Hydration tips

As warmer weather and the road racing season begins, I am frequently asked about dehydration and the best hydration strategies for runners.

How important is proper hydration for runners? Dehydration as little as 2% of body weight can begin to significantly impact performance. For an athlete that has a higher sweat rate (greater than 2 liter per hour), that level of dehydration can occur after 30 minutes of exercise in hot and humid conditions. Additional, research has shown that level of dehydration can slow 10-km run times by 6.3% compared to running in a hydrated state. That equates to a race time almost 3 minutes slower if you usually run a 40-minute 10k!

Tips

Calculate your fluid losses – An easy way to determine sweat rate and fluid losses is to weigh yourself before and after a run, but before rehydrating. A one-pound weight loss is roughly equal to 500 ml (about 1 pint) of fluid loss. Remember to account for any fluids you drank during the workout.

Match your fluid losses – Overhydration can be as problematic as dehydration. If you overhydrate, you run the risk of hyponatremia. Since there is a wide variety in the rate of fluid loss among individual runners, the current American College of Sports Medicine guidelines don’t recommend a specific volume of fluid to drink per hour. A better guide to fluid replacement is to drink when thirsty and attempt to at least partially replace fluid loss during exercise.

Pre-hydrate – Starting a race or a training run already slightly dehydrated can have an impact on performance. Make sure you start a workout or a race well hydrated and start hydrating at least 60 minutes before exercise if possible. Smaller amounts of fluids (200 to 500 ml) are more easily and quickly absorbed -For longer races such as marathons, there may be a slight risk of developing mild hyponatremia (low blood sodium) before the race. Liquids containing electrolytes may decrease this risk compared to hydrating with only with water.

Drink during the run – Get in the habit of drinking during longer runs. Try running with a water bottle or run a course that has water or other fluids available. If you don’t like running with a water bottle, try a shorter loop course and leave the fluids at the start. Take a short break each time you pass the starting point.

Set the timer on your watch for every 15 or 20 minutes to remind yourself to drink. Try a sports drink for runs lasting longer than 60 minutes to help replace sodium and carbohydrates.

Post Work-out – Rehydration after exercise is also important for recovery. The best strategies include drinking smaller amounts of fluid over a period of time instead of drinking a large amount quickly once you finish the run. Sports drinks with electrolytes including sodium may help you to rehydrate quicker compared to water. A post-race meal higher in sodium will also help stimulate the urge to drink and replace lost fluids.

John M. Martinez, M.D. is Medical Director of Coastal Sports & Wellness Medical Center in San Diego, a comprehensive sports medicine clinic focusing upon active patients and athletes. Find out more at www.coastalsportsmedicine.com

This article originally appearred as part of the May Running Centers email newsletter. To learn more about the Running Centers or to find a location in Southern California, click here.

Shin Splints (Medial Tibial Stress Syndrome)

Medial tibial stress syndrome, (MTSS) or “shin splints”, is a common ailment that many runners experience, especially when returning from inactivity or after a rapid increase in mileage.

Symptoms
Typically, there is pain in the front portion of the shin above the ankle. Pain is usually present at the start of a run or exercise but may gradually improve. Stress fractures in the tibia The painful area involved in MTSS is usually 3 to 5 inches in length along the edge of the tibia. Pain that is concentration in a smaller area on the tibia or pain that continues to get worse with prolonged running may represent a stress fracture of the tibia. Shin pain that does not improve or continues to worsen should prompt a visit to your physician.

Find out more in our newsletter at Coastal Sports and Wellness Medical Center in San Diego, California

Exercising while sick

With the cold and flu season upon us, a common question we hear from athletes is recommendations for exercising when ill. There is some misinformation out there that suggests trying to “sweat out” a cold or flu. However, that exercise could be doing more harm than good when you’re sick.

While regular and moderate exercise such as light jogging has been shown to boost immune system function, more vigorous exercise such as a hard tempo run, intervals or racing temporarily suppresses the immune system up to 24 hours after exercise.

Immune system suppression may lead to a worsening infection such as pneumonia or bronchitis, or even an infection of the heart muscle (myocardium) called myocarditis that can be life threatening or fatal.

One easy piece of advice is to remember the “neck check” in determining whether to exercise during an illness or not. If your symptoms are mild and isolated to the neck and above, such as a runny nose or sore throat, then you’re probably ok for light to moderate workouts. If the symptoms are below the neck- fever, muscle aches and pains, productive cough, or diarrhea, then consider holding off and rescheduling your workouts.

How fast can you return to a full workout schedule? Start back at about fifty percent of your normal exercise distance or time at a reduced intensity. Also allow extra recovery time between workouts. A proper amount of rest is important to a quicker recovery. Listen to your body and if you’re finding that you fatigue quickly, continue to limit your exercise time, duration and intensity.

Plantar Fasciitis

Are you waking up in the morning dreading those first few steps because of the pain it causes in your feet? Do you avoid going barefoot on the beach because of the pain that develops in the arch of your foot?? There’s a good chance you make be suffering from plantar fasciitis.

Symptoms
Pain in the arch or the heel of the foot, usually worse with the first few steps in the morning or after sitting for a long period of time. The pain usually improves after a few minutes of walking or stretching. Some people complain of pain that develops after standing for a long period of time.

Causes
The plantar fascia is a thick band-like structure that originates from the heel bone (calcaneus) and attaches to the metatarsals. Plantar fasciitis is the result of inflammation and tightness of the fascia of the bottom of the foot.

Prevention & Treatment
Basic treatments include stretching, massage and ice. Other tips include filling a plastic soda bottle with cold water and rolling the injured, bare foot over the side of the bottle for 3 to 5 minutes at a time several times a day. Massaging the area with either a golf or tennis ball or cross-friction massage may help break up scar tissue.

Stretching exercises for plantar fascia focus on stretching the Achilles and calf muscles. Other exercises include trying to pick up a towel or small objects with the toes, which increases flexibility of the plantar fascia.

Achilles Tendinosis

Symptoms
Pain or swelling in the back of the calf, usually 2 to 3 inches above the back of the running shoe. The pain is typically worse when the heel strikes the ground or when pushing off from the ground on your toes.

A rupture of the Achilles can occur during a forceful push-off. Typically there is a “pop” or ripping sensation in the back of the calf, followed by pain and decreased movement of the ankle.

A suspected Achilles rupture requires evaluation by a sports medicine physician and may require surgery or prolonged immobilization in a cast or walking boot.

Causes
Common causes of Achilles tendinitis include: tight calf muscles, recent increase in running mileage or running up hills. Over-pronation (rolling in of the foot) as well as high foot arches (pes cavus) and flat feet (pes planus) can also cause Achilles tendinitis.

Prevention
Prevention includes proper stretching, slowly increasing your mileage and proper running shoe selection.

Treatment
Ice decreases inflammation, pain, and swelling. Apply ice for 10 to 15 minutes three to four times a day. Anti-inflammatory pain medications such as ibuprofen (Motrin or Advil) or naprosyn (Aleve or Naproxen) as directed by your physician.
Gentle range of motion and calf stretches can be helpful. Eccentric calf exercises can be helpful in recurrent cases.

These exercises are done by standing on a step or stairs with the toes on the step and the heels hanging off the step. Slowly lower your heel so that it drops below the step. You should feel a slight stretch in the calf. This movement is the eccentric or lengthening movement. Slowly return to the starting position. Repeat 10 to 15 times twice a day.