Zen & the Art of DNF

A couple of weeks ago I wrote a post titled, “Oops…I overtrained. Again.” This post, a brutally raw admission of my constant struggles to maintain a balanced, healthy training regimen, was not easy to write. I had a really great autumn season this year, training for nothing in particular but coming off a rest-filled summer with the gusto and enthusiasm of a newbie. But suddenly, like a ton of bricks, a deep fatigue set in around the end of December–a fatigue that was all-too-familiar, and surely indicative of my overdoing it, yet again. I was met with a pervasive, intuitive sense that if I didn’t take a rest week (or two), I’d crumble. I’d hit a physical limit.

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It can be incredibly humbling to meet one’s own limitations, whether physical, psychological, or emotional. At the same time, it can be excruciatingly difficult to tease apart the subtle nuances through which psychology and emotion are intermixed with our physical capacity–especially in endurance sport. When was the last time you heard someone refer to an endurance event as [at least] “90% mental?” For me, it was only a few days ago. Anyone who’s run a marathon or done a long-course tri knows this as fact–and probably has this mantra engraved across his consciousness as gospel. And I tend to agree that the mind is the biggest player–for most of us mere mortals, at least.

But what about those times when the cold, hard boundary of our physical limitations is actually hit, head on? How do we know when to put our egos in our back pockets and keep soldiering on, and how do we know when it’s time to stop?

I have never had a problem motivating myself to keep going in a long race after “hitting the wall”–with enough pep talk, those last few miles, although painful, slowly begin to melt away. However, I have plenty of friends who hold DNFs to their names, and I expect my turn is coming soon. Most professional athletes also boast DNFs, but I think that’s a little bit of a different story given that many of them are attempting to defend titles and personal records; a DNF can be a good way to save face as a pro. That aside, I remain curious about age-group DNFers.

If I were a psychology grad student, I might make a dissertation out of interviewing DNFers to try to elucidate their thought processes when they decided to withdraw from a race. What physical limitations did they experience? How did they know when they’d reached the “point of no return”? Did the decision feel more voluntary, or more essential for survival?

Most importantly, though, would be the thought processes of these athletes. What algorithms did they use to weigh the risk-benefit ratio of continuing the race? Or was logic thrown aside because the physical suffering was too much to bear? Endurance athletes tend to be stubborn folks with few qualms about pushing through minor- to moderate-physical unpleasantries that others would balk at. Also, considerable research has suggested that as a group, age-group triathletes tend to have a much higher pain tolerance than the general population, and even other athletes. As such, I approach my theoretical dissertation with a wary eye.

I recently started watching a Discovery channel documentary series following a team of mountaineers up Everest. One of the crew members, an ultra-fit Danish triathlete with an incredibly endearing, humble personality, is attempting to summit without oxygen–the holy grail of Everest climbing–after three prior unsuccessful attempts. Despite a personal history of severe asthma, Mogens Jensen pushes on with vigor and a charmingly positive attitude. I imagine all audiences following this documentary cheering hard for this delightful Dane, who displays the classic “90% mental” attitude so characteristic of his endurance sport roots.

Unfortunately, Mogens decides–or is forced, rather–to turn back a mere 350 meters from the summit of Everest due to severe frostbite secondary to oxygen deprivation. Obviously this is a rather extreme example, but I wonder how Mogens came to the conclusion that it was time to turn around–especially after encountering numerous prior obstacles that would have sent anyone else scurrying back down the mountain face. How did he know he’d hit that “point of no return”? Plenty of mountaineers push on through frostbite; some make it, some don’t. But Mogens seemed to possess an uncanny ability to understand exactly when he could push on, and when he absolutely needed to stop. He was so close to clinching that dream–and after three prior attempts at that–but he knew that he had to relinquish it this fourth time.

Perhaps most indicative of this minor tragedy was the team guide’s response to Mogens’ defeat. Russell Brice, one of Everest’s most seasoned mountaineers and guides, notes that while he would have been extremely impressed by an asthmatic summiting Everest sans oxygen, he was considerably more impressed by Mogens’ very wise ability to sense exactly what he was dealing with.

