Heat Exhaustion Vs. Heatstroke

Heat Exhaustion Vs. Heatstroke

By Coach Adolfo Salgueiro

Once again, the usual disclaimer: I am not a doctor, so please do not take medical advice from me. If you have any questions on what you are about to read, please consult a professional, which, yet once again, it is not the author of this blogpost. Now, let’s proceed.

Heat Exhaustion vs. Heatstroke

Running in the summer heat requires a certain level of preparation to avoid heat related issues, including death (Jonas Ferlin, pexels.com)

As we enter the Summer months in the Northern Hemisphere and the coolness of the spring weather turns into a combination of heat and humidity that can make even the most motivated runner miserable, the time has come to refresh our knowledge on two important concepts. It is extremely important to understand and differentiate the signs and symptoms of heat related illnesses, such as heat exhaustion and heatstroke. They are both serious conditions, but one can lead to death.

According to the Mayo Clinic’s website, there are three heat-related syndromes that may affect your body depending on your exposure to extreme heat conditions. In order of severity, they are: heat cramps, heat exhaustion and heatstroke.

Heat Exhaustion is caused by exposure to high temperatures, particularly when combined with high humidity and strenuous physical activity. Without prompt treatment, it can turn into a heatstroke, a life-threatening condition that can be prevented by avoiding entering in the heat exhaustion zone in the first place.

Heatstroke is a condition caused by your body overheating, usually as result of prolonged exposure to physical exertion in high temperatures. This most serious form of heat injury, it can occur if your body temperature rises to 104 F (40 C) or higher.

Certain conditions and medicines can enhance your risk of a heat-related illness. Ask your doctor if any of your medical history or current prescriptions can make you more susceptible to these diseases considering your level of physical activity during the warmer months.

I can’t state enough how important to know and understand the symptoms of each one of these syndromes. Not only it could help you prevent them, but it can avert a tragedy.


Heat Exhaustion

The evaporation of your sweat regulates your body temperature. However, when you exercise strenuously or otherwise overexert yourself in hot, humid weather, your core temperature (body\’s heat combined with environmental heat) fails to regulate, preventing your body to cool itself. A normal core temperature is around 98.6 F (37 C).

 If you don’t deal with this situation immediately, it may develop into a dreaded heatstroke.

The symptoms of Heat Exhaustion are:

  • Cool, moist skin with goose bumps

  • Heavy sweating

  • Faintness

  • Dizziness

  • Fatigue

  • Weak, rapid pulse

  • Low blood pressure upon standing

  • Muscle cramps

  • Nausea

  • Headache

Should you feel these symptoms, stop your activity immediately, move to a cooler place, drink cool water and/or sports drinks and rest. If these symptoms don’t get better within in an hour, contact your doctor. Remember you are avoiding at all costs to have this escalate into a heatstroke.

Heatstroke

Heatstroke not only requires immediate treatment, but it can quickly injure the brain, heart, kidneys, and muscles. Damage can get worse the longer treatment is delayed and lead to serious complications and, once again, even death.

The symptoms of Heatstroke are:

  • High body temperature (over 104 F or 40 C),

  • Altered mental state or behavior (Confusion, agitation, slurred speech, irritability, delirium, seizures),

  • Alteration in sweating (skin feels hot and dry to the touch),

  • Nausea and vomiting,

  • Flushed skin. (Skin may turn red as the body temperature increases),

  • Rapid breathing (rapid and shallow),

  • Racing heart rate (Pulse may significantly increase),

  • Headache (Throbbing).

     

Prevention

  • It is imperative to be proactive, both for ourselves and on behalf of our running mates, in the avoidance of situations that may trigger heat exhaustion during the hot summer months. The Mayo Clinic recommends the following:

  • Wear loose-fitting, lightweight clothing,

  • Protect against sunburn,

  • Drink plenty of fluids,

  • Take extra precautions with certain medications (ask your doctor),

  • Take it easy during the hottest parts of the day,

  • Get acclimated to the new weather conditions.

Last year we wrote a blog post on Training Adjustments for the Summer Months, which may be worth revisiting as we prepare for the upcoming weather conditions.

Let’s take a little bit of time and learn about heat exhaustion and heatstroke so we can prevent a tragedy.

 
2 Breathing Techniques to Improve Your Running

2 Breathing Techniques to Improve Your Running

By Coach Adolfo Salgueiro

A few months ago I bumped into a challenge with one of my coached runners. As soon as she reached mile 3 or 4, she got a side stitch. It didn’t matter what we tried with the timing on her nutrition or her fluid intake. Come that point, boom! Stitch! We needed to attack this problem and fast. Before it became a psychological issue.

