3 weeks ago I developed an IT band injury. Didn't know what it was and was seen by a sports ortho docotor. I have been resting it, no running. I have been doing some stationary biking to keep some level of conditioning. I have been icing it, taking a prescription anti-inflamatory drug, and doing some stretching. What I'm wondering is, based on your experience, when do people typically get back to running after an IT band injury? How does a person know that they can / should be able to start running again? I was training for a my first marathon. I was up to 18 miles for my long run. I had run 16 and 14 a couple times before going up to 18 miles. I appreciate any insight you can share. Thanks Keven
Reply - Janet
Keven - the current thinking in the research world is that stretching of the ITB is pretty unlikely to help your condition.  The current thinking is that ITB issues often arise because of a lack of adequate strength in the gluteal muscles - the maximus and medius in particular. The other interesting tidbit is that it's pretty unlikely to be an inflammatory condition... it's more likely a degeneration of the collagen fibers.  Given the tendency for anti-inflammatory drugs to mask pain - it might be worth reconsidering your use of them.  If they mask your ability to feel your body's symptoms you'll be more likely to go out and do something that takes your tissue beyond it's ability to tolerate.  The second potential complication with anti-inflammatory drugs is that they may interfere with some of the cellular processes needed to optimize the healing rate.  My benchmark for allowing athletes to return to running is that they need to be off all pain-killing medications (over the counter anti-inflammatories included), they need to be able to accomplish all activities of daily living painfree, walk painfree for up to 10 miles a week, and able to accomplish all their usual strength training activities (especially for the key muscles involved) with no pain.   If they clear those hurdles, then it's time to transition back into running. The transition depends on how long they've been off -- and what their training was like before.  An athlete who had just reached for a new distance is in a very different place than one who had years of high-mileage weeks behind them.   Hope this helps a bit.  As in all things... your individual situation may vary!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Any first hand recommendations of any flat 'barefoot' running shoes besides the Vibram 'toes' type? (tried several of those at a local place; can't get them to fit). One website lists quite a few here: http://barefootrunningshoes.org/barefoot-running-store/ I liked the old original Adidas I got in the early '70s, simple leather shoes, better than anything I've had since. Local store does have a treadmill/video setup; any pointers on what to ask about with that? I wear a 3/8" lift under one heel (leg bones slightly short, since teenage years) so shoe wear is very different. Very high arches, always been sold 'cushiony' lasted shoes but have my doubts that's right. Reading the book, is "1865" on p.12 for introduction of the first running shoes a typo? A few pages that seem helpful: http://www.orthop.washington.edu/uw/tabID__3376/ItemID__131/mid__10313/PageID__251/Articles/Default.aspx (differential diagnosis) Exercise good for knee pain: http://www.medicalnewstoday.com/articles/168223.php If I were a rabbit they could fix my knees now (but then they'd have to kill me) http://arthritis-research.com/content/9/1/R8 Impressive: http://arthritis-research.com/content/9/1/R8/figure/F2
Reply - Janet
Hank, sorry I can't be of much assistance on the shoe issue.  I've a friend who runs in the Nike Free shoe and likes it, and also has a Brooks trail shoe that is very low in the heel and light and flexible.  He also does some running in the Vibram shoe.  He says some people are experimenting with those slip on neoprene-booties that you get for wandering in the water... you might check out some dive shops or sporting good stores for those. Best of luck with your barefoot endeavors.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor.

2nd followup -- can you cite your sources on this? I know this was debatable in the past but at present, my doctor disagrees, so does the medicine I am able to look up. If you have current information I'd very much appreciate knowing the source. I can get the journals via my library. This is the most recent info I have: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/rheumatology/osteoarthritis/ Not claiming that's reliable (it recommends glucosamine/chondritin, and I've seen other papers saying they don't work!) -- just noting this stuff needs to be tied to current sources. I'm not saying you're wrong, I'm asking for the sources you rely on and why you consider them reliable on this. "Pathophysiology Understanding the metabolic pathways at the molecular level has greatly enhanced our understanding of the tissue factors involved. 7 Although the role of inflammation in osteoarthritis has been unclear for a long time, significant progress has been made in more recent years. The molecular pathways involved are being more clearly defined, and this is an area of intense ongoing research. Studies also show that there are ongoing inflammation and synovitis that result in permanent joint damage. 1,5,8 At times, this may be more striking, with flares of symptoms or joint effusions. Effusions can be very large at times, and we have aspirated more than 100 mL of fluid from an acutely swollen knee on more than one occasion. Biopsies of synovium from patients with osteoarthritis show more inflammatory infiltrates than normal controls do...."