This art is utterly beyond me, but I imagine with more experience I’ll have a better understanding of how to interpret the fine gradations of physical wellbeing. Until recently, there was little incentive to develop this talent; I’d always had fine success pushing through and finding comparable alternatives rather than stepping back. More recently, I’ve hit an obstacle that feels a little more concrete–a wall that won’t budge. For the first time in my life, I can’t simply charge through like a rhinoceros at full-speed: rather, I have to stop and turn around–or even better, find a creative way to circumnavigate the boulder blocking my path.

I think I’ll take up rock climbing. I hear it’s good cross -training.

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Oops…I overtrained. Again.

I’m sure we’ve all heard this oft-referenced Einstein quote before: “The definition of insanity is doing the same thing over and over again and expecting different results.”

Well, the evidence is clear. I’m officially insane.

Einstein seems to have been right about everything (I’d like to point out that he was also a very strict vegetarian).

I encountered my first brushes with overtraining during my second year of medical school. A combination of intense, drawn-out, daily trail runs and mounting stresses from my life outside of the mountains ended up being a recipe for disaster. Hugely in denial, reluctant to give up the one thing I felt was serving me at the time (trail running), and being the know-it-all med student I was (smack in the middle of my endocrine unit, nonetheless), I did what any running addict would do: I just kept running.

They say hindsight is 20/20, and in retrospect, I recognize today just how stupid this was. I had all of the classic symptoms of what is referred to in the sports medicine literature as uncompensated overreaching-induced overtraining syndrome: debilitating lethargy, complete lack of motivation, mental fog, slowed heart rate, orthostatic hypotension (e.g. “seeing stars” every time I stood up), decreased appetite, and fitful, unsatisfying sleep. Basically, the concept here is that if an athlete does not compensate (a.k.a. “rest”) after overreaching (a.k.a. pushing hard for a couple of days or even a week), an almost inevitable outcome is insurmountable stress overload on the body: hormonal systems are suppressed, neurotransmitters shut down or dysregulated entirely, oxidative damage skyrockets, inflammation goes unchecked, and a deep, unshakable fatigue settles into the very bones of one’s body. It really kind of sucks.

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The physician in me knows today—and even back then, knew—exactly how to remedy this. It was fairly clear that I was in the early stages of some sort of adrenal insufficiency, and perhaps even hypothyroidism, induced by overtraining, and the natural sequela would be Addisonian Crisis if I didn’t just stop, take the time to recover, nourish my body appropriately with rest, nutrition, and adaptogens, and re-hash my approach to running and training. Instead, I’d down a couple of cups of black coffee, take a pretty heavy-hitting dose of Siberan Eleuthero, and be jazzed up enough to convince myself I was fine.

I rarely felt bad during a run. But it was afterward that I’d feel like I’d been hit by a bus.

I employed stopgap therapies to try and fix the problem while still being able to run large volumes on a daily basis. I took supportive, adaptogenic herbs by the fistful. I set an early bedtime and tried to force myself to sleep for 9, 10, 11 hours a night. I took melatonin, licorice, ginseng, ashwagandha. I even stopped being vegan and started eating meat and eggs for a period of about four months. I only felt worse.

The answer was clear: I needed to rest. By six months into my stint with chronic overtraining, I had read nearly every medical journal publication out there on the subject. I was an expert. Every description pointed to exactly what I was experiencing. And the recommendations at the end of each publication were unequivocal: rest was the primary solution. In some cases only a few weeks of rest do the trick; in others, athletes toe the line between chronic burnout and wellness for years or even decades. Years? Decades?! Even the concept of weeks was unfathomable to my endorphins-hooked brain.

Rest was never an option for me. If I stopped being my endurance junkie self—admittedly, an enormous slice of my identity—then just who would I be?

I would be just another twenty-something girl. Just another medical student. Just another sister, daughter, friend, and girlfriend. While I appreciate these aspects of my identity enormously, I can’t help but admit that they feel frighteningly banal in comparison with my identity as an endurance sport lover.