I consulted with a few coaches I know, and they gave me their suggestions and home remedies. While we found a couple of things to temporarily remedy the nagging stitch, they were not the permanent solution we were looking for.

While researching the issue I came across a book from 2013 called “Running on Air: The revolutionary Way to Run Better by Breathing Smarter”, by Bud Coats and Claire Kowalchik. This was a publication of Runner’s World Magazine, published by Rodale.

The book goes into details about many things that are not necessarily related to breathing. So, since this is not a book review, I am skipping them. But it does go into detail on the science and mechanics of breathing and breathing while running in layman terms. To my trainee, there were two specific aspects that not only made the difference, but solved the problem:

 

Breathing Techniques

Breathing from the belly and doing in in an add-number pattern may help you improve you running. Worth giving it a try (image from pexels.com)

1-   DIAPHRAGMATIC BREATHING

Known colloquially as “belly breathing”, involves engaging the stomach, abdominal muscles, and diaphragm, which means actively pulling the diaphragm down with each inward breath. Compared with coastal breathing, it helps the lungs fill more efficiently.

I cannot teach you diaphragmatic breathing in a few paragraphs, but I can tell you that I’ve been doing it for over 20 years, and it has worked for me beautifully. It also helps you strengthen the diaphragm, located beneath your lungs, which is the major muscle of the respiration process. It contracts and flattens when you inhale, creating a a vacuum effect that pulls air into the lungs. A stronger diaphragm means more air, more air means more oxygen for your body to burn, and less side stitches.

Regardless of your preferred type of breathing, a strong diaphragm will help you breath better, relax, meditate, improve digestion, and provide you the obvious running benefits that more oxygen in your system can offer.

If you want to learn more about diaphragmatic breathing, its benefits and strengthening exercises, click here for a YouTube video from the UCLA Integrative Digestive and Health Wellness Program, which can help you get started.

2 – RHYTHMIC BREATHING

I have been breathing on a 3/2 count (inhale for 3 steps and exhale for 2) for about 5 years, and the benefits have been tangible. I don’t even think about it anymore, it just happens. In my personal experience, it works better than the 2/2 I did for years. Once I got my hands on this book, I understood why, and it made sense.

It is because “the greatest impact stress of running occurs when the foot strikes the ground at the beginning of exhalation and also that core stability is at its lowest during exhalation”.

Based on this, it is easy to understand that by breathing on an odd count, you will be alternating sides each time you are at your weakest while hitting the ground. Think of it this way: In one mile, you will be hitting about 750 times on each side instead of 1500 on the same one. Multiply this by the number of miles you run in a week, a month, or a year, and if you are not breathing on an odd number count, my suggestion is you better start thinking about it, today.

How do you do it? Just do it. Three in, two out. It will be weird at first, but with time, it will feel more natural and within a couple of weeks you won’t even notice it anymore.

As for rhythmic breathing, there is plenty more to learn than what four paragraphs can tell you. So, if you are interested, this is a good book where to get started.

As for my trainee, she read the book, she started strengthening her diaphragm, breathing in a 3/2 pattern, and finished not one but two half marathons with a time beyond our wildest expectations. Oh! And no more side stitches.

My Case on Behalf of Glucosamine

My Case on Behalf of Glucosamine

By Coach Adolfo Salgueiro

 Before we get started, I am disclosing I am not a doctor, and I am not giving medical advice. What you are about to read is just my personal experience mixed with light internet research.

Glucosamine

Glucosamine and chondroitin are popular supplements used to treat osteoarthritis. About 6.5 million adults, or 2.6 percent of the population, have used one or both products

I’ve had issues with my left knee for a long time. It kept me from running for many years. It has always been my weakest link. But just like millions of runners, upon the recommendation of someone who I can no longer remember, I started taking glucosamine many years ago, and somehow, it kept the pain at bay and allowed me to keep running consistently for many years. This is my story, and I am sticking to it.

When I decided to give marathoning another try, as I was eyeing the New York City Marathon, I asked my doctor about Glucosamine. He told me there were no conclusive studies proving that it worked or that it didn’t. His professional recommendation was that if I thought it was beneficial to me, to keep taking it. If not, then don’t bother.

Glucosamine is not cheap. A bottle of the good stuff can go from $40-$50 for a few months’ supply. So, when it was time to replenish the stash, with cash in short supply at that particular time of the month and with the recent lecture from my doctor, I decided to skip it. A couple of weeks later, my knee started to hurt and other joints felt stiffer. How could this be? There was no proof! I ran to the drugstore, got my glucosamine and a week later, the pain was gone. This is all the research I need.

