If it only occurs at distance my 2 best suggestions would be that your system is too anaerobic or you are not replenishing properly.

When you run constantly anaerobically, the elevated waste product that builds up eventually starts causing problems, especially the soft tissue variey. I have seen so many distance runners and triathletes come down with these problems due to incorrect training methods. Have you ever run with a heart rate monitor?? If so what is your usual HR?

What do you drink during your race? These problems also often correlate with a functional B5/6 or folate deficiency derived from sweating.

Hi Dr. Trev;

Thank - You for your reply. I started using a Polar HR Monitor a month
before the Marathon. My anticipated use range was to be 168 - 173 BPM,
as I was hoping to maintain a 7:30 pace. I intentionally went out slower
for about the first 3 miles. I was talking to an old friend I had not seen in
a very long time. He was projecting an 8:00 ppm. I knew I could not hang there long, and it cost me time. However, I thought I might pick it up, I was only 3 minutes behind at the half. Of course when I saw that, I picked up the pace. My average BPM for the 3:48:49 was 175 BPM. So,
YES according to the chart for my age the average recorded BPM was
only 1 beat below my MAX. After I started having problems I dropped
to 143 - 158 BPM, on the back end.

I had 24 oz. of water with me, and started drinking it at the 1/2 marathon. I consumed about 40 oz of water before I headed out the door in the morrning. I also made some treats to eat penut butter & oatmeal, rasins wrapped up in a spinach leaf. I had read somewhere that spinach was suppose to help with the lactic acid build-up. I ate a few of them just
before we arrived at the start. I didn't eat anymore of them though, but
I was eating salad or sandwhices for 2 days before the race with spinach in them. Hey, it woked for Popeye! :P I did drink available gatorade
around mile 15 and at two other stops along the way after that as I was beginning to feel a bit dizzy.

John Murphy suggested that I have my gait analyzed. I will after I am able to see my GP (who is also a runner), but the eariest appt I could get with him is Dec 12! Well, that's OK as I do not necessarily have to begin
training for the May 30, 2006 attempt until January. So, with all this to consider, it will give me plenty to chew on between now and then. Thank - You Very Much Dr. Trev.

Sincerely,

cjchartree

Thanks for the info. John is a great guy with a good head on his shoulders, given that you don't have the issue on the shorer distances though, I would find it extremely unlikely for you to have a Gait issue responsible for this problem. Such a problem should come out a lot earlier than that.

My strongest thought is that you are running to anaerobically for too long. The build up of lactate will inhibit fat metabolism and create a much lower pH for your system. End result... major increase in the risk of soft tissue problems, especially on stabilising areas (tendon insertions, core stability areas etc...) altered cardiac function due to the lack of aerobic function within the heart and a huge demand on blood glucos levels (which wil probably account for the dizzynes).

To deal with it, not only for performance, but also for you health, you need to switch to a more aerobic performance schedule. This doesn't mean running slower in a race if you train right. Without knowing too much about you, your expected aerobic max will be somewhere in the order of 135. When you train, train with a heart rate as close to this as possible without exceeding. It will initially be a slow pace.

As aerobic capacity builds, you should find that you are able to perform at the same speed but with a heart rate average much lower. I would aim to have an average in the order of 150. It's too complicated to explain the training regime you should use here, but purchase "everyone's an athlete" or "Training for Endurance" by Dr. Phillip Maffetone. Both books have specific programs you can use and teaches you how to write your own. Being in an anaerobic excess mode fo long periods has severe consequences in terms of both sport and health.

Mark Allen is a great example of spomeone who needed to do this. Originally running a 3min km with heart rate at 180+, 12 months of training this way saw him doing a 3.05 km with a heart rate of 145.