So what did I ultimately end up doing? I continued to live in denial for another year or so, but during the spring of 2013 my behavior caught up with me. At the time, I was living in New York, but flew back to San Francisco to attend to some school-related things and visit my sister. I distinctly remember feeling so tired, so foggy, and so out of it while I was there. I could hardly motivate myself to get up from the chair I was sitting in. Climbing up a small hill in Bernal Heights Park—a hill that normally would seem like child’s play to me—I felt my heart thumping wildly in my chest and my blood pressure dropping precipitously. I felt so weak that I was sure I was going to pass out. While everyone else around me was enjoying the view and enjoying their lives, I was seeing stars and wishing I could crawl under the covers. That was the catalyst. When I flew back to Connecticut to spend a few days with my parents, I completely broke down, and resolved to give several weeks of rest a genuine try.

It was extraordinarily difficult at first, and I have to admit, it didn’t get much easier. As someone who has grown psychologically accustomed to being very physically active on a daily basis, putting the lid on training for a while was agonizing. I traded my long runs for long walks and long cuddle sessions on the couch with my dog. I dabbled in gentle and restorative yoga. I drank green juices and ate avocados by the bushel. All the while, I felt mentally restless. It was hard to see my running shoes stare up at me from the depths of my closet floor each morning. I had to put them in the basement.

I took some time to rest last summer, and got back into the swing of things last fall. Yet, like any endurance junkie, my tendency to overdo things—without realizing I’d overdone it until far, far after the fact—got the best of me. So here I am, in January, looking back at my insane training log from November and December and, from a logical perspective, not wondering in the least how I’ve managed to find myself in the same exact predicament.

Remember that definition of insanity? Yeah, that’s definitely me.

So what conclusions have I come to as a result of experiencing this? And what advice would I give?

Well, for one, overtraining is definitely a very real thing—and not something to be messed with. Secondly, I think it’s critical that anyone involved in very taxing and stressful endurance sports on a regular basis honestly assess his or her ability to cope with stress, period, at any point in life. At the time when I first began experiencing symptoms, I was puzzled as to why—I had, after all, had no problem recovering from similarly intense levels of activity in previous years. Why such a sudden and drastic shift? It is now clear to me that the non-physical stresses in my life at the time–the unending demands of medical school, the sadness of a failing long-term relationship, confusion and distrust of my own body through experiencing illness–were all taking an enormous amount out of me as it was. Add to that the stress of endurance exercise, which is well-documented to interfere with some of the body’s most vital functions, and overtraining becomes a distinctive possibility.

As I’ve opened up to friends and family about this rather humbling experience, I’ve been met time and time again with a very similar response: “Imagine how much better of a doctor this will make you!” Very true words, but they don’t console the fact that I can’t bust out 18-mile runs every day a la Dean Karnazes. Bummer.

Alas, I suppose I am only human after all. I guess I actually do have to take rest days.

The question, then, is this: what to do with all of the extra free time I’ll gain by having rest days?

Maybe go swimming?

Meh, once an addict, always an addict…

How I Injury-Proofed My Legs: 10 Unorthodox Practices I Use to Run High-Mileage Pain-Free

Injury. It’s the endurance athlete’s worst nightmare. It’s an almost inevitable experience that comes with being a runner. Heck, my personal experiences with sports-related injuries have been so poignant as to drive me to center my career around identifying and treating them.

I currently run more based on how I feel than any set training plan; that said, most of my runs are over ten miles. Some weeks I run up to 60 miles, other weeks I might run 20. However, there was a distinct period of time, several years ago, when I noticed my body starting to break down if I went over 30-35 miles per week. Fearing injury and almost constantly plagued with some strange ache, pain, or tightness, I kept my mileage capped at less than 40 miles per week. Looking for a more sustainable way to continue running and also up my mileage, I started to tinker with my habits and daily practices to find a long-term plan to keep me running strong well into adulthood.

We are all an experiment of one, and here’s what I’ve cooked up in my laboratory so far when it comes to preventing running-related injury for myself. My disclaimer is that what works for me might not work for everyone. That said, I came to these methods after years and years of trial-and-error, and only after I’d mustered up the courage to break away from some of the classic dogma that has come to define running as a sport irrespective of science.

I hope these prove useful, and if anyone has any additional insights or experiences to offer, please post in the comments below!