Glucosamine

This is the brand I use and the results have been stellar. I don’t need much more research than that.

Then I thought: Of course! Why in the world would a drug company invest time, effort and millions of dollars researching the benefits of glucosamine when every drug store carries ten over-the-counter options from which you can purchase as many as you want, whenever you want? This is no moneymaker. No reason to invest just for the pure pursuit of knowledge. It works for me, and this is all I need to know. I am the research paper my doctor was unable to quote.

Glucosamine has been around since 1876. It is manufactured by processing a polymer from the shells of shellfish, shrimp, lobsters and crabs. It also comes from other animals such as cows and pigs. Newer versions made from fungi and fermented corn have been brought to market to cater the needs of vegetarian consumers.

Glucosamine is a dietary supplement, not a prescription drug. Because of regulations, in the US it is marketed as a supplement to support the structure and function of the joints. It is also directed to people with osteoarthritis. Tests have shown that you can consume up to 1500 mg per day with no adverse effects.

Glucosamine pills usually include a compound named chondroitin. According to WebMd, chondroitin is a substance that occurs naturally in the connective tissues of people and animals. As a supplement in higher doses than is found naturally, chondroitin is also a popular treatment for osteoarthritis.

Arthritis.org states that “glucosamine and chondroitin are popular supplements used to treat osteoarthritis. According to one estimate, 6.5 million adults, or 2.6 percent of the population, have used one or both products”.

Both glucosamine and chondroitin are usually found in healthy cartilage and have anti-inflammatory properties. “They also have some cartilage-protecting effects through a variety of different mechanisms,” says Chris D’Adamo, PhD, director of Research & Education at the University of Maryland School of Medicine Center for Integrative Medicine.  

Glucosamine and chondroitin protect cells called chondrocytes, which help maintain cartilage structure. In theory, these supplements have the potential to slow cartilage deterioration in the joints, and to reduce pain in the process. 

Sounds good to me!

I take the Kirkland brand with 1500 mg of glucosamine with 1200 mg of chondroitin, and it has worked for me. If I ever forget to take it for a few days or if my resupply delays, my body promptly reminds me. Once again, what additional research do I need?

Please don’t take medical advice from me. I am not a doctor, nor I wish to be one. Glucosamine with chondroitin works for me. If you have joint issues, I suggest you check with a real doctor and then give it a try.

Running with Lymphoma

Running with Lymphoma

By Coach Annamarie McCormick-Howell

 I’ve been a distance runner for years, so when lockdown started in 2020, I was still in my element, as running outdoors in Germany was still allowed and encouraged. I found myself kind of tired as the year went on. I attributed it to the pandemic fatigue so many of us were experiencing, as I was unexpectedly homeschooling my 4-year-old twins and confined to our tiny neighborhood. I completed my birthday run in July, starting my 32nd year with 32 miles and a renewed attitude.

Running with Lymphoma

Before her last cycle of chemo, Annemarie set out to complete a half marathon.

Shortly after that, I started having some mid-back pain. Within a few weeks, I noticed my toes were numb. I was having ascending weakness when I was exercising, and then I began to fall. I went to see a German physiotherapist, thinking I had a herniated disc.

He did an assessment, and then sat me down and said: “Annamarie, do you ever have night sweats?” I knew then that there was a chance something bigger was going on. He helped me navigate the German hospital system, and I was able to get an MRI in early October. The radiologist came to get me afterwards and broke the news that I had a tumor on my spinal cord. He recommended I have surgery immediately, or risk permanent lower limb nerve damage.

I went to the American hospital at Landstuhl but was told they were not comfortable performing the surgery. I would need to take the next medevac flight to Walter Reed Army Medical Center. In one of the hardest days of my life until that point, I left my husband and children and flew to back to the US for a hemilaminectomy.

The surgery was a wild success. I woke up and was walking with full feeling in my legs and feet within the hour. I was elated and asked my neurosurgeon when I’d be able to run again. He laughed, but was supportive of my enthusiasm and, when I left the hospital a few days later, while I waited for the pathology results, he told me I could walk as much as I wanted and to be as active as I could without putting direct pressure on my scar.

The next week, despite feeling good enough to be walking 8-10 miles per day, my world was turned completely upside down. I was diagnosed with lymphoma. The next few days felt like I was in a wind tunnel of information, learning everything I had never wanted to know about cancer. My oncology team was wonderful, and incredibly supportive, from day one.

