from our senses are registered in the cerebral cortex.
Basic life functions, such as heart rate, breathing, and blood pressure, is carried out by the brain stem. It regulates whether we feel tired or awake, as well as coughing, sneezing, and swallowing. The brain stem is the body’s “autopilot”.
About the size of a pearl at the base of the brain, the hypothalamus regulates physiological processes, such as blood pressure, heart rate, body temperature, cardiovascular system function, fluid balance, and electrolyte balance. This portion of the brain plays a vital role in maintaining homeostasis: the process of maintaining the body’s equilibrium by monitoring and adjusting physiological processes. It also influences emotional responses, sleep, appetite, and tells the skin to produce sweat when it’s hot to keep you cool.
The hippocampus (HC) region of the brain deals with the formation of long-term memories and spatial navigation. In diseases such as Alzheimer’s, the hippocampus is one of the first regions of the brain to become damaged, which leads to memory loss and disorientation.
The atrophy rate of the hippocampus (HC) is shown to be 2-3% per decade (Raz et al., 2004, 2005), and further accelerated to an annual loss of 1% over the age of 70 (Jack et al., 1998). Recent research, however, has shown the HC is among a few regions of the brain that generate new neurons.
In particular, exercise causes hippocampal neurons to pump out a protein called brain-derived neurotrophic factor (BDNF), which promotes the growth of new neurons. Higher cardiorespiratory fitness levels (VO2 max) are associated with larger hippocampal volumes in late adulthood, and larger hippocampal volumes may, in turn, contribute to better memory function (Erickson et al., 2011; Szabo et al., 2011; Bugg et al., 2012; Maass et al., 2015). (22)
Running Fact:A study published in the Journal of Neurobiology of Learning and Memory finds that running mitigates the negative impacts chronic stress has on the hippocampus region of the brain. “Exercise is a simple and cost-effective way to eliminate the negative impacts on memory of chronic stress,” according to the study’s senior author, Jeff Edwards, associate professor of physiology and developmental biology at BYU.
THE PERSONALITY OF A RUNNER
Observational studies have identified common personality traits among runners, including a strong vision, focus and resilience. Runners consistently exhibit mental toughness, an extraordinary capacity to plan ahead, and the ability to handle unexpected problems with a calm yet competitive demeanor; we are more willing to accept feedback, and acknowledge our mistakes.
Imaging of a runner’s brain show connections in areas required for higher-level thought, including more connectivity between parts of the brain that aid in working memory, multi-tasking, attention, decision-making, and the processing of visual and sensory information. Less activity is noted in a part of the runner’s brain that tends to indicate lack of focus and mind wandering. (24)
A 2009 study found ultra-marathoners were less dependent on rewards (self-motivated), they were more individualistic, and, not surprisingly, exhibited a far greater tolerance for pain. Studies of older runners show them to be more intelligent than their non-running peers, more imaginative, self-sufficient, reserved, and forthright.
The most common trait among runners of all ages is the belief that they possess the resources needed to achieve their own success. (13) (14)
Running Fact: An abstract presented at the 2018 American College of Sports Medicine Conference indicate runners who exhibit ”perfectionist” tendencies were 17 times more likely to suffer an injury that forced them to miss training as compared to other runners.
When we exercise, the brain recognizes this as a moment of stress, and invokes a “fight or flight” response. The body’s protection mechanism to this new threat is to release the BDNF protein in the brain. The greater the exercise intensity, the more BDNF proteins are released. At the same time, endorphins, another stress-reducing chemical, is released in the brain. The main purpose of the endorphins is to minimize discomfort and block the feeling of pain, sometimes also associated with a feeling of euphoria.
As exercise continues, physiological changes are signaled to the brain, such as body and skin temperature, increased heart and breathing rates. These signals are interpreted by the brain and compared with previous experience to determine allocation of resources.
The brain begins to change as soon as the athlete begins a sport, and the changes continue for years. In just one week, athletes develop extra gray matter, and different regions of the brain begin to interact – some neurons strengthen their connections to other neurons as they weaken their connections to others.
After deciding on a specific goal, to run a fast lap around the track for example, several regions of the brain collaborate to determine the best course of action to complete that goal. Initially, neurons in the front of the brain (the prefrontal cortex) are active; a region vital for the top-down control that enables us to focus on a task and consider a range of responses. By predicting what sensations should come back from the body if it achieves the goal, the brain can match the actual sensations received and revise its plan if needed to reduce error. With practice, however, the prefrontal cortex grows quiet; our predictions get faster, more accurate, and the brain becomes more efficient, learning to make decisions sooner.
In just a few sessions of exercise we become stronger, but not because our muscles have suddenly increased in size. The initial gains that take place are neuromuscular adaptations: the brain gets better at communicating with the muscles, using more of them, and using them more efficiently. The brain also learns to tolerate heat, lack of oxygen, and muscle pain. It becomes better at suffering. In essence, the brain is changing.
Neuroplasticity, or brain plasticity, is the process in which your brain’s pathways are altered as an effect of environmental, behavioral, and neural changes. Neuroplasticity occurs as the brain deletes connections that are no longer necessary or useful while strengthening the necessary ones. Which connections are pruned and which are strengthened depends on life experiences and how recently connections have been used. Neurons that grow weak from underuse die off while new experiences and learning new things strengthens others. In general, neuroplasticity is a way for your brain to fine-tune itself for efficiency. To learn new tasks, you need good plasticity.
Neuroplasticity affects both short-term memory (chemical changes) and long-term memory (structural changes). Initial changes in the brain’s structure take place quickly, showing immediate results. These changes are imbedded in short-term memory, but to transfer these changes to long-term memory requires more time (practice). It takes time and repetition for the brain to re-wire new connections, or pathways, that create long-term learning.
Practice is not a new concept for athletes. Distance runners build mileage gradually to teach their bodies to endure long distances, and then we practice these runs until our body transfers the distance to long-term memory. Sir Roger Bannister learned to run the 4-minute mile in the same way. He reduced the race to its simplest common denominator – 400m in one minute or multiples thereof, and trained until running 400m in a minute, 24 km per hour, became automatic.
The third way the brain changes is in function – how and when neurons are activated. Although each of these changes can take place in isolation, chemical, structural and functional changes typically work in concert to facilitate learning.