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Not my legs. But a girl can dream, no?

1. I stopped running every day. Prior to 2012, I let my ego get in the way and was intent on running every.single.day. I wanted to be a “streaker“–and I succeeded somewhat, running at least one mile every day for 1,812 consecutive days (or just shy of five straight years). I ran through many minor running injuries, employing band-aid and stopgap therapies to keep me on my feet. However, a traumatic knee injury brought that chapter of my life to an abrupt standstill, and through rest and periodization of training, I learned so much about how my body responds to and recovers from running. In fact, I not only healed well from my injury by significantly cutting back on my running, but I also got faster!

I can’t say that running less is what caused my improvement so much as an integration of all of the following practices listed below. Regardless, I really do think there’s something to taking at least one–but preferably two or three–days off between runs to allow the body time to repair all of the microdamage that occurs to bones, joints, and connective tissue during the run. Today, I run 2-3x per week, but I make those runs really count. I also never run if I don’t feel fully “healed” from my prior running session. I haven’t had an injury in the two years since I’ve implemented this practice.

2. I started pushing heavy resistance. Want to bulletproof your legs? Pedal backwards on the elliptical, at the highest resistance you can maintain for a minute at 150-180 rpm. Rest. Repeat.

I know “elliptical” is a dirty word among running purists, however for me, high resistance training on the elliptical and bike has been the cornerstone of keeping my legs super strong. Pushing heavy resistance here doesn’t mean classic weight training, although I know that targeted strength training can have huge benefits for injury-prone runners. Instead of doing endless squat and lunge variations, which I find cause flare-ups in my patellofemoral pain, I have found that pushing heavy resistance on low- or non-impact cardio equipment, such as bikes and ellipticals, has a significant impact on my ability to push power as well as withstand pavement pounding.

I think that high resistance and lower cadence, especially on the bike, is underrated. This method of training improves both strength and cardiovascular endurance as well as VO2max, and can be sustained for longer periods if done in an interval format. I have had to do some experimentation to find out which types of ellipticals work for me, since some position my feet awkwardly in the foot pedals and screw with my kneecap tracking. Generally speaking, though, the higher-end ellipticals (Precor, Cybex) that allow the user to alter incline and direction in addition to resistance really provide the most bang for your buck, as they allow you to truly tax every major and minor muscle group in the lower body, depending on angle and direction.

3. I cross-train like it’s my job. See above. Hiking, uphill walking, ellipticalling, pool running, trail running, and snowshoeing together comprise far more of my training time than simple road running.

4. I rotate my running shoes. I rarely wear the same shoe two runs in a row. These days, I am running in everything from super minimalist (New Balance Minimus trail shoe, Vivobarefoot Breatho trail shoe) to super maximalist (Hoka One One Bondi B) to everything in between (Mizuno Wave Rider, Pearl iZumi EM Road H3, Brooks Pure Flow, Nike Free 5.0). As an osteopath and biomechanics nerd, I have come to understand that variety, and keeping the body constantly guessing, are key to injury prevention. I keep a wide variety of radically different shoes on heavy rotation, because each shoe causes a very subtle and slight change in my gait, foot strike, and stride, stressing different muscles and aspects of connective tissue. This is why, at least anecdotally, trail runners are far less likely to experience injury than road runners–they are constantly mixing up their terrain, and landing in novel ways depending on the surface presented to them. As for whether or not there is one optimal and pure foot strike for everyone, well, the jury’s still out on that one. But striving to land midfoot certainly can’t hurt.

5. I stopped stretching so much. Disclaimer: I am already incredibly flexible, and prone to hypermobility. In fact, it was my tendency to have hypermobile joints that caused me to injure my knee several years ago, when my kneecap became dislocated. Someone like me needs to work more on restoring stability and strength to the knees, ankles, and hip girdle rather than encouraging them to become even more lax through extreme yoga postures and stretching. If I feel specific tightness in a certain area, I hit the foam roller instead–that way I can target the muscle belly, rather than risk overstretching tendons, ligaments, joint capsules, etc.