Running with Lymphoma

Within an hour of her surgery, she asked her neurosurgeon, when would she be able to run again.

I underwent a series of invasive and painful tests and then got a port placed to start chemotherapy. My doctor told me that his patients that manage chemotherapy the best are those able to be the most active throughout.

Feeling beat up, alone, and nearly unrecognizable, I had my first chemotherapy infusion the day before Thanksgiving. I knew that the person I was before cancer was gone, but that I could hang onto the elements that made me feel most like myself, so I got up and walked a Turkey Trot on Thanksgiving morning. I started counting down the days (30 more) until I would be allowed to resume running, rotating among long walks, bodyweight strength training, and indoor cycling.

A few days after Christmas, and in the middle of my second cycle of chemotherapy, I got out and did a 3-mile run/walk. This felt as big as any other running accomplishment I had achieved—however small and inconsequential it seemed to anyone else. I began running every other day, not worrying about my pace, just focusing on how my back and tibia felt. I enjoyed the movement and the normalcy. Within a few weeks, I was running almost daily, free of any post-op discomfort.

I set a secret goal to run a half marathon before my last cycle of chemotherapy, scheduled for the first week of March. I found that, no matter how tired or sore I felt, running gave me relief. I felt normal, I forgot that I was bald and bloated and nauseous and a shell of myself. I felt normal, alive, even powerful.

On March 6, 2021, the Saturday before my final cycle of chemo, I set out to run a Chemotherapy Half Marathon. Just over 2 hours later, I finished in front of our new house, smiling and sweaty (such a familiar, proud feeling), noticing that the light in my kids’ room was on, knowing that I had managed to exceed my own expectations, and that I would get to walk inside, a finisher of my first and only Chemotherapy Half Marathon, and be a mom to my kids. A mom who been carried through chemotherapy on a pair of running shoes and a lot of endorphins.

Coach Annamarie McCormick-Howell is an RRCA Certified Running Coach and an ACSM Certified Personal Trainer . She lives in Fort Meade, Md. You can follow her at @amcchowell on Instagram or reach out to her via email at amccormickhowell@yahoo.com.

 
The Mechanics of the Arm Swing

The Mechanics of the Arm Swing

By Coach Adolfo Salgueiro

Last week I wrote about the first aspect of arm swing biomechanics, which is pushing your elbows back. If you haven’t read that one yet, I invite you to do so by clicking here, before returning to this post. You will find the link back to this one at the end of that post.

US runners usually keep their arms in a 90-100 degree angle and do not cross their bodies as they swing. East Africans use a different technique. This is US Marathon record holder, Ryan Hall.

Pushing backwards is just the first part of the equation and by no means its only part. Many pieces need to be coordinated so the best biomechanical and energy-saving results can be reaped. As with everything else in our sport, it starts with a good posture. There is nothing to gain when you have a beautiful arm swing motion if you are not running upright, leaning forward at the correct angle, and not bending from your waist.

When it comes to arm swing, there are many components that need to work in a coordinated fashion. It must be a seamless symphony of motion between the upper and lower body. One where the arms will complement and enhance what is happening with your legs and feet.

Check what Coach Steve Magness has to say on this subject in his book The Science of Running: “it goes beyond just the arms and legs working in opposition; when they both stop, forward and backward motion is also coordinated. When the arm stops moving forward and is about to reverse direction the opposite leg should reach its maximum knee height before starting its downward movement. Similarly, when the arm reaches its maximum backward movement before switching directions and coming forward, the opposite leg and hip should be at their maximum extension backwards”.

Arms should be relaxed and that starts at the fingertips. When you tighten them in a fist, the rest of the muscles follow the trend upward until you reach the shoulders. This refrains the free flow of the arm swing. The best way to relax that kinetic chain is with the “potato chip technique”.

Pretend you are holding a potato chip between your thumb and index fingers. They are very fragile and will break if you press too hard. As you do this, the remaining three fingers will be forced to relax and easily positioned below the potato chip. This relaxation on your hands will start creeping upwards and relaxing your arms, as long as you are positioned properly. Avoid having your wrists parallel with the road, as it will make the relaxed wrists sag down. They should be perpendicular to the road.

East African runners hold their hands closer to the heart and cross their bodies as they swing. US runners have a different technique. This is Tirunesh Dibaba, from Ethiopia, winner of the 2017 Chicago Marathon, who also has two seconds in London.