Fun Fact:Neuroscientist Charles Limb and others have scanned rappers’ brains during a freestyle rap and during a memorized rap. The studies show that during freestyling, there’s a functional change in their neural networks. Through practice, the rappers have reorganized their brain activity, allowing their improvised lyrics to bypass many of the conscious-control portions of the brain, which regulate behavior.
The greatest discovery regarding neuroplasticity is that nothing affects the brain more than our own behavior, and nothing is more effective than practice to help you learn. In fact research shows that increased difficulty, or increased struggle during practice actually leads to more learning and greater structural change in the brain. These studies have also identified the best methods to prepare, or prime the brain to learn include brain stimulation, exercise, and robotics. (33)
The important take-away, something confirmed from cancer treatments and the study of stroke victims, is that the way our brain functions is unique to each person. It goes beyond the fact that we all learn differently. Every human brain processes commands, makes connections, and functions differently. So the common denominator in learning is practice.
Skill athletes (basketball players, dancers, gymnasts, figure skaters) show greater motor cortex plasticity while endurance athletes (cross-country skiers, orienteers, runners) show enhanced plasticity in task-unrelated brain areas.
Motor Cortex Plasticity In Action: Giannis Antetokounmpo’s slam dunk.
In a blatant show of coordination and focus, Antetokounmpo snared the ball mid-air with his right hand while soaring over the head of Knicks’ guard Tim Hardaway Jr. without seeming to notice the obstacle at all – and then slammed the dunk.
THE LIMITS OF HUMAN ENDURANCE
Fatigue refers to the inability to continue exercise at a given intensity. In all sports and exercise training, the onset of fatigue varies depending on a person’s fitness level, exercise intensity, duration, and environmental conditions (e.g., heat and humidity). Fatigue develops over time, but is largely dependent on duration and intensity.
There are two distinct types of fatigue: central and peripheral. Central fatigue (also called Central Nervous System fatigue) involves the brain and spinal cord rather than the muscles. Central fatigue happens in the regions of the brain involved with mood, emotion, and psychological arousal. This is why being psyched, such as during competition, can help performance, but is also why fatigue, like pain, is relative.
With central fatigue, the brain becomes unable to send enough signals to the muscles to maintain optimal muscle activation, resulting in general body fatigue (tiredness, loss of drive, sleepiness, etc.) and reduced muscle force.
Peripheral fatigue results from the muscles becoming fatigued. A lack of resources within the muscle results in the accumulation of lactic acid, causing a burning sensation and fatigue within the muscle. Although both central and peripheral fatigue result in decreased performance of the muscles, they follow different mechanisms.
The question is, how much can you separate the two? It’s hard to distinguish central fatigue (the brain) from peripheral fatigue (the rest of the body) because the brain tends to influence everything, and is in turn influenced by everything.
THE CENTRAL GOVERNOR
Although fatigue produces the belief that our resources are limited, exercise generally ceases before the muscles are depleted. In fact, in all forms of exercise fatigue develops before all skeletal muscles are recruited. Just 35-50% of the active muscle mass is recruited during prolonged exercise (Tucker et al., 2004; Amann et al., 2006), and even during maximal exercise this increases to only about 60% (Sloniger et al., 1997a,b; Albertus, 2008).
Muscle biopsies from cyclers revealed that intramuscular measurements were no different at exhaustion compared to rest, and that these (ATP) levels never dropped below 50% of resting concentrations at any time during the exercise bout, suggesting fatigue causes people to terminate exercise well before muscle energy reserves are depleted (Noakes & Gibson, 2004; Parkin, Carey, Zhao, & Febbraio, 1999).
This supports the updated theory that fatigue is a central (brain) perception – a sensation or emotion – and not a direct physical event. Exercise seems to be regulated in anticipation to insure biological failure never occurs (in healthy humans).
Based on studies done at the time, this new definition of fatigue supported the idea that a central governor reduces the mass of muscle recruited during prolonged exercise gradually to prevent the development of muscle glycogen depletion and muscle rigor, or of hyperthermia leading to heat stroke. In other words, fatigue is one way the brain protects the body and preserves homeostasis by regulating power output – what runners will recognize as pacing.
If fatigue is an emotion, it will (like pain) be perceived differently by different people. Ultimately, the Borg Scale of Perceived Exertion was developed, which matches how hard you feel you are working to a “relative” scale of numbers from 6 to 20. The physical sensation of fatigue increases along the Borg RPE scale as a linear function of exercise duration. Maintaining a strategy that follows this linear increase of effort has been thought to produce the optimum pacing strategy (start slow/easy, finish faster).
The Borg RPE scale has since been described as the manifestation of information about body temperature, oxygen levels, fuel storage, and the more subtle indicators like mood or how much you slept last night. Perceived effort (RPE) gradually increases based on a combination of these psychological and physiological changes. Runners probably don’t consciously correlate pacing to the Borg scale, however, and researchers disagree as to the extent pacing decisions/computations take place consciously and voluntarily or unconsciously and automatically. Where they do agree is on effort: how hard it feels dictates how long you can sustain.
Understanding how we control the feeling of effort is still being studied, especially as it relates to pacing. Two concurrent studies recently looked at pacing methodologies. One uses an effort-based approach where runners increased pace based on self-determined effort rather than the traditional approach of pre-set increments along an increasing scale (start slow/finish faster). The effort-based subjects reached higher VO2 max values. This study, by Alexis Mauger, was co-published in the British Journal of Sports Medicine alongside another study (by Noake’s student, Fernando Beltrami) which used a “reverse” protocol that started fast and gradually slowed. This protocol produced higher than “max” VO2 max values.
Alex Hutchinson aptly summed up these conclusions in his book Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance, ”If you execute a perfectly paced race, that means you effectively decided within the first few strides how fast you would complete the full distance. There’s no opportunity to surprise yourself. . .”
Once exercise begins, pace is continuously modified by continuous feedback to the brain from conscious sources including information of the distance covered (Faulkner et al., 2011) and of the end-point (duration and intensity). Studies show an athlete’s perceived exertion can be positively influenced by knowing the duration of an exercise bout, and that energy is held in reserve and available for an end-spurt regardless of their rating of perceived exertion (RPE). (27) (28).