Reply - Janet
Hank, I'm on the road teaching a class this weekend and not at my references which are in my office - but send me an e-mail (janet at runningstrong dot com) and I'll pull together what I have and send it to you.  An interesting author to search is Dr. Karim Kahn - he's done a fair amount of research on the issue of inflammation vs. degeneration, and though his research has focused more on tendon issues, he cites a fair amount of research on articular issues so his reference lists may be a nice jumping off point in your research.  I think that the article you mentioned in another post that says the issue is still not clear is probably right on... and that some people in the early stages of osteoarthritis probably do have active inflammation going on.  Some others who have had long-standing symptoms may not have any evidence of cellular markers of inflammation.  I think the underlying question is "do you take the drugs or not?"  It's not a simple question and deserves some consideration.  Certainly the drugs are usually effective at controlling symptoms so that will enable you to accomplish exercises that might prove to be very helpful for your condition.  On the other hand I think you'd be wise to be cognizant of the fact that they ARE controlling your symptoms possibly by masking your ability to feel pain... so it might behoove you to be a bit more conservative in your progressions than you would be otherwise.   In addition, like all drugs they have side-effects, primarily related to their ability to inhibit prostaglandins - which may result in upper gastrointestinal side-effects. 
I'll do some digging in my articles when I get back to the home office and send you some citations.  Thanks for the dialog!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor.

Following up on the earlier question: -- is there any anti-inflammatory that doesn't block pain to the extent of risking injury? Reducing inflammation is apparently the main goal early on with what might be possible osteoarthritis. And if not -- the NSAIDS wash out within 12 hours or less; will an injury be apparent promptly or might it take a day or two to feel an injury? Wondering if I can alternate between the antiinflammatory and the exercise, get the benefits of reducing inflammation, and the benefits of exercise, alternately. Hate to be stuck where I have to either block the pain and risk injury from exercise, or not block the inflammation and risk injury from developing osteoarthritis problems.
Reply - Janet
Ah, herein lies the conundrum.... osteoarthritis is NOT an inflammatory condition!  It is a degenerative condition!  To my knowledge there are no NSAID's that lack analgesic properties... in other words they all are very effective at blocking pain. Inflammation is usually a relatively short-lived process and in truth is considered by most to be a necessary first step to healing.  Without inflammation, the healing process doesn't get off to a good start.  The issue with osteoarthritis (which might better be termed osteoarthrosis) is that it's a degeneration of the articular cartilage... not an inflammation of the articular cartilage.  Anti-inflammatory drugs do a wonderful job of making things feel better... but they also alter the dynamics involved in tissue repair and regeneration. Studies on athletes who took NSAID's showed a lower response in terms of muscle hypertrophy (growth) and also a change in the bone-cell turnover.... in other words some of the physiological adaptations you're hoping for with any training program (more muscle growth and enhanced bone health) may be adversely affected by the NSAID. 
If it were me - I'd focus on strength work for the muscles that support the affected joints, gentle flexibility exercises to maintain adequate range of motion, and a variety of forms of aerobic exercise to help maintain ideal body weight and cardiovascular health.  You may find that by combining a variety of exercises (walking, running, swimming or deep water running) that you can get adequate training response without further irritating your joints. 
Book is on it's way to you - thanks for your order!   Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Help me clarify this question? I'm 60; early retired, wanting to get back to what I loved long ago, running trails, long slow distance 'birdwatching' runs). Got what doctor says is probably early osteoarthritis --knee pain but only after sitting or at night, bad enough sometimes that if I get down on my knees I can't stand up without pulling with arms, and I've fallen a couple of times just from pain when stepping up a single step. But naproxen (one pill/24 hours or less) stops it. And it's very intermittent, it doesn't happen when I'm running or after running as long as I stay standing (I'm starting with 30sec run/4-1/2 min walk x6 every other day). Also some shoulder pain, none at present. I don't have the money for your program here, sorry. But if you can help me focus this as a question and suggest who to ask, it'd help. I know NSAID risk goes up at my age. I know I need to lose about 30 pounds (5'10", 185 lbs). I can switch to swimming (boring!); I'm doing "prehabilitation" exercises like standing on one leg; exercises for strengthening knees and stretches. What's the worst thing that could happen? (My current 'worst' is GI bleeding from NSAIDS, just statistically a risk, but I don't know how much to worry about that--if I don't worry about it, I'll just use a naproxen a day and go on running and see what happens). No regular MD; there's a new one at the office every time I go in (I rarely need a doctor's attention so far)
Reply - Janet
The GI risk is not the only one to consider with NSAID's in my opinion.  One problem with them is that they ARE very effective at pain control.  That means that you're likely to go out and exercise on tissue that may or may not be ready for the load.  In other words it masks your ability to feel the symptoms that might otherwise stop you.  There is no research to say that running "causes" osteoarthritis, but if you currently have been diagnosed with it, you might want to progress very slowly to make sure that you give your tissue time to adapt.  The best thing for your knees is to maximize your hip strength so focus a lot on lateral hips and gluteal muscles (not the knee extension/flexion machines at the gym).  Easy paces (like you referred to) are best and if you follow a very conservative walk to run progression - listening to your body's response along the way - you should be able to progress back to running several days a week.  The only way to listen to your body is to NOT mask the symptoms with naproxyn. 