Regardless of your arm swing technique, the movement begins at the shoulder, like a pendulum and not from the elbows. From there down, what I like to teach my athletes is to have forearms below the elbow at an angle from 90-100 degrees, with the relaxed hands at the end. As you push back your elbows, the relaxed knuckles should reach the hip, before changing directions. As you began to run faster or sprint, they will automatically start reaching further back.

In his book Run for Your Life, Dr. Mark Cucuzzella goes through his Five Principles of Running. Number 3 is “Use your arms and hands to set your rhythm”. The key here is that when you swing your arms from your shoulders using the strong lower trapezius muscles “your knuckles stay close to your sternum but should not cross your center line”.

As in everything, there is no one-size-fits-all technique when it comes to arm swinging. Elite East African athletes run with their arms tucked closer to their bodies, in an acute angle (about 45 degrees) and with their hands very close to their hearts. They also cross their torsos on the swing. In the US we carry our arms lower and we don’t cross. Regardless of what style you use, they both have relaxed arms, and they both push elbows back.

I tried this East African arm-swing style for myself and I did feel a change in my stride. It became shorter and started falling closer to my center of gravity. But it was exceedingly difficult to keep my arms relaxed in that position and it required extra effort to push my elbows back. My arms became automatically tense. But it works for Eliud Kipchoge and his running buddies, so we can’t discount it.

As for the many benefits of the proper arm swing technique, Dr. Cucuzzella adds that the arm swing will help also in providing stability, counterbalancing the movement of the opposite leg, balancing the pelvis, and helping maintain forward momentum. This alone should be enough for any runner to start paying attention to their arm swing technique, right away.

Please understand this is not a comprehensive research paper on arm swing. There are entire books and studies on this subject. It is just a review on the basics biomechanics and technique so you can understand how important this is in your running form. If you start being aware of your arm swing, you can make your running way more efficient.



The Key to the Arm Swing

The Key to the Arm Swing

By Coach Adolfo Salgueiro

 As a running coach, one of the most common issues I see in running form has nothing to do with heel striking or lack of cadence. It has to do with one of the most important, yet neglected, parts of our running biomechanics: the arm swing.

Key to the Arm Swing

Check that triangle between Meb Keflezighi’s left arm and his torso.

Gordon Pirie, British 3-time Olympian and a 1958 medalist in the 5000, says that “there is a lot more to running correctly than just getting your legs and feet working properly. What you do with your hands and arms is equally important”.

Arm movement balances our running form and usually is the culprit of many of the issues that happen below the waist. Fortunately, arm swing issues are way easier to correct that leg mechanics. A few basic exercises should assist you, unless you have skeletal issues that will prevent you to move your arms in the optimal way.

Grant Robison, a 2004 US Olympian in the 1500, observes that that is easier for runners to adjust their arm motion instead of their legs because arms are always in front of you, thus, they can be seen constantly, so you can really focus on them.

I read about a fascinating series of experiments led by Dr. Rodger Kram starting in 1999, which determined that about 39% of the energy used in running is dedicated to moving forward. Subsequent studies determined that 20% was used to the swing of your legs. When you include supporting your body’s weight and moving forward, you are talking about 90% of your energy use. Interestingly, he also found that the arm swing motion can provide an energy saving effect of 4% compared to not swinging your arms at all. Imagine what you can do with 4% extra energy.

The Key is Pushing Backwards

All the articles and books I’ve read about the biomechanics of running, and racewalking for that matter, agree that the key in the arm swing movement is pushing your elbow backwards. Robison says that “A powerful arm drive is 100 percent backwards. It is just the recoil that brings it forward. The stronger you can drive your arm back, the quicker your turnover will be, and the more reaction your feet will have in relation to that”.

Translation to that last statement: You want more cadence? Swing your arms faster.

I read in a book, but unfortunately, I couldn’t find exactly where so I could quote it and credit it accurately, that the great Meb Keflezighi, in order to find out if his arm swinging mechanics are working, he looks at his shadow. If he sees a triangle of light between his arm and torso, then he knows he is swinging back far enough. I’ve tried this and it works. Most likely you will only see the triangle in one arm, so to see the other one, turn your direction 180 degrees.

Of course there are other aspects of arm swinging that go beyond pushing backwards. For one, your arms need to be loose and your hands relaxed, starting at your fingertips. There can’t be any tension so they can swing back and forth and be part of the symphony of coordinated movement needed to achieve a good and energy efficient stride.

All this cannot be covered in the few hundred words of this blogpost. We will revisit this topic, next week for some additional biomechanical recommendations. In the meantime, start pushing those elbows back and reap the benefits.

If you want to read the follow up post, please click here.

 
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