In terms of fluid, when running aim to create a 3% glucose solution. Easiest way is to dilute gatorade by 2. (eg. 1 litre to 2 litres) Alternatively create the solution by using normal table sugar, add a 1/4 ts of sea salt. To this (specifically for your problem) purchase a B complex vitamin and crush 1/8-1/4 of it into the drink (per 2 litres). This should help the knees during the event. But the anaerobic problem is crucial!

Please do a very quick and simple test for me. Put the HR monitor on, stand still for a minute. Write down HR. Jog properly on the spot for 1 minute. Write down HR achieved. Remain standing for 1 minute. What is your HR after 1 min. Let me know, it will tell me a lot more.

Hi again
I am sure Dr Trev knows what I think on the subject, and to why it happens. To refresh the memories, I find the common cause, and treatable one is the lack of control of the sympathetic nervous system over the demand for blood flow. This is such a common problem, but gets overlooked in the therapy field. It will affect the supply of blood to the muscles and soft tissues and this will result in biomechanical changes, muscle weakness, soft tissue tightness and eventually mechanical pain...somewhere. In a runner the knees would be a more common area of stress loading if the hips are not supporting.
It would be interesting to know where in the knee the pain is, as this may give a clue to the pathway of fascial change.
Two questions though Dr Trev:
1. If it was a case of anaerobic activity, would this not cause a more widespread effect, including muscles and soft tissues, and not a specific localised pain.
2. I was of the understanding that mixing anything with water means the water part takes up to 6 times longer to enter the system compared to water on its own. This means the athlete is dehydrating while liquid is sitting in the stomach being digested, which also takes energy away from where it is needed ie in the muscles.

This is very interesting to me. I am not running Marathons, but I regularly experience knee pain when I do my 10 KMs runs. Sometimes its the left, sometimes the right one, never both. I always thought I am starting to get old (I´m 25). But the anaerobic thing sounds interesting. Could that be the reason for my pain too? I never ran a marathon.

The area of damage will relate to the area of stress. Why would you develop a strained/damaged opponens digiti minimi muscle during running, it isn't really stressed. Quads are amoungst the highest worked muscles from an isometric/eccentric contraction process during runing and thus have the most force placed on them. Hence they give in the easiest. In saying this, if there was a major unsupported overpronation issue, then it would be most likely to occur within the tib post or aductor origin (such as osteitis pubis) due to the alteration in gait receptor function. Anything that creates a generalised weakness will create a problem in the area most significantly stressed first. Eventually, a constant anaerobic state will lead to cardiac arrythmias, psychological changes (such as depression and suicidal tendancies), etc... In this situation the person will go into a sympathetic hyperexcitable state due to the vigours of maintaining an anaerobic basis. The sympathetic problem can easily be controlled by various nutritional, vascular and neurological mechanisms, but it will remain recurrent until the physiological adaptation the cells have undergone is reversed. If this process becomes significant enough, eventually a parasympathetic dominance will occur or burn out of the Hypothalamic-Pituitary-Adrenal axis resulting in a pathologically detectable cortisol, DHEA-s and aldosterone alteration.

In regards to the fluid, don't confuse the average person nutrition with sports nutrition. I remember when I first started working with athletes many years ago, I couldn't understand the change that occurs phsiologically after approximately 55mins of performance until I actually started testing patients at this point. Nutritional guidelines change at this point. In sweating you lose vitamins, minerals and fluid. A common theme amoungst endurance athletes is to replace the fluid without the other components or to have too high a sugar concentration that they consume. Accoding to the research, a sugar concentration in the order of 2-5% will significantly increase the rate of absorption of water out of the stomach. (This backs my personal clinical findings) At 8-12% this reverses as osmosis kicks in to dilute the stomach contents. To the average person, consuming a 3% glucose solution will cause an abnormal sympathetic response through a heightened insulin level. This doesn't occur in the athlete until after approximately 45mins when the body cries for a replacement for the lost carbohydrate.