So to summarize - your best chance of success is to progress very gradually, make sure you're keeping aware of your body's symptoms, and get your hips as strong as you possibly can.  Best of luck to you!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I've been running fairly regularly for most of the last 14 years, and that's gone pretty well. I do have your book and reference it, both for my use and fellow club members. This past year, though, I did get my first real running injury. It's enough that I'm effectively a beginner again. Something I recall reading, and perhaps the 14 years has rendered it obsolete, or it was never correct, is that the two peak periods for injuries in beginning runners are a) the first 2 weeks and b) between 8-12 weeks. If I remember right, and it's true, the reason for the 8-12 weeks is because that's the length for the aerobic system to adapt, but the muscles are still adapting. Is that 8-12 week injury-prone period true? Is it for that reason? And, if you could, could you mention a reference that I might be able to look up for more details? (I do have Noakes, 4th ed., for instance, and a friend is a member of the ACSM, but he doesn't remember a source on this point.) If it really is something like this, I need to avoid racing in that period. I have too much experience at what my paces used to be, and could force things to an injury this time around.
Reply - Janet
I don't have the actual reference in front of me, but the rate at which different tissue systems adapt varies and the cardiovascular system does seem to adapt a bit faster than the skeletal and connective tissue system does.  Noakes is a great reference but I don't know that I've seen a specific reference stating a certain number of weeks for this or that physiological system.  If you look at cell turnover rates for bone - it kind of points to about a 6-week adaptation cycle, meaning that at about 6 weeks into a training rampup your bones are probably not at their strongest....  As an experienced runner you'd be wise to come back from your injury with a big dose of common sense.  That means gradually building your base mileage, making sure you've dealt with any underlying factors that might be contributing to the inujury you have and making sure you've established a solid foundation of base mileage before dabbling in the speedplay or racing.  Good luck in your come-back!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Im a junior in high school and this past summer I did alot of training with speed and races to train for xc season. I was doing two a days probably 45mpw. I went into the season and I pr-d by over a 1:30 form a 19:50 to 18:08, and for the first month and a half I was running low 18s.The weather got colder and I continued to train hard, well y times started declining and I ended the season running about 19flat. I believe I over trained. Now this summer I am wanting to up mileage t0 60-70mpw just base mileage. I wont be including speed work, or races just some striders here and there. Will this plan be effective to drop a nearly a minute to around 17:15, and will I get my form back like I did at the beginning of the season.
Reply - Janet
Dylan I think you hit the nail on the head - you started your season at a peak and you can't expect to maintain that peak non-stop.  I think your plan to focus more on base mileage in the summer is a sound one. Talk to your coach about when is the appropriate time to transition into a sharpening phase that would include the harder intesnsity stuff.  As you do that - you'll drop your total miles per week a bit to keep from overtraining. Good luck in your senior year!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I'm currently recovering from a stress fracture of my femoral neck. It's been about 12 weeks, and I'm just starting to try running again for short intervals at a low speed. I still feel some pressure when I run, but my physical therapist told me that as long as it isn't painful, the pressure is fine. She recommended that I start to run on a flat surface. However, when running on the treadmill at the gym today, a trainer told me that that actually puts more stress on the hip and that I should be running at a small incline (of about 5.0) instead. Now I'm confused since I have conflicting information. Can you let me know what is best when beginning running again after recovery from a femoral neck stress fracture? Thank you!