Other conscious deceptions that improve performance and positively impact RPE include sudden noise, music, seeing the finish line or an encouraging smile, rinsing the mouth with carbohydrate (without actually ingesting the fluid), being provided with inaccurate information by a clock that runs slowly, or the pace of a prior performance that had been deceptively increased by 2%, and a host of psychological factors, including hypnosis.
Interestingly, just swishing a glucose solution in the mouth led to improvements in 1-hour cycling performance, whereas intravenous infusion of glucose did not (Carter, Jeukendrup, & Jones, 2004.) These effects are probably not specific to glucose; recent evidence suggests that simply handling ibuprofen without ingesting it promotes pain relief, for example (Rutchick & Slepian, 2013). Glucose is absorbed almost entirely in the gut, so it would be impossible for glucose briefly swished in the mouth to cause an increase in available blood glucose (Gunning & Garber, 1978). Instead, the presence of glucose in the mouth may simply provide an anticipatory signal of glucose availability, which leads some experts to argue that the body’s glucose resource issue is one of allocation, not of limited supply. (32)
The Greatest Human Strength
RPE prevents the athlete from continuing exercise at a given pace when it might cause bodily harm. This anticipatory regulation, or pacing, balances the desire for optimal performance with the requirement to defend homeostasis. You may not even notice the body’s regulatory reaction at first, but gradually the effort required to sustain a given pace increases. Ultimately, exercise is terminated when the perceived effort reaches a level that is considered higher than the perceived benefit. (25) This conscious decision of whether to maintain, increase or decrease the current workload or indeed to terminate exercise altogether may be the outcome of a balance between motivation and the sense of effort.
One of the most obvious characteristics of human exercise performance is that athletes begin exercise at different intensities, or paces, depending on the expected duration of exercise – a bout of short duration is begun at a much faster pace than one of longer duration. Also, athletes typically run harder in competition than in training. The point is that athletes always show an anticipatory component to their exercise performance that seems to be influenced by neural mechanisms relating to willpower (self-control), motivation and belief.
In 2013, at 64 years old, Diana Nyad set out to be the first person to swim from Havana to Florida without a shark cage. A marathon swimmer can expect chafing, nausea, severe shivering and hypothermia, swollen lips, an irritated mouth, diarrhea, extreme weight loss, and sleep deprivation. At the peak of her strength, age 28, she tried but failed to complete this swim. She later said: “I never had to summon so much will power. I’ve never wanted anything so badly, and I’ve never tried so hard.” Coming back to the sport 30 years later, she claimed, “I thought I might even be better at 60 than I was at 30. You have a body that’s almost as strong, but you have a much better mind.”
Nearly 53 hours after jumping into the ocean in Havana, Nyad finished the 110-mile (180 km) swim; her fifth attempt since 1978 and the fourth since turning 60. In one interview she said, “ — you tell me what your dreams are. What are you chasing? It’s not impossible. Name it.”
Research has suggested that self-control relies on a limited resource – that it unfortunately appears to wane over time similar to a muscle that becomes fatigued with overuse. Humans are less willing to exert effort the longer they have already exerted effort. This so-called ‘ego depletion’ effect has been supported by over 200 separate studies, which show that repeatedly resisting temptation drains your ability to withstand future enticements. With the right motivation, however, it appears you may be able to persevere even when your willpower strength has been depleted.
Motivation combines internal and external factors to stimulate the desire and energy to be continually interested, committed to, or make an effort to attain a goal. It is the result of conscious and unconscious factors such as the (1) intensity of desire or need, (2) incentive or reward value of the goal, and (3) expectations of the individual and of his or her peers. These are the reasons we behave in a certain way. (35)
When motivational arousal is high and must be concentrated within a brief period, the intensity of motivation must also be great. It is the difference, for example, between moving 100 pounds of books one book at a time or all at once, or running an all-out 400m challenge versus enduring a 10,000m race or marathon. Motivation tends to increase as the difficulty of the task increases until the required effort is greater than is justified by the motive – or the required effort surpasses the individual’s skills and abilities. At this point motivational arousal drops. We can see this play out time and again on the marathon course where runners find the reward of finishing the race no longer surpasses the pain of continuing to run.
An increasingly accepted body of exercise physiology has emerged that looks to psychology to understand endurance. This ‘psychobiological model based on motivational intensity’ theory (Brehm and Self, 1989; Gendolla and Richter, 2010) suggests that perception of effort and potential motivation are the central determinants of exercise duration, with people consciously deciding how much or how little effort to apply based on a number of considerations. These new studies suggest endurance is strongly influenced by the manner in which the brains of runners generate the sensations of fatigue.
Remember that fatigue is an emotion entirely self-generated by each athlete’s brain, and therefore unique to each individual – or illusionary. Based on this model, the winning athlete is the one whose illusionary symptoms [of fatique] interfere the least with actual performance.
But psychologists have also found evidence among athletes in what they call “self-efficacy,” or a belief in their own competence and success. This is where self-efficacy converges with the placebo-effect.
Studies repeatedly confirm that interventions such as sugar pills, ice/cold/lukewarm baths, massage, caffeine, beet juice, altitude training, or even a “lucky” ball, in the case of golfers, improve our game. Athletes everywhere swear by them, yet science repeatedly proves the effects are null or ambiguous at best.
Christopher Beedie, a sports psychologist at the Canterbury Christ Church University in England, is among the few scientists who study the placebo effect in athletics. His work often examines how elite athletes perform under intense fatigue when they think they have some kind of performance enhancement.
Beedie recently finished the largest placebo study ever done in athletics—600 subjects in all—and found that the people most likely to respond to placebo were the ones experienced using supplements. Perhaps the previous supplements the athletes had taken primed them to have a placebo response, or maybe athletes who naturally respond to a sports placebo are also likely to have taken performance enhancers. Either way, it suggests that artificially boosted performance and performance boosted from expectation produce similar effects. In some cases, athletes performed better when given a sugar pill than the athletes that were given certain performance enhancing drugs.
Even in the arena of these performance enhancing drugs and placebos, especially for elite athletes, there’s a limit to the benefits of both psychological and pharmacological performance enhancers, so why not just use belief instead? “We’re trying to educate athletes into the idea that the headroom is there to be filled, and drugs are not necessarily the only way of filling that headroom,” Beedie says. “Confidence is the drug of champions.”