6. I alkalized my diet. What does that even mean? Simply put, it means I have made fruits and vegetables comprise the vast majority of my diet. Because of the vitamins and minerals present in plant foods, along with the process by which they are digested, fruits and vegetables encourage the blood as well as body tissues to shift their pH from a more acidic to a more alkaline state. An alklaline state is a healing state; it is naturally anti-inflammatory, and encourages the healing of tissues as well as improved immune function. You can imagine what this means not only for injury recovery, but also for keeping injury at bay.

Alkalinizing foods include pretty much anything fruit and vegetable. On the flip side, acidifying foods include concentrated protein sources (especially animal products such as meat, eggs, and dairy; but also concentrated vegetarian proteins such as tofu, tempeh, seitan, etc.), some oils, some grains, refined flours, refined sugar, and certain fats. Most whole grains, nuts/seeds, legumes, and pulses are either neutral or very slightly acidic.

Highly acid-forming foods, especially animal protein, have such a profound effect on blood pH that eating even moderate amounts can encourage the body to leach calcium from bones, causing demineralization as calcium serves as a very potent buffer of the acidic conditions. Sounds like a recipe for a stress fracture to me.

So, long story short, I eat tons and tons of fruits and veggies. As much as I can. That’s not to say I don’t eat acid-promoting foods; as a whole foods vegan, grains, nuts, seeds, etc. are an important part of my diet. I just eat them in much smaller amounts.

7. I ignored the scale. Many runners tend to be a little too weight-obsessed, in my opinion. Obviously being somewhat on the lighter side is an advantage, but only up to a point. In my experience, I found that I was actually–and this may seem paradoxical–far more injury prone at a lower weight. Why? I’m not sure exactly, but more and more evidence is lending itself to the notion that nutritional status–especially among women–is a crucial component of the body’s ability to deal with stressful exercise, both on a hormonal level as well as a musculoskeletal level. I think that most of us have a “sweet spot” where are bodies are most nutritionally replete while also balancing athleticism and power. We may not look like Kara Goucher or Josh Cox at said sweet spot, but who gives? Running isn’t about how we look anyway–it’s about how we feel. Right? Who’s with me?

8. I stopped weight training. See #2 and #3. While I do still do some strength work, I have found that classical weight training aggravates my joints, especially in my lower body, a little too much to be worth it. I have found high intensity, high resistance cross-training to be more than sufficient in making my lower body strong and bulletproof.

9. I nipped niggles in the bud. Say wha? Okay, this term–“niggle”–is one I stole from Chrissie Wellington. She refers to little odd aches and pains, muscle tightness at an early stage, etc. as “niggles.” A niggle is that very subtle sensation of tightness in your IT band that occurs after a long run. It’s that slight cramp in your calf after a hill workout. Nipping it in the bud involves attacking it–not too aggressively, though–at first sign. My methods of choice involve foam rolling, Epsom salts baths, magnesium oil, Po Sum On (a Traditional Chinese Medicine remedy), and osteopathic manipulative medicine (if I can cajole one of my poor unsuspecting osteopath friends to fix me!).

10. I trashed the ibuprofen. It is only on extraordinarily rare occasions (read: once every two or three years) that I use any sort of NSAID, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). If I do feel that a certain amount of inflammatory pain is hanging around a little too long–which, to be honest, these days is a rarity–I prefer to use herbal anti-inflammatories, such as Boswellia Serrata and Cat’s Claw (both of which are evidence-based for their ability to attenuate musculoskeletal inflammation). These herbal medications have a lighter, more subtle effect than traditional synthetic NSAID drugs, and also have a lower side effect profile. Why not just go for the ibuprofen, you ask? Well, mounting evidence suggests that turning inflammation completely off, as NSAID drugs do, may not be such a good thing, especially when it comes to healing. Rather, a healthy level of post-exercise inflammation is an important impetus for the regeneration and renewal of muscles, tendons, bones, and joints. In summary, a small amount of inflammation encourages the body to recruit healing cells, such as white blood cells, fibroblasts, and chondrocytes, to areas of microtrauma, such as ligaments and tendons. So instead of popping “vitamin I” so I can run the next day, I take a day–or three–off.

So there you have it–my personal prescription for running pain-free high mileage.
How do you keep your running sustainable?