Reply -
Katie, a femoral neck stress fracture is a very serious injury and it will take a LONG time to heal fully.  The short answer to your question is trust the Physical Therapist (who probably has either a masters or doctorate degree and a heavy emphasis on biomechanics) rather than some personal trainer at the gym with little to no formal education in either kinesiology or biomechanics.  The PT is right... any running you do should be done on level terrain.  You'd also be wise to get off the treadmill.  Do your running and walking outdoors - the loads are more appropriate and you're much less likely to make errors in your pacing judgment.  My guidance would be to NOT run at this point but work your way through a walking protocol first and get to where you can walk comfortably (no pain during or after, no stiffness... just feels normal) for about 10  miles per week.  Your long walk might be 3-4 miles, your short ones 1 mile and your medium ones 2 miles.  This way you alternate the overload with recovery, and you are giving a small progressive overload that your muscles and bones can adapt to.  Did your PT help you figure out why you got the stress fracture in the first place?  Have you adequately addressed all the issues that may have played a role in that?  If not - that should be your big focus at this point... not getting back to running but rather getting your body healthy and READY to return to running.  Hills (even on a TM) should wait until level ground walking (and running) is 100% symptom free and then introduced very gradually and only on one or two of your days per week.  Hope this helps clarify things for you - feel free to e-mail me if you have more questions (janet at runningstrong dot com).  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi Coach! I am training for a half-marathon in February and I'm following a canned online programme which emphasizes building the miles and some speed workouts...but I have no race I can do when I'll be ready (early in the month). In March there are a lot more races out there. What should I do for that month--should I not taper and just keep building up my endurance?
Reply
Luck you Julie!  An extra month to train is a lovely thing! It allows for  a little wiggle room along the way if you get a cold or flu or take a vacation and miss a run or two or three... and it also allows you to pause at a level along the way if you feel you're not quite ready for the next build up.  Here's what I'd do - I'd follow the program but listen to my body and if it's telling me it needs another week at a level - I know I've got it so I'll do that.  If everything is going well, then as the program reaches a peak mileage, instead of tapering right away to the race - I'd hold at that peak for a few weeks and then taper toward the race.  Have fun on your journey and good luck in your race.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor.

Hello! I am taking the next three months to train for a 3:40 marathon. This is a significant drop from my last marathon (4:20, over a year ago). Thankfully, this matches with a three month slow period of work. I have about 5 hours a day I can devote to training. However, I am also prone to over-use injuries. What is a good way to push myself just enough without going too hard? Thank you!
Reply - Janet
Hi Maggie, training for such an enormous improvement in your marathon time in such a very short period (12 weeks is no time at all!) is going to be a challenging task for sure.  You're essentially talking about knocking 40 minutes of your previous time... speeding up your pace by about a minute and 30 seconds per mile.  Whether or not that's a realistic goal for you is hard to say without knowing more about you but the one tidbit you did reveal is your propensity to overuse injuries.  Here's my general guidance -
1.  train with paces that are based on your CURRENT fitness level, not your goal time. That means you take a recent race time (a 10K perhaps) and calculate appropriate training paces based on that.  There are many pace-calculators out there - let me know if you don't already know of a few you can use.
2.  Build mileage base first, then work on speed.  Emphasize volume of miles and especially consistent training through the week (not just a long run and one or two short ones each week).
3.  Alternate days - some days a little longer workout, others a little shorter. This will provide both overload (the stimulus to make you stronger) and recovery (the time for your body to actually get stronger). 
4.  Do your homework - strength training is important in the realm of running injury prevention! Make the exercises functional and specific. 
5.  Time is your friend... 12 weeks is a VERY short window of time to do this unless you're already well established with 40 miles per week of running.  If you're base building from something less than that, you might want to consider giving yourself a little more time.
If I can be of assistance, please feel free to e-mail me (janet at runningstrong dot com) and I'll be happy to help you reach your goal.  Best of luck on your marathon!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I need to do some speed traing to help build up my endurance. Do you have any suggestions on how to do this, how many times a week etc?
Reply - Janet
Melissa, I usually don't have athletes begin speed training until their endurance base is well established.  There are a couple of issues to consider here - one: speed training is probably not your best way to build endurance... it's probably going to be more effective to work on increasing your volume of eary pace running in order to develop the physiological systems that will best enhance your endurance.  Two - speed training introduces another layer of injury risk because it's higher intensity.  The volume of speedwork you can safely introduce is directly proportional to your total weekly mileage base.  If you don't have much mileage base, you can't give yourself a big dose of higher intensity speedwork stuff. 
With that said - once your endurance base is built and you're ready to introduce speedwork... I usually recommend doing only one workout per week.  In more advanced athletes I'll sometimes prescribe two "intensity" workouts per week - one more intense speedwork session and one slightly less intense pace work session.  I'd be happy to help you with this - if you're interested, go to the services page of the website and download the coaching questionnaire and fill it out and send it to me via e-mail.  Remember - the type and volume of speedwork needs to be correlated to the type of event you're training for and also to your current fitness base.  You can't bludgeon your body into fitness, you have to finesse it there! Hope this helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have recently started running and I really enjoy it. I completed my 3rd 5K last week and plan on doing one this week and a 10K on Thanksgiving day. I would like to do the ING 1/2 marathon in Atlanta in 2010 and wanted to know if I should get a running coach to help me prepare for this race. Thanks!