In the end, the question we all share is how do we go further/longer/faster; what is the secret of endurance?
Dr. Lara Boyd, Director of the Brain Behaviour Lab, is a physical therapist and a neuroscientist leading the effort to understand what therapies positively alter patterns of brain activity after a stroke. In a research-based TEDx Talk, Boyd describes how neuroplasticity gives you the power to shape the brain you want.
The new discovery is that learning changes our brains differently. My brain will go about learning a new task differently than your brain will learn the same new task. Understanding these differences, these individual patterns, is the future of neuroscience – and possibly sports science as well.
Boyd suggests we understand how we learn. What is it that your brain responds best to? For runners learning to endure, maybe this means experimenting with self-talk, visualization, or forcing yourself to try a new training approach altogether. Coaches are increasingly realizing they can push athletes to new limits just by asking them to do something they didn’t think they could do.
Even when athletes were sufficiently motivated, by monetary rewards or recognition for example, they did not perform as well as athletes who were led to believe they could accomplish the task.
Humans keep doing impossible things. Running a 4-minute mile, running 100 miles, lifting 500 pounds over our head, being an undefeated wrestler with no arms or legs. Each of these things have been accomplished even though public opinion claimed they were impossible at the time. The difference was that in each example these people believed, or were tricked into believing they could do this thing.
The pursuit of endurance is a unique journey for each of us, but it seems science has concluded what athletes have known all along – that there’s more in the tank, if you’re willing to believe it’s there.
A 2017 animal study published in the journal Behavioural Brain Research concluded that a sprint interval training regimen, rather than intensive endurance training regimen has the potential to improve anxiety and depression through a greater increase in (brain-derived neurotrophic factor) contents in the brain.” (10)
A NOTE ON MUSIC: Diversionary techniques to distract the mind, such as listening to music or self-talk, were discussed in a previous post on Pain, and have proven effective in lowering the perception of effort. Music, in particular, can narrow attention and divert the mind from the sensations of fatigue. However, this holds true for low and moderate exercise intensities only; at high intensities, perception of fatique overrides the impact of music. At high intensities, the physiological feedback to the brain regarding things like respiration rate or blood lactate accumulation dominates the conversation, and music fails to divert the mind from the body’s feedback. Listening to music seems to shape how the mind interprets symptoms of fatigue, however, which may enable athletes to perform more efficiently resulting in greater endurance. (16)
Studies demonstrate that running economy significantly changed, along with perceived effort, based on whether the runners knew they were running 20 minutes or whether they did not know the duration, even if they ended up running 20 minutes.
In a recent study published in BMC Medicine, the 64-day ultramarathon TransEurope FootRace Project followed 10 ultra-endurance runners covering about 4,500 km from Bari, Italy to the North Cape, Norway recording a large data collection of brain imaging scans. This study indicates cerebral atrophy among the runners amounted to a reduction of approximately 6% throughout the two months of the race, but was completely reversed within the 6-month follow-up. The results of this unique study, which revealed no brain lesions, gave clues to the effect of extreme fatigue with energy deficits on cortical grey matter volume. Having an understanding of what the brain does during an ultra-marathon event could help refine research on the matter of mind over muscle in determining exercise tolerance in endurance athletes, but may also benefit military personnel involved in physical work over prolonged periods and patients affected by unexplained chronic fatigue syndromes.
A 2011 study (Erickson et al.) demonstrated that 1 year of aerobic exercise increased the volume of the hippocampus by 2% in elderly adults, while controls who underwent 1 year of stretching exercises exhibited a 1.4% decrease in hippocampal volume.
Kids who participated in vigorous physical activity scored three points higher, on average, on their academic test, which consisted of math, science, English, and world studies. (23)
Telling runners they look relaxed makes them burn measurably less energy to sustain the same pace. Giving rugby players a post game debriefing focused on what they did right rather than what they did wrong had effects that continued to linger a full week later. (34)
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.
The sixth in a series of posts about what makes runners uniquely equipped to run. This post explores why it hurts. . . and how to make it stop.
“Being a distance runner is about handling pain. If you can’t manage pain, you probably won’t end up as a distance runner.”
KARA GOUCHER, American long-distance runner
There are many ways to categorize pain, but a broad definition would be acute vs chronic. Acute pain comes on suddenly, has a limited duration, and is often caused by damage to tissue (bone, muscle, organs). Chronic pain lasts longer and is more resistant to medical treatment, such as with long-term illnesses like osteoarthritis.
1 of 3 graphics from totalinjury.com: How the Brain Responds to Pain
WHY IT HURTS
Recurring pain is normally caused by:
mechanical injury, such as a fall or twisted joint;
repetitive micro trauma, as with overuse injuries that cause stress to the tendons or bones, or micro tears to the skin, as with calluses or blisters; or
muscle imbalances – weak glutes, overdeveloped quads, or not having a strong core, for example.
The medical community says “pain is what you say it is” because pain is subjective. A person’s general health, previous experiences, stress, anxiety, depression, and motivation can influence how we perceive pain.
Soreness vs Pain
Everyone gets sore with intense exercise. Pain from sore muscles is usually felt the next day and comes from microscopic tears in the muscle fiber. Rebuilding of the muscle damage creates larger, stronger muscles.
If soreness seems especially severe and lasts for several days, it’s probably delayed onset muscle soreness (DOMS), and may be a result of performing new exercises at a relatively high intensity. Studies suggest theories to explain the mechanisms of DOMS, including lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and enzyme efflux.
Muscles build up resistance to DOMS with multiple sessions, but new runners who can’t shake the burn after a day or two can try massage or light exercise. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms.
Reference: Cheung K, Hume PA, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003;33:145–164
A sharp pain during exercise – in contrast to muscle soreness – can be indicative of an injury. This type of pain can be located in the muscles or joints, and may linger without fully going away even after a period of rest. Runners should not push through a sharp pain since it can exacerbate the injury.
ATTACK AND HEAL
The body’s response to injury is inflammation, which is designed to attack and heal. The early stages of inflammation enlist the immune system to protect the body and control infection. Like pain, inflammation is categorized as acute or chronic.
John Hunter (1728–1793, London surgeon and anatomist) was the first to realize that acute inflammation was a response to injury that was generally beneficial: “But if inflammation develops, regardless of the cause, still it is an effort whose purpose is to restore the parts to their natural functions.”
Increased blood flow to the area causes redness and heat; the accumulation of fluid causes swelling, pain is due to the release of chemicals that stimulate nerve endings, and loss of function is a combination of factors.
Inflammation is part of the natural healing process; without it wounds and tissue damage would never heal. Reducing inflammation may be necessary in some cases where inflammation has caused further inflammation – becoming self-perpetuating, which may lead to chronic inflammation.
When joint tissues have not been given adequate time to fully regenerate between workouts, they may become chronically inflamed and/or degenerate to the point of serious injury. Overuse injuries, such as runner’s knee, develop in this manner. It’s the harder than normal workouts that cause significant tissue damage and post-workout inflammation. For this reason, most training programs increase duration and/or intensity more slowly to allow the body the necessary time to recover and adapt.
Note: Scientists at Emory University School of Medicine in Atlanta, Georgia, found in a study that poor sleep quality, and short sleep durations are associated with higher levels of inflammation.”which in turn increases the risk of developing heart disease and stroke.” What drives the inflammation in the first place is still a mystery.
Physiologists at the University of Wisconsin used spinal injections of a powerful painkiller to block lower-body pain in a group of cyclists; the cyclists actually got slower. They initially felt great and started out faster than normal, but then faded. Without the feedback of pain, they couldn’t pace themselves properly. Training to live with pain: What we can learn from Olympic athletes
Everyone reacts differently to pain, which means how each person manages their pain will also be unique. Complicating each approach is the fact that injuries themselves react differently to treatment therapies. Following is at least a partial list of pain management therapies, in no particular order.
Ice or Heat? If the injury is sudden and acute, ice is preferred for the initial two or three days post injury – 20 minutes each two to three hours until the ‘heat’ comes out of the injury. Ice will also reduce inflammation and provides pain relief by reducing the blood flow to that area. (A bag of frozen vegetables, such as peas or corn, is an excellent way to ice an injury.)
Heat should be avoided in the first 48 hours as it encourages bleeding. Once the ‘heat’ is out of the injury, heat packs can be used to stimulate blood flow, which will aid healing, help muscles relax and ease the pain – 20 minutes a few times a day using a heat pack, or alternatively take a warm bath or hot shower. Heat stimulates sensory receptors to block the transmission of pain signals to the brain.
Post Exercise: Ice, Heat, or Both? Although light exercises or gentle stretching may be equally effective in reducing pain after a hard bout of exercise or race, ice baths, or cold water immersion, has long been a popular interventional strategy (the ideal temperature range seems to be between 50 and 59° F for 10-15 minutes).
There is some reasoning that the benefit has less to do with the temperature of the water than the immersion itself, however, and the deeper underwater the body is, the better (in other words, jumping in a lake or swimming pool is even better than soaking in a tub).
Tart Cherry Juice: Researchers have found tart cherries reduce a type of inflammatory activity in the body by about 38% (Naproxen, a powerful NSAID, provides a 41% reduction). Long-distance runners drinking cherry juice before marathon-level events have less muscle damage and up to 1/3 less post-event soreness compared to those who did not drink cherry juice. Students given 12 ounces of tart cherry juice before and after strenuous resistance training suffered only a 4% reduction in muscle strength the next day, compared with a 22% loss in exercisers drinking a placebo.
Meditation: studies show that meditation increases immune function, decreases pain, decreases inflammation at the Cellular Level, decreases anxiety, depression and stress, increases grey matter of the brain and cortical thickness in areas related to paying attention, improves focus and memory (see all the studies at psychology today.com.) Lebron James, Kobe Bryant, Misty May-Treanor and Kerri Walsh are a few of the athletes that meditate to improve their game.
Strapping tape vs supportive tape: taping can stabilize and support the injury, provide pain-relief via de-loading of the vulnerable or painful structures, and facilitate normal movement, muscles or postural patterns.
Rigid strapping tape is commonly referred to as ‘sports tape’ or ‘athletic tape’.
Elastic strapping tape can be used when less rigidity or support is required.
Kinesiology tape is an improved version of elastic sports tape that acts to dynamically assist muscle function.
Massage: Massage has been utilized in the treatment of illness and injury for thousands of years by health care practitioners as a treatment for reducing stress, pain and muscle tension. Nonetheless, research has generally failed to demonstrate massage significantly contributes to the reduction of pain associated with delayed onset muscle soreness, enhances sports performance and recovery, or plays a significant role in the rehabilitation of sports injuries. The most successful treatments combined a massage therapy program that also included stretching, walking, swimming, aerobics, strengthening exercises, and education on posture and body mechanics. (Reference: The Role of Massage in Sports Performance and Rehabilitation: Current Evidence and Future Direction – Jason Brummitt, MSPT, SCS, ATC North American Journal of Sports Physical Therapy)
Massage therapy modalities can include Swedish, Deep Tissue, Sports Massage, Trigger Point Therapy, Thai Massage, Thai Herbal Compresses, Hot Stone, Lymphatic Draining Therapy, Shiatsu, Cupping, and Reflexology, among others.
Acupuncture: Dating back more than 2,500 years, acupuncture is based on the premise that there are more than 2,000 points in the human body connected by bioenergetic pathways, known as meridians where Qi, or energy, flows. When a pathway is blocked the disruptions can lead to imbalances and chronic disease.
In various studies, acupuncture has proven beneficial in the treatment of chronic health conditions, and has been found safe for children. It works, in part, by stimulating the central nervous system to release natural chemicals that alter bodily systems, pain and other biological processes.
Proprioception / Balance Exercises: These exercises teach your body to control the position of a deficient or injured joint. A common example is the use of a balance or wobble board after an ankle sprain. Unpredictable movements provoked by the balance board re-educates the body to react without thinking, restoring natural balance and proprioceptive reactions.
Stretching: In its most basic form, stretching is a natural and instinctive activity. Considered a form of exercise, stretching improves the muscle’s felt elasticity and achieves comfortable muscle tone. The result is a feeling of increased muscle control, flexibility, and range of motion.
There are five different types of stretching: ballistic, dynamic, SMF stretching, PNF stretching, and static stretching. (Read about each one here.)
Athletes stretch before and after exercise in an attempt to reduce risk of injury and increase performance, although these practices are not always based on scientific evidence of effectiveness, and depending on which muscle group is being stretched, some techniques may be ineffective or even detrimental. A study in 2013 indicates static stretching (vs dynamic stretching) weakens muscles, or “stretch-induced strength loss,” which you would want to avoid too close to exercise or competition. (Note: other studies have found that reducing the amount of time a static stretch is held (say 15 seconds instead of 30) is beneficial to some individuals pre-exercise.)
Muscle “tightness” results from an increase in tension from active or passive mechanisms. Passively, muscles can become shortened through postural adaptation or scarring; actively, muscles can become shorter due to spasm or contraction. Regardless of the cause, tightness limits range of motion and may create a muscle imbalance – which we have learned will eventually lead to acute or chronic pain. (Source: International Journal of Sports Physical Therapy)
Static stretching is more effective than dynamic stretching for those recovering from hamstring strains, and they seem to recover faster by performing more intensive stretching than less intensive stretching, and a gentle, static stretch relieves the pain associated with a sore Achilles’ tendon. Patients with knee osteoarthritis can also benefit from static stretching to increase knee range of motion. Researchers have shown that 12 months of stretching is as effective as strengthening exercises or manual therapy in patients with chronic neck pain.
The effectiveness of stretching is very individual, but most research concludes a routine of regular stretching, especially as you age, is beneficial in overall conditioning, can alleviate pain, and will improve muscle strength over time.
Yoga & Pilates: Pilates is a form of exercise that focuses on the activation of the deep core muscles, while yoga is a mind-body workout that combines strengthening and stretching poses with deep breathing and meditation or relaxation. Both exercises will improve flexibility, core stability, overall body strength, postural alignment, balance, reduce the chance of re-injury, and help correct muscle imbalances that created the pain initially.
Bergamot: Bergamot essential oil reduces the feeling of pain in the body by stimulating the secretion of certain hormones which lessen the sensitivity of nerves to pain. Massage a few drops into the affected area for temporary relief. (Read more.)
Arnica: dating back to the 1500s, Arnica is used topically for bruises, sprains, muscle aches, wound healing, joint pain, inflammation and swelling from broken bones. Arnica is available in gels and creams, but should never be applied to an open wound or taken orally, except in an extremely diluted form.
Aspirin: A standard (325 mg) or extra strength (500 mg) dose is an effective pain killer and also works as an anti-inflammatory, making it a possible treatment for rheumatoid arthritis, osteoarthritis, lupus, and mixed connective tissue disease. (People at increased risk of bleeding should avoid aspirin. Contact your health professional to discuss possible contraindications before beginning any pain management therapy.)
Over-the-Counter Pain Relievers include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Motrin, Advil) or naproxen (Aleve, Naprosyn)
Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs also reduce inflammation. (Inflammation is a necessary part of the healing process, and reducing injury-related inflammation may not always be an effective treatment therapy.)
Acetaminophen (Tylenol) works on the parts of the brain that receive the “pain messages.” NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain.
Using NSAIDs increase the risk of heart attack or stroke and have also been known to cause stomach problems. (Source: webmd.com)
One study on the effects of Ibuprofen on skeletal muscle showed that taking ibuprofen during endurance training canceled running-distance-dependent adaptations in skeletal muscle.
Another study confirmed in the laboratory that the use of NSAIDs after exercise slowed the healing of muscles, tissues, ligaments and bones.
During the first 2 to 3-days of an acute injury, taking a NSAID is advised, but once you exceed this window, general advice is let the body do the work. No evidence shows that a NSAID will provide benefits during a run or race, and may hinder.
A list of possible side effects of NSAIDs can be found at nhs.uk.
A Montane athlete, Marcus Scotney, had a potentially life threatening experience following the 2014 Iznik Ultra in Turkey. Read an interview following that event with UK’s key specialist on kidney function, Dr Richard Fluck, regarding the impact of NSAIDs and Sport.
Note: People given a placebo for pain control often report that the pain ceases or diminishes.
This post is meant for informational purposes only. It is not intended to provide medical advice. Please consult a physician to discuss your specific pain/injury, the treatment options most appropriate for you, and to ensure there are no contraindications in the treatment options you may adopt.
Hitting the Wall: In endurance sports such as cycling and running, hitting the wall or the bonk is a condition of sudden fatigue and loss of energy which is caused by the depletion of glycogen stores in the liver and muscles. (Wikipedia)
Alternative Definition: a collapse of the entire system: body and form, brains and soul.
Etymology, usage, and synonyms: The term bonk for fatigue is presumably derived from the original meaning “to hit”, and dates back at least half a century. Its earliest citation in the Oxford English Dictionary is a 1952 article in the Daily Mail.
The term is used colloquially both as a noun (“hitting the bonk”) and a verb (“to bonk halfway through the race”). The condition is also known to long-distance (marathon) runners, who usually refer to it as “hitting the wall”. The British may refer to it as “hunger knock,” while “hunger bonk” was used by South African cyclists in the 1960s.
It can also be referred to as “blowing up”.
Possible Symptoms: a fast or pounding heartbeat, cranky/irritable, headache, dizziness, light headedness, nausea, hunger, extreme and debilitating fatigue, shaking or trembling, unclear thinking, poor coordination, possibly hallucinations and/or mental confusion, a complete absence of energy.
Endurance athletes experience indescribable ‘pain’ as a result of glycogen depletion: a complete or a near-total depletion of glycogen, the storage form of glucose which is the source of human energy derived from carbohydrates consumed through food.
Glycogen is a molecule derived from the carbohydrates in our diet, which is stored in the body and used as a source of energy. The amount of glycogen stored in the body mostly depends on physical training, basal metabolic rate and eating habits, but the average body stores approximately 2,000 kilocalories of glycogen at any given time – just about enough glycogen to support the average adult for 12-14 hours, or up to about 2 hours of exercise.
Why do marathon runners ‘Hit the Wall’? (Yahoo Answers)
Athletes engaged in endurance exercises produce energy via fat metabolism and the breakdown of glycogen into glucose – both facilitated by oxygen. How much energy comes from each source depends on the intensity of the exercise.
Activating the fat-burning process takes longer (and more oxygen) than burning sugar, which is why the body generally uses glucose unless it has a compelling reason not to. (In extreme cases, such as severe hunger, the body can also use protein for energy.)
Note: Carbohydrates – foods such as rice, potatoes, bread, tortillas, cereal, fruit, vegetables, and milk – are the body’s main source of glucose. If you eat more glucose than you need, your body will store it in your liver and muscles or change it into fat so it can be used for energy when it’s needed later.
With intense exercise that pushes the limits of VO2 max, most energy comes from glycogen and is burned off quickly. Lowering the intensity will also lower the amount of energy burned per unit of time, which is why runners learn not to start a race too fast. Elite runners practice maintaining their ideal race pace with an even effort to extend their glycogen stores for as long as possible – hopefully to the end of the race.
The brain uses glucose exclusively – in fact, it is said that seventy-five percent of the glucose available to the body is used to service the energy requirements of the brain and the central nervous system. Stored glycogen is also used to regulate blood sugar levels in the body between meals.
Once the glycogen is stored in the muscle for fuel, however, it is not flexible in terms of its deployment in the body since muscle-stored glycogen isn’t capable of being shared with or transported to other areas that might require fuel. It must be used at the point of storage.
If the body were to rely solely on glycogen for energy, 31 kg (67.5 lbs) of stored glycogen would be required as compared to 4.6 kg (10 lbs) of fat.
As people become more fit, it has been thought the muscles shift from burning carbohydrates (glucose) to burning fat; in fact, this shift in substrate utilization from glucose toward fat has been a traditional hallmark of trained muscle. In other words, it has been long believed that training improves endurance because it allows the muscles to more effectively burn fat as an energy source.
There are several issues with using fat as the predominant source of energy, however:
Fat is slow to digest and be converted into a usable form of energy (it can take up to 6 hours).
Converting stored body fat into energy takes time. The body needs to break down fat and transport it to the working muscles before it can be used as energy.
Converting stored body fat into energy takes a great deal of oxygen, so exercise intensity must decrease for this process to occur.
Hitting the Wall
“Top-level athletes get closer and closer to their real physiological maximum,” says Dr. Samuele Marcora, a fatigue researcher at the University of Kent in Britain, “but they never quite reach it: the brain applies the brakes before the heart, lungs or muscles fail.”
Findings in a study released in May 2017 (PPARδ Promotes Running Endurance by Preserving Glucose) shows that rather than training the body to use fat more efficiently as previously believed, training actually teaches the body to burn less glucose (remember, the body simultaneously burns a combination of glucose and fat depending on the level of intensity).
In other words, the body prioritized energy derived from fat (FA catabolism) thereby lowering the conversion of glucose to energy (glycolysis) with the net effect of preserving systemic glucose reserves in the body. This new thinking is that training progressively re-programs muscle to burn less glucose, preserving it as an energy source for the brain.
A focus of the study was to better understand ‘hitting the wall’ – their results show that when the brain runs out of glucose, the body shuts down. . . the wall is made of sugar.
In endurance sports, ‘hitting the wall’ is a dramatic demonstration of sudden and complete exhaustion. You become disoriented, maybe dizzy, overtaken by sudden and overwhelming fatigue – the symptoms of hypoglycemia, or low blood sugar.
“The surprise of the science here is that the longer the brain stays active, the longer you will be able to run. And so it’s more about the brain and sugar than we previously thought.”
Ronald Evans, co-author of the study, American professor and biologist at the Salk Institute for Biological Studies in La Jolla, California and a Howard Hughes Medical Institute Investigator.
Note: The next logical question for the scientist of this latest study was whether a drug could trigger the body’s exercise gene to instruct the muscles to burn fat and preserve glucose. The chemicals (mimetics) given to the mice in their study improved performance by 70%. Their goal now is to quickly transition this into a drug for people (currently known as the ‘exercise pill’), which has been taken on by a Boston-based company, Mitobridge. The study’s abstract concludes by saying, “Collectively, these results . . . highlight the potential of PPARδ-targeted exercise mimetics in the treatment of metabolic disease, dystrophies, and, unavoidably, the enhancement of athletic performance.”
Moving the Wall
It may not be that you have simply hit the wall, maybe there’s a blister on your foot, you’re dehydrated, or worse, your stomach is having its own moment of distress, and no matter how hard your mind wills your legs to move, they refuse. How endurance athletes convince themselves to keep putting one foot in front of the other despite the pain requires that we understand ourselves, and how committed we are to what motivated us to be here in the first place.
There was a good article about pushing through the wall in RunnersWorld a few years ago where one expert was quoted as saying the biggest challenge in pushing through the pain is to understand that this kind of pain won’t kill us. “After a lifetime of avoiding pain or being protected from it, the reason a runner won’t push through a wall of exhaustion could be good old-fashioned self-preservation.” Instead of pushing through the pain, our natural instinct is to stop.
Dealing with pain can be learned; it’s one of the objectives of our marathon training programs. There’s a few different approaches to consider – marathon pace runs help prepare our minds for race day, as will speeding up for the last third of a long run, for example. Another option is to eliminate carbs the day before a long run, or go all the way with a ketogenic diet. If you typically run with music, try turning it off completely for your next long run, or, as some coaches recommend, go for a run when you’re hungry, or tired – something that may not require a lot of planning for some of us. (Thoroughly research the strategies you deploy to understand risks and recovery.)
Whatever the approach, the intent is to prepare our minds for the inevitable end-of-race push we’ll need to reach the finish line.
Elite runners tend to use the attentional strategy of ‘association’ to deal with pain, which involves focusing their attention internally on the body’s sensations, such as muscular strain, breathing, etc. They literally embrace the pain and see it as a necessary part of their eventual success.
Non-elite runners, on the other hand, are more likely to direct their attention away from the body’s physiological signs of distress by distracting themselves and concentrating on other things, or ‘disassociation’.
Although research findings seem to be mixed, association is generally related to faster running times than dissociation, although runners of all levels are more likely to associate during competition and disassociate during training runs.
It is the state of association that holds a greater risk of injury by continuing the effort despite the body’s warning signals. When used properly, however, association can allow runners to successfully ride the thin line between pushing hard and overdoing it.
The Carbo Load
Carbohydrate loading is the technique of gradually increasing carbohydrate and fluid intake each day, beginning anywhere from a week to 24 hours before competition, while exercise is tapered downward, to maximize glycogen storage. Some strategies also called for depleting carbs by exercising intensely and lowering carb intake. This approach has proven dangerous and did not necessarily optimize glycogen stores (Reference: Advanced Sports Nutrition by Dan Benardot).
Each subsequent study seems to tweak the original carbo-loading approach ever so slightly, which is why I’m going to stick with my favorite advice on this one: do what works best for you. However, there’s some interesting information out there in regards to pre-race nutrition and refueling options during the race:
Maybe it’s the taper, not the carbo-loading: a 1992 study at McMaster University reported that a seven-day taper increased glycogen stores in middle-distance runners significantly and also resulted in a 22 percent increase in running time to exhaustion. Diet was not manipulated in this study.
By sharply reducing mileage, as with the pre-marathon taper, the amount of carbohydrate the muscles burn daily also sharply decreases, causing glycogen stores to increase without any change in the diet.
A study of 257 male and female runners in the 2009 London Marathon revealed that carbohydrates eaten at breakfast on race day, during the race itself, or on days earlier in the week were relatively unimportant. It was primarily what people ate on the day before the race that mattered. The runners who consumed more carbohydrates the day before the race maintained their pace past the 18-mile mark where the others did not.
It’s worth repeating that glycogen stores are used up faster if your pace fluctuates above and below a certain average than if your pace holds steady at that average.
On the other hand, if you feel your glycogen stores won’t last, a walking break will help preserve glycogen. You might also try Jeff Galloway’s run-walk-run approach.
Instead of increasing food volume or calories the day before a race, replace some fats or proteins with carbohydrates.
A 2016 study found that carbo-loading may be harmful to the heart by reducing the production of atrial natriuretic peptide (ANP), a hormone that helps the body get rid of excess salt and reduces blood pressure. The principal driver for this acute reduction in ANP appears to be the increase in glucose. A word of caution for Clydesdale runners or runners with pre-existing health issues.
Immediately following an intense workout is an ideal time to consume simple carbohydrates (some say this window of time is within the first hour while others say within 2 hours). There’s a great post by Rob Sulaver on Arnold Schwarzenegger’s website explaining the science behind this (Exercise & Carbs: A Game-Changer). This science shows that consuming carbs during this window of time feeds the muscles without getting stored as fat.
The Carbo RE-Load
Refueling during the race is a science of its own, and the options seem limitless when you consider energy drinks, energy gels, caffeinated options, and homemade varieties. Studies continue to find carbohydrate refueling an important component of maintaining exercise durations longer than 90 minutes.
A Human Kinetics post, Carbohydrate Intake During Exercise, included an excerpt from a study (as documented in the book, Sport Nutrition) that showed glucose concentrations dropping during exercise (at 70% of V.02max) after 1 hour, and reaching extremely low concentrations at exhaustion after 3 hours. With carbohydrate feeding, glucose concentrations were maintained and the test subjects continued to exercise for 4 hours at the same intensity.
The very best article I’ve found on the subject of refueling is at fellrnr.com. This article, “A comparison of the best energy gels”, explains which gels work best, for what reason, a definition of gel’s ingredients, as well as a comparison of the ingredients between major brands of gels, and when to use them. There’s also dozens of links to additional resources from the original article. What follows is an excerpt of this article copied directly from the fellrnr.com site.
1. Energy gels are easy to digest, but they can spike your blood sugar, so ideally take one within 5 minutes or so of starting the run. I think the Peanut Butter Gu is a good option as it has a little bit of fat and isn’t too sweet, but other gels will work well. If you need something more substantial, consider a meal replacement drink like Ensure.
2. An Accel Gel is a good option as far as gels go, but you’re better off with something more substantial like a meal replacement drink (Ensure, etc.) or a chocolate milk. I’d only use Accel Gel if I needed something post run that I had to carry on the run itself.
The time and distances here are broad guidelines. Generally you shouldn’t need carbohydrate support for shorter runs, but if you’re Glycogen depleted from a long run, then a Gel might be useful. On ultra-distances, carbs and gels become less important and you start needing more “real food”.
3. Caffeine can improve performance at all distances, but for shorter distances, it’s probably best to take it before the run. Consider a Red Bull or other caffeinated beverage, or even caffeine tablets. I’d avoid coffee as there is evidence that you don’t get the same benefit from caffeine when it’s in coffee.
4. A little protein can help offset muscle damage, and so swapping your carbohydrate based gel for an Accel Gel might be good on ultras. However, you should be looking at other fuel sources in an ultra for most of your calories.
5. Caffeine can improve performance at all distances, and a gel can be a convenient way of taking it. Note that Caffeine can trigger some digestive problems in some people, and other forms of Caffeine might be easier pre-run. Consider a Red Bull or other caffeinated beverage, or even caffeine tablets.
6. You can sweat out a lot of sodium when sweating heavily, with estimates as high as 5,000mg/hour in some cases. In those situations, even the 200mg of PowerBar gel is not much, but it may help. The sodium in a PowerBar gel could help augment the limited sodium you would get in most sports drinks. (See The Science Of Hydration for details.)
7. There is some evidence that pickle juice can help with Cramps, and that it is the taste rather than the absorption of the pickle juice that helps. Therefore it is possible that the sour, tart flavor of eGels might help deal with cramps.
8. Reactive hypoglycemia is where consuming carbohydrate causes your blood sugar to rise, and then the resulting insulin release causes a blood sugar crash. This is believed to be quite rare and even rarer during exercise. If you think you suffer from this problem, I would advise you to verify this by checking your Blood Glucose. The meters are cheap and easy to use.
9. As well as Hammer gel, consider Carb BOOM or SIS Isotonic gels.
This post is meant for informational purposes only. It is not intended to provide medical advice. Please consult a physician to discuss your specific pain/injury, the treatment options most appropriate for you, and to ensure there are no contraindications in the treatment options you may adopt.