Talas, it depends on the distance. If it occurs within the 1st km then you need to look more biomechanically, nutritionally and neurologically. eg. Foot pronation issues, pelvic imbalance, leg legnth inequality, folate deficiency, fascial issues, tibial/fibula subluxations, muscle imbalances, vascular issues etc... In saying this however, most people live anaerobic lives and then train anaerobically. It may be a physiological problem within you, but not necessarily the cause of your problem.

I have a much simpler approach. As a physical therapist there are only certain systems I have access to, but I believe by treating these systems, it starts the ball rolling and the body will be able to do the rest. My philosophy is treat the blood flow rate, release any soft tissue problems, and let the body do the work. I think sometimes the body does not get the necessary respect that it deserves. It is designed to survive and will do what it can with what it has to do so, even if it means changing the biomechanical status of the body. If we do too much for the body it will tend to become dependent on the treatment, so keep it simple, trust the body, and give it the guidelines to restore itself.

On the subject of the quadriceps, in all the years I have treated knee problems, no matter what the cause, I have found the quadriceps to be the least common cause, or even victim of another cause. It is often amazing how knee extension strength can remain so strong, when other muscles of the knee or hip are weak. This is also the case with the hip adductors. Quads tend to become victims of the hips and ITB changes more than being the primary. I can see your logic about the quads being worked more, but they are designed to do that so it is a bit illogical for the body to cause stress in the strongest muscles. Remembering of course that without the support of the hip muscles the quads then become jeopardised, and can become phyically overused. But as I have said before the hip weakness stems from poor blood flow rate, which is a result of fatigued vaso-motor nerve cells, caused by overuse/overdemand. A lot of what you explained physiologically will thus fit under this same umbrella, because physiology depends on RATE of blood flow, not quantity or content. The stress will always affect the weakest link, usually an area with less 'give', ie smaller/shorter muscles, ligaments, etc.
Your point on water/sugar intake is taken as I was not aware of this, so thanks. Only one thing there, I would imagine the effect would be better with sugar water, as, correct me if I am wrong, Gaterade, and the like have more than just glucose, ie colourants, flavourants, etc. which are stressful to the human body, and are more things for the body to digest, thus slowing the water intake???
You once said I should look more into the science of what I do. I agree, and do so, but we must realise that we are meant to be guided by science, not blinded by it.

Mate I don't know what you mean by being blinded by science. We may be guided by it, but it is stupid to be ignorant of it. It is easy to believe one thing causes everything but this is just not the case. I know of many people who are blinded by their philosophy. I could make such a case for the power that made the body can heal the body. The first organised system embryologically is the nervous system as it co-ordiantes growth. Science backs this statement. I can say the most common cause of malfunction in the body is neurological and the most common form of neurological interference is spinal in original, specifically that of pathological vertebral movement which results in changes in proprioceptive input to the higher centres and an increase in nociception that alters the Hypothalamic-Pituitary-Adrenal axis, resulting in changes in blood flow systemically, hormonal imbalances, altered cerbellar function within the flocculo-nodular node and vermis altering brain co-ordination decreasing memory, concentration and altering the co-ordination of visceral function leading to disease. In addition the alteration of movement within the upper cervical complex puts direct pressure on the cranial nerve nuclei housed within the upper cervical spine and the dural tension alters medulla function suppressing the auotnomic centres of the brain.

Thus, by ensuring correct alignment and movement within the vertebral column will restore and ensure proper neurological function. The only way to correct vertebral alignment is via highly specific corrections.

All of the above is scientifically justified and based on over 100 years of research. However, it is ignorant to presume that EVERY problem has its cause in vertebral misalignment, even though I have seen in my own office with only the input of a spinal correction infants who don't sleep sleep perfectly immediately after a 60 second adjustment, stroke victims regain movement, chronically constipated adults rush to a toilet within seconds, cerebral palsy kids able to talk again, cluster headaches clear, hypothyrodism heal etc...

Likewise it is ludicrous to presume every autonomic problem has its origin in blood flow when science has shown that athletic activity, chemical imbalances, pineal changes resulting from UV light changes, emotional stress, dietary habbits, hypoglycaemia etc... will all create these imbalances. Thus when looking for the cause of a problem, these are all differentials that need to be checked, tested and possibly primarily dealt with. Vascularity will change is in response to all these issues, hence it is a secondary problem.

In relation to the quad weakness, if you are not finding it you are not testing it properly, its that simple. Quad function is linked to small intestine function, particularly that of the duodenum. Given duodenal function changes with stress and adrenal dysfunction (dysbiosis) and that the villi break down with folate deficiency (extremely common due to change soil conditions) and that quad function is neurologically linked to the transverse arch (one of the most common arches to have problems) quad weakness is very common!!

You need to remember that the Quads are a very strong muscle that may lift 100+ Kg in the average person. Thus if you are using 5-10 kg to test, you will not detect an even partial weakness of 5%. Easiest way to test is to test rectus fem individually, ensure you take out psoas before testing. (Ensure you are performing a G1 muscle test not a concentric test as it will give false readings if the wrong nerve fibres are activated.)

In regards to the "they are designed to do that" comment, every muscle is designed to do that, so why does any muscle become damaged? Proper function is only obtained in the properly neurologically, chemically, physiologically and biomechanically functioning individual!!

I also dispute your reasoning that physiology is determined by rate of blood flow. It isn't. Rate of blood flow is altered by the availability of required nutrients. Thus it is nutrient count and neurological function that governs physiology. The RATE of flow is a consequence of nutrient availability and neurological function, not vice vers.

Finally the body will only heal itself if the aggravating stress is removed. If you keep cutting the same area it will never heal. Likewise if you constantly consume refined sugar a T7-9 thoracic problem will never correct, nor will the quadrecp problem in a patient with a folate deficiency or dysbiosis. If you don't think laterally you will fall victim to your own phillosphy.

My implication is that too many of my colleagues and others in the medical field are so busy looking at the smaller intricate details that they forget that the body is a logical and 'common sense' mechanism.

I don't dispute that the nervous system is where most faults would lie, this is what I have been saying, but it seems that the concept of nerve cell fatigue is not being grasped. This IS where it begins, which then affectes the blood flow rate due to a lack of blood vessel tone and reduced peristaltic action of the vessels, which then affects a lot of other systems, and can cause a lot of other changes in the body be they physical or physiological or neurological.

I do, however, find it difficult to grasp the concept that a common cause is spinal in origin (primarily), giving that the spine itself is suspended and thus controlled, position-wise, by connective tissues. The spine is thus dependent for its movement on the soft tissues and muscles. Any change in soft tissue shape or tension will adjust the position of the spinal segments. Two bones on their own will never come closer or move without the action of an outside force. When 'spinal manipulation' is done there are soft tissues between the applicator and the bones and it is adjustments of these that cause the effect and thus re-positioning of the spinal segments and hopefully they will remain so. Changes in the soft tissues, however, are a result in most cases to some form of stress, one of which is an altered blood flow rate, which causes connective tissues to shrink, thus placing stressful forces on bony structures and altering their position. hence my angle of blood flow rate being a major cause of dysfunction.

So I would add a prefix to your chain of events

, and put in fatigue or changes in function of autonomic nerve cells, slower blood flow rate, alterations in connective tissue tension, malpositioning of spinal segments...

To reiterate, I have never said

, but the autonomic nervous system gets stuck in a vicious cycle set about by its own fatigue state from overuse as it cannot control its own blood flow rate when dysfunctional.

I have done spinal mobilisations, and manipulations, and I agree the results can be amazing as you listed there, but my question has always been: Is it the change in position of the spine that causes the change or is it the alteration in the connective tissues that rearranges the spinal segments, due to the pressure put on the connective tissues altering them from a chrystalline form into a gel form and thus altering their shape, and mechanical pull? Personally I feel it is the latter, as I have worked extensively with soft tissues and found boney segments repositioning without directly manipulating them.

As for the quads, I do understand the links with the small intestine, not to mention teh continuous link up through the neck, etc as often when working on the fascia of these muscles you can hear the gut gurgling, as if being released of tension. Obviously you seem to have machinery to do your muscle testing, (un)?fortunately I use manual muscle testing, and trust my feel, and the patients feedback rather than a machine. I have no doubt if you want scientific evidence you need figures and reference points, but I feel I get accurate readings from touch, not to mention repetetive readings, which makes it scientific.

If your nutrition is not being delivered quickly enough (blood flow rate) your body will not be nourished at its erquired rate thus will not function at an optimum rate, thus physiology suffers.

One of the reasons I am successful is because I think laterally, also logically. I will however submit to one thing, another of my policies has always been, 'If it works and is safe use it. If it is not safe, make it safe and use it.' What I do works, what you do works, ain't the body amazing!

PS One thing that does fascinate me is how you can isolate the rectus femoris, for 2 reasons.

1. The body as a functioning unit does not work in or understand single muscle actions.
2. The nerve supply to the quadriceps is a shared supply, not from individual segments, so I find it hard to believe the rectus femoris can or will work on its own, and that nerve fibres to the other quads muscles will somehow be 'not activated'.

Muscles are designed to work as units and it is this type of testing, 'isolating' individual muscles that gives inaccurate readings of strength. It also when used as a strengthening technique trains muscles in a way that they are not going to be used in regular natural movements.

I have always found it very simple to guage muscle strength by testing a muscle in its 'weakest' range (eg shoulder abd at 90 degrees, knee extension at full extension, etc) If they are strong in their 'weakest' range then their basic strength is good.

In reference to your first posting, your logic makes sense, but neurology doesn't work that way. You have a concept of efferent without the neuological knowledge of afferent. Your thinking is correct, but the neurology ehind it is off. We are not referring to a manipulable lesion within the spine based on spinal biomechanics, but an alteration in neurology arising from an area. The spinal segment can be in perfect alignment, but still produce a change in neurology.

Nerve cell fatigue only occurs in the abnormally functioning individual and is very easy to test for. This can be chemical, as in the case of a neurotransmitter imbalance or EFA imbalance, or it can be due to the poorly functioning higher brain centres. Restoring both of these will easily remove the fatigue.

It is true that the spinal column is suspended by connective tissues, but these tissues respond via spinal mediated reflexes (such as the arthrokinetic reflex) and higher centres. Given the higher centres are most significantly controlled by proprioceptive input, most of which is found in the spine (upwards from 80%), higher centres are influenced and then in turn influence the lower functioning of a area.

Either way, altering blood flow tone is only a small part of the issue given that higher centre malfuncion will result in reoccurance of problems in that same way altered gait reflexes will do the same. Remembering that a blood vessel will not change its rate unless acted (primarily) neurologically upon, restoring neural pathways will most often restore vessel function. (remembering I am talking about neurology from a wholistic perspective, all centres)

The statement that if blood flow rate is not delivered quick enough body will not be nourished correctly is partly true, but you forget the multiple anastamosis that occurs in every area (with exception of S.Spinatus tendon). Thus a localised flow problem is most often dealt with easily by the body. If you are talking about systemic blood flow, then there is only one thing that can alter this and that is neurological. There are literally hundreds of ways this can be altered, restoring blood flow.

In terms of the testing, I am highly trained in Applied Kinesiology, the father if you like of Kinesiology. I've been trained by people who were close with George himself and am currently performing clinical based AK research in several areas.

Rectus femoris can be very easily isolated by bringing the leg up beyond 90 degrees. This will eliminate the psoas, sartorius and TFL as primary flexors. Having the knee straight puts quads in a position of strength, you will never find a weakness if you test this way. You need to have the knee bent to increase the lever arm forces and weaken the muscle for testing. Perfoming the test this way would be as impossible as performing a gastroc test using a plantar flexed foot.

It is very possible to have only one quad weak. Often seen with overpronation problems, patella tracking issues, osteitis pubis etc... is a unilateral weak quad. Similar nerve roots, doesn't mean same nerve roots. Remember that each fibre has its own dedicated supply. If you only tested groups, you would never pick up truly weak muscles or spindle problems, golgi problems etc... As George always says, you need to keep it cord specific to be accurate.

I guess the overall picture is that neither the neurology nor teh blood flow can survive independent of each other, as with the rest of the body there is intercommunication and inter-dependency. Whether you treat the nerves or the blood flow it will tend to cause a chain reaction and other systems will be positively affected.

I must admit, however, that I cannot support the notion of isolating muscles for testing or training especially as they would, in a normal day to day situation, work as part of a group. Rectus femoris is part of the quads group and does not work independent of the other 3 muscles. There seems to be a modern trend in physical therapy to break the body down into seperate parts, try and treat or train (strengthen) these individually, and then expect them to work with the rest of the body again as a team. I just feel this goes against what the body is designed to do. The approach should be more holistic and natural than that, treating and training in the manner the body is going to be used.

PS It is unfair to say you will 'never' find a weakness if you test the quads in extension as I test many weaknesses, from a minor quads lag to gross weakness in this starting position. Remembering that the muscle is strongest when it acts at 90 degrees to the surface it is acting upon, so with the quads at approx. 180 degrees to the tibia this is a weak range relatively, and it is easier, I find, to pick up subtle changes. I will try some testing in 90 degrees hip flexion and knee flexion to compare if I find weakness in full extension starting position and see if I can get a reading comparable. Thanks for the tip.

Mate, if you don't think quads work independantly then you need to do basic anatomy again. All the quads have different functions due to the varying origin & insertions. It is true is some instances they are antagonists and synergists to each other.

However, in terms of functioning together in all instances, you are once again basing this on the correctly functioning person with perfect neuroloy and phsiology. I am not referring to training individual muscles, but testing them. Given this though, yes it is sometimes important to train 1 specific muscle if there has been many years of abuse to the area.

With regard to the quads test, let me clarify by saying you allow for muscle recruitment in testing in this manner. In terms of not being able to isolate muscles, I suggest you refer to a reputable source for muscle testing such as Kendel or walther before making those comments.

Good luck

Thanks mate, but I will stick to a more natural approach, respecting the fact that the body works in patterns of movement not individual muscles, and based on functional anatomy not dead anatomy.
Good luck to you.

Thanks mate, but I will stick to a more natural approach, respecting the fact that the body works in patterns of movement not individual muscles, and based on functional anatomy not dead anatomy.
Good luck to you.

Good Morning Doctors;

My requests for an answer to my performance problem seems to
have snowballed into deep scientific approaches that are differrent
as well as related. My apologies. I was merely looking for an
answer and an approach to correct a condition that I encounter
while running long distances. I do find both views intresting, but it
gets beyond my understanding. I only have a bachelors degree
in education to teach children in a classroom. I am new to the fitness
field, and I am teaching myself and gaining certifications to help
others. The most complicated book I have read is, "Designing
Fitness Programs," by Fleck & Kraemer. Sometimes I feel like I get
the concepts, but at times it just blows me away. Your discussions
I find interesting, but I did not mean to touch off a philosophical
indifference as it would seem.

Philosophically speaking, I am in favor of a wholistic approach tailored
to meet an individuals' needs. I also need to keep things simple and within the realm of my understanding. It is how I grow a little at a time. Perhaps it would be better to continue further discussion Outside of this thread? I do sincerely thank both of you for your time and effort on my behalf.

cjchartree :P

Try Glucosamine. D

Regards, roll

Max. 8)