Reply - Janet
Nicole, congratulations on catching the "running bug"!  It's great you're having fun with this and training for the ING half marathon in March is certainly a doable thing - you're starting at the right time!  Whether or not you need a coach is really a personal decision. You could certainly follow any number of the "canned" half marathon programs that are out there but they're not really customized to you. As a coach. I can provide you with customized and detailed guidance not only on the distance to run for each workout but also proper pacing for each training run and exercises to help you avoid running injuries.  In addition, when your base mileage is built enough to support it, I can give you specific workouts to do that will help to maximize your pace potential for race day.  Using a coach is not a necessity, but it usually improves your odds of success.  If you're interested - don't hesitate to drop me an e-mail and we can discuss your options.  You can reach me at janet at runningstrong dot com.  I'd be delighted to help you reach your goal.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor 

Hello...I love to run and usually run 3 or 4 miles 3 to 4 times per week. Over the past couple of months, I think I've pulled my hip flexor muscle so I've been using my elliptical more to give it a rest. Well, I ran again yesterday and now I'm in quite a bit of pain (only on my left side - hip area). What would you recommend?
Reply - Janet
Tanya it's hard to tell based on the info you gave me but it appears that your only "treatment" for your hip flexor pain was to back off the running and substitute elliptical trainer - did you not do any specific exercises to deal with the underlying cause for the hip pain?  If not - that may be what's missing.  Specific stretches and strength exercises designed to deal with things like inflexibility or muscle imbalance in your core region might help.  In addition, when you took time off running and then returned to running, did you try to jump back in at your old mileage or did you work your way back into it by doing a walking program and then a walk/run transition program?  If you jumped back in where you left off - perhaps that was a bit much? Also - are you doing your running on a treadmill?  If so - transitioning out onto mother earth will likely help since it offers varying terrain and you're more likely to run at appropriate paces.  I'll be happy to help with more details but I'd need to know a bit more about your situation.  Feel free to e-mail if you like - janet at runningstrong dot com.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have been running since last November, ran my fisrt half in the Atlanta ING and had a severe ankle sprain in May that out me down for 2 months. I have picked up my running again in September and am training for a 10k on Thanksgiving and the half marathon again in March. My heart rate is always maxed at 187-190. I know this is extremely high for a 30 year old woman. I'm not sure if it is a cause of my running or a problem with my lung strength. My chest always feels like it is on fire and I average about an 11.5 - 12 minute mile. I have exercise induced asthma and have had numerous tests run to check my lungs and heart. Nothing came back as a problem. What do you suggest to help bring my heart rate down and get a faster mile? Thank you.
Reply - Janet
Melissa it sounds to me like you're trying to get speed before you have endurance.  You've only just gotten back into your running - perhaps you're trying to run too fast for your current fitness level.  The best way to get speed is to get the endurance first.  Work on running at a more leisurely pace on your training runs - ease off a bit and keep it comfortable. As your endurance improves, your pace will naturally improve as well. This will take many weeks - or even several months... so just nestle in and be patient while your body works the miracle of building a better engine!  I'd be happy to help with specific training advice to help you reach your goal but I'd need to know a lot more about you.  If you're interested in this, check out the Services page and fill out the coaching questionnaire that's linked there and send it to me in an e-mail (janet at runningstrong dot com).  Relax - enjoy the journey... they don't give out prizes for the fastes training run!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

My sixteen year old son is a cross country runner. He was sick for about three weeks and was not getting better. We took him to the doctor and was diagnosed with strep throat and was perscribed amoxicillin. He has started feeling better and is continuing his training, but he has really slowed down. He struggles through his workouts and his times are way off. Is the antibiotic causing him to feel this way? He has two more days of taking the medication. Once he is off it can he expect to start feeling strong again?
Reply Janet - If he had a three week respiratory illness it's pretty likley that it is the cause for the decline in his race performance, not the antibiotic.  Bacterial infections like strep really take their toll on your body and his immune system is working hard to fight off this infection. It's hard to do your best when your body is busy fighting off illness.  Hopefuly the medication will work well and he'll gradually be able to get back to his normal training and normal performance.  I recommend he not try to push at this point but rather give his body a chance to get well!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor