Week 222: spinal tracts

Ouch – we had some monster neuroanatomy learning outcomes this week. From an anatomy perspective we want students to be aware of the major motor and sensory tracts of the spinal cord, what type of information they carry, where they run (and where they cross over from one side to the other), and what would happen if the spinal cord or brainstem was damaged on just one side in terms of sensory info coming into the brain and muscle control. (It’s pretty easy to work out what would happen if the spinal cord or brainstem is completely severed).

I’ve included a bunch of images, but excuse my scribbles, lack of legends and minimal labels. Some of this is intentional, and some of it suggests I don’t have enough time to do this as completely as I would like (I tried to write this when I taught it last year and have had it on my to do list for 12 months!) The images below are of a spinal cord in transverse section with some of the spinal tracts indicated by coloured blobs, and of the brain, midbrain and spinal cord cut in coronal section with the paths of neurones indicated. Yes, really, that’s the brain at the top of the diagram. The thick grey is the grey matter of the cerebral (and cerebellar) cortex.

Spinal Nerves And Cord

We started with the spinal cord. By now you guys have a pretty good idea of the structure of the spinal cord, and we ran through the white (myelinated neurone axons running up and down the spinal cord) and grey (cell bodies, synapses) matter, the ventral horns (motor neurones go out) and dorsal horns (sensory neurones come in) and talked briefly about the terms “commissure” and “decussation“, because the concept of neurones crossing from one side of the body to the other is important.

Tracts within the spinal cord are bundles of neurones running together, usually with a common function and going to or coming from similar places. A fascicle does the same thing. Some areas of the spinal cord are described as columns, such as the dorsal column of the spinal cord’s white matter, in which tracts run bunched together.

Some major tracts to be concerned with are the corticospinal tracts (ok, there are lateral and anterior corticospinal tracts so that’s two on either side), spinothalamic tracts, dorsal column tracts, and maybe spinocerebellar tracts.

Spinal Tracts

Corticospinal tracts carry motor neurones (and upper motor neurones at that). Upper motor neurones start in the cortex of the brain, namely the motor cortex (or precentral cortex), run through the white matter of the brain to the brainstem, cross over to the other side of the body (decussate) in the pyramidal decussation of the medulla, and then carry on down the spinal cord in the lateral corticospinal tract. At the appropriate level they synapse with a new motor neurone (this would be a lower motor neurone) in the ventral horn of the spinal cord, which carries the action potential out along a spinal nerve and peripheral nerves to the target muscle (and the muscle contracts). The muscle that contracts is on the opposite side of the body to the side of the brain that started this, in the motor cortex.

Corticospinal Tract

Well, this happens for around 90% of upper motor neurones. The rest run down the same side of the body as the side of the brain that they started from, in the anterior corticospinal tract. They tend to control muscles of the body wall.

If the spinal cord is damaged on only one side, muscles on the same side as the injury (ipsilateral) will be affected because they decussated up in the medulla. (Damage to upper motor neurones tends to give muscle weakness, increased muscle tone and changes in reflexes.) Theoretically if the brainstem was damaged superior to the pyramidal decussation, effects on muscles on the opposite side to the lesion (contralateral) would be seen.

Dorsal columns and spinothalamic tracts carry sensory neurones up the spinal cord to the thalamus (which filters sensory information before relaying appropriate stuff to the somatosensory cortex).

The dorsal columns contain neurones conveying fine touch, vibration, two-point discrimination and proprioception. Peripheral neurones pass into the dorsal horn of the grey matter, pass into the dorsal column (without synapsing) and stay on the same side of the spinal cord, running superiorly to the brainstem, where they synapse with a second order neurone. This second order neurone crosses to the other side of the body and ascends to the thalamus.

Dorsal Columns

Spinothalamic tracts convey neurones of pain, temperature and crude touch. In these cases peripheral neurones enter the dorsal horn of the grey matter, and may ascend on the edge of the dorsal horn for a couple of spinal segments. There they synapse with a second neurone, which crosses to the other side of the spinal cord and ascends within the spinothalamic tracts through the brainstem to the thalamus.

Spinothalamic Tract

If we consider injury to the brainstem again, in the case of sensory information the patient would lose senses of pain, touch and proprioception on the opposite side (contralateral) of the body to the lesion (because all of the sensory neurones have crossed to the other side by this level).

If we consider injury to the spinal cord, the patient would lose senses of pain and temperature on the opposite side of the body to the lesion (those neurones crossed sides already) but would lose senses of touch and proprioception on the same side as the lesion (those neurones will not cross sides until they get to the brainstem).

Weird, huh? Have a read about Brown-Sequard syndrome.

I beat myself!

View from the Rhigos Mountain
I had another crack at getting the me of 2012 to beat the me of 2011 today, and succeeded! Winner! I used a 113km course running from Gowerton out through Neath, up to Glynneath and over the Rhigos and Bwlch mountains, back to Neath and home again. It’s a lovely, lovely route, along the Neath canal on quiet and interesting roads up the first valley, a climb up around the valley’s head to the mountains that give fantastic views. Good hairpin climbs and descents on clean tarmac (well, except for the ice and grit), past old coal pits, showing off the South Wales valleys. Nice.
Today's profile
Last year, including pee stops and a garage refill stop, and a brief excursion because of some roadworks, I got round in 5:07. Its an aerobic ride so its not super quick, and there’s around 1500m of climbing. From the start today I put a gap into my old self of 1km, that built to around 2km by the base of the Rhigos according to Garmin’s virtual partner. Nice! I kept that gap up for the rest of the ride and beat last year’s me by about 6 minutes, again including pee stops. My nutrition was a bit better managed this year (I only need a couple of tubes of Glucotabs) so I didn’t need to stop for a refill.
Hairpin Climbs
The huge wind turbines nestled in the hills looked ominously inanimate. Good for the winter cyclist. There was very little wind today, and when the rain came in the last hour or so it wasn’t too bad. I hadn’t believed that it would rain at 2C. It usually either gets a little milder for rain round here, or it snows when its that cold. But it did. 2C and rain. Good job I was well prepared. Today was a good example of how you can prepare yourself for bad weather with good clothing. I use mostly Castelli layers at the moment. As I’ve mentioned before, I think the silvered radiation vest makes a big difference when it gets below 5C. I could really do with a clothing sponsor if anyone’s interested in me trying out some stuff! Cycling is nuts for clothing costs, summer and winter.
Climbing the Rhigos
So that’s my base training pretty much done. A week of recovery and testing should give some more fitness gains, I hope, and then it’ll be time to get stuck into lactate threshold and above threshold sessions, relearning race pacing and a little early season racing.

Finishing my (winter?) base training

This week I’m coming to the end of my base block of training. For nearly 3 months I’ve been building my training load by increasing volume and workout intensity bit by bit, with an easier week every 4 weeks to allow myself to recover. Most of that work has been aerobic, but more recently some faster paced stuff has been added. My fitness has been building nicely, I’m feeling strong, movement in the water feels good, running is going well (touch wood, cross fingers) and the biking seems to be going well with a higher functional threshold power output than last year.

I am tired. That’s normal right now and a good sign, but I’m looking forward to some easy days and some more testing next week. And a lie in or two.

This week has been a bit nuts with a lot of work, blocks of my timetable taken up by various things and training getting squeezed out into early mornings as the sessions have been a bit longer. I swam a 5km session this week too which is the biggest single swim I’ve done, and swimming makes me sleepy. Up early and in the gym this morning I was already tired, and I had more than 4km to swim later in the morning with a bunch of 400m reps at threshold pace. It went rather well though. A good sign!

My right calf has been a little tight this week, so I skipped the box jumps to help everything recover a little for tomorrow’s long run. I’m running 5 days a week so I need to be a bit careful.

Speaking of tomorrow’s run, here’s an example of fitting training in with working and family. I did a set of hill reps on the bike first thing in the morning yesterday and rode back past my house to pick up my bag on the way to work. I had planned to run in the afternoon and then ride home, but my last meeting was rather long so instead I ran home (with a little extra loop to make up the volume). Once home my day was done & I could eat with the family and put the kids to bed without having to go out again. But of course that left my bike in work and I needed to get into the gym early this morning. Drive? Nah. I rode another bike in this morning, gym, work, swim, work, cycle home, leaving some warm cycling kit in my office and a couple of quid. Why? Tomorrow I’ll do my long run from home, over about 20km by the sea to work. I’ll get rid of my wet kit, spend the cash in the vending machines and grab a snack, put on the warm cycling stuff and ride the other bike home. Job done!

Jack’s got a laser tag birthday party in the afternoon, so I can give myself plenty of time to help with that. Then all I’ll have left to do is a long, 5 hour(ish) ride on Sunday with a little bricked run off the bike. I hope it’s not too wet and cold – the weather has turned again. Wish me luck.

Sunwise Waterloo

Sunwise Waterloo polarised Chromafusion sunglasses
I went out on the bike the other day in perfect testing conditions for the Sunwise Waterloo glasses. It had been chucking it down all day, the roads were wet but the sun came out. It was super bright and low, into my face on the way out (sometimes in Wales we don’t see the sun for a week or more so I’m not complaining), but then I was hidden in the shade on a wooded hill to knock out some threshold hill reps. Normally I’d struggle with a single pair of glasses but the Sunwise Waterloo’s are great for this. So it was a shame I hadn’t taken them as when I’d left the house it had been dark grey and chucking it down with rain. D’oh!
Fortunately I did the same workout a week later under similar conditions and took them that time!
They’re a bit clever, in that they have polarised lenses, which cut out the glare from the sun on wet roads, and they’re Chromafusion lenses, meaning that the darkness of the lens changes in response to the brightness of the light. Sun in your face? No problem. Shady woods? No problem. Dark clouds rolling in? Not to worry.
I’ve been very impressed, and I like the styling too. I’ve got the white pair – white seems to have become a colour of mine since starting racing again. The polarised lenses are great at cutting the glare from the sun reflecting from puddles in the road, but they’ve never hidden the water on the road (or ice, as I found out coming down the Black Mountain the other weekend) so they seem safe for cycling to me. I can see the puddles and avoid them. They’re great for rock pooling too – you can see through the water to spot the crabs and gobies, although I tend to wear my orange Shipwrecks on the beach.
Running with Sunwise Waterloo sunglasses
The grey lenses give a very natural tint, and as they adapt to the brightness of the day I usually forget I’m wearing them. They’re my favourite for running on sunny days too as they sit well on my face. Light. I often walk back into the house still wearing them as they adapt to the light so quickly. The size and shape of the lenses mean that their coverage of my view is better than some of the other glasses I use. If I’m on the bike and glance down to my bike computer on the stem it’s still within the Waterloo’s lenses. The polarised lenses give a funny effect to LCD screens too, usually giving the display a little more contrast. Another interesting effect is that you can see into cars. Because the reflections from the glass are cut out you can see quite naturally into the cars around you. The advantage of this for me is in aiding my cyclist’s telepathy: on the bike you have to second guess what drivers are going to do as many don’t bother indicating (or looking) and being able to see the driver helps with this. And if a mate toots his horn I can look inside the car to see who the hell it is and wave or give a two fingered salute (depending on how well I know the occupants).
This is a top quality pair of glasses that I really like the look of, that work really well, are polarised and adjust to the brightness of the day. And you can pick them up on the internet for under £60.
OK, don’t forget that Sunwise are sponsoring me and my racing in 2012, but I’ve been using and recommending their glasses for years (check back through my Flickr photos and you’ll spot them).
Sunwise Waterloo on the Sunwise website
Sunwise logo on Waterloo sunglasses

New sponsor: Swansea Health Solutions

Swansea Health Solutions pain relief centre
If you’ve been reading this blog or following me on Twitter for any time you’ll probably know about he-who-looks-after-my-legs. When I started running again I had a few problems and biomechanical issues as my mileage got a bit thick, and he was key to working out what was going on, working on my legs and pushing me towards a strength and conditioning program, and in keeping my running mileage increasing through the year. The end result of that was a 2:46 for my first marathon. I think its fair to say that I wouldn’t have managed to get the training done that I needed to develop my fitness to that level without his help. Gareth is the guy that keeps me going.
Since then Gareth has worked with me very regularly, and with triathlon things got more complicated. He looks after my upper back, my shoulders, my lower back, my hips, my legs and my feet. My calves are an area of constant work. When I’m healthy I see him for massage, mostly for calf work, probably mostly because I hate him working on my quadriceps. Ouch! The day after a deep tissue massage running feels easy and loose again. You don’t realise how tight you get sometimes.
Leg massage
When I injure myself Gareth helps me heal and recover as quickly as possible. He works on the damage, he advises me on what else to do, and he’s someone to talk to about training loads, injury and recovery. He’s also been very helpful in developing my post-race recovery routine that gets me back to normal training as quickly as possible, minimises soreness and gets me ready for the next race. On those occasions when I’ve hurt myself and have not been able to get to see him, my recovery has taken longer.
Gareth also points me towards what needs to be stretched, and links up parts of my body to problem areas that I, as an anatomist, don’t make the connections too. Having to lie on a firm foam roller in my living room of an evening is all his fault. He knows his stuff, and he’s about to finish his osteopathy training so his knowledge and experience is fresh.
Running the Dale Half-marathon
Gareth is about to set up a new business in Gowerton, in Swansea. He’s preparing a new clinic, happily just around the corner from my house! His new Swansea Health Solutions practice will provide a single location for sports massage, soft tissue therapy, physiotherapy, osteopathy, acupuncture, and so on. And with me looking for sponsors to help me fund my 2012 triathlon racing season we’ve agreed to extend our relationship and add a professional element to it. So Swansea Health Solutions will sponsor me for my 2012 racing season. Thanks Gareth!
I’ve been recommending Gareth to students and friends ever since I met him, and I’m continuing to do this. I’ll have his logo on my website, and on my racing kit, and I’ll include updates in my blog through 2012. He has a bunch of photos of his new clinic before and during construction, which I’m hoping to share from my blog.
You will be able to find the Swansea Health Solutions Pain Relief Centre here:

View Larger Map
I’ve labelled Station Road, but the clinic will be on the corner of Station Road and Gorwydd Road. You’ll see it.
If you want to contact Gareth you can email him at gareth@swanseahealthsolutions.co.uk. His new website has a placeholder at the moment, but there’s more contact information there:
Coming soon:
Swansea Health Solutions Pain Relief Centre

Cardiff Tri Male Athlete of the Year

I forgot to mention that I was voted Male Athlete of the Year for 2011 by members of the club. Thanks everybody that voted, and thanks even more to those that voted for me!
I couldn’t make it to the Christmas dinner unfortunately, but it was a very lovely thing to be told of at the end of a hard year.

Race yourself. Virtually.

Garmin virtual partner
I noticed some nice new motivational winter training videos and bits up on Garmin Connect the other day (here’s the cycling video) and it reminded me to use the virtual partner function for this morning’s ride as I ride solo & fancied comparing myself to this stage of training last year. I’ve built up a collection of rides that I can use for this. Woah! Racing yourself is tough!
I was out on a ride with a couple of long climbs, the main climb going over the Black Mountain. I did this route last March, so found the original data from my Garmin from that ride, and turned it into a “Course”. You can do that in the Garmin desktop software, or you can now do it in the online software at Garmin Connect (see the image below).
Garmin Connect toolbar
You can then stick the course on to your Garmin computer, select it from the “training” and “courses” menus, and it’ll then show you a black line to flow as your route, a little graph of the hills and dips coming up, a bunch of data about how long the route is and how long until you reach your destination, and a page with 2 little cyclists on it. One little cyclist is the you of today and the other little cyclist is you (or your mate if you’ve been sent a file from a friend to race against) from last time. There’s a note underneath of how far ahead or behind you are, which changes colour depending upon whether you’re in front or chasing. Clever, eh?
It’s an easy, visual way to compare yourself instantly and constantly to a previous performance, and gives you a motivator to keep pushing.
I’ve used it before but only with courses I’d planned out on Map My Ride with a constant speed to chase. It’s very helpful if you want to plan a nice complicated route with lots of lanes, as you can be confident you won’t get too lost following the black line breadcrumb trail, and it’s easier and quicker than pulling your phone out of your pocket to help you navigate every time you hit a junction.
Using it with a previous ride is something else entirely though. I was really surprised at how close we were throughout the whole ride. We started off together, but I had a bit of a headwind and was unlucky with traffic lights (you can avoid this if you use the auto-stop when stopped function – I don’t) and he got a gap on me. I caught him at some other lights, but he slowly built a gap on me of about 1km on the way out. I caught up with him when he stopped for a pee (you remember that this is all virtual right? I just remember what happened when I did this route last year) and got ahead of him briefly. He had a gap again of only about 300m by the bottom of the main climb and I chased him down. The gap went up briefly, then I brought it back again but he beat me to the top by just a couple of hundred meters. Wow, that was tough chase!
The virtual me stopped for another pee at the top (must have been a big cup of tea) and I stopped for a photo or two (the one at the top and the one below). Maybe I should have taken some more picturesque photos of the views, but it was cold and my phone wasn’t playing nicely. The image I have in my head is of the red kite hunting beside the road as I climbed, at eye level in bright sunshine, holding position in the updraft and tweaking its tail and wings to slide from side to side.
Frozen top of the Black Mountain.
It was about 4C when I set off but the top of the hill was frozen about 500m higher than my house. Chilly! Me and my virtual me (Mii?) set off down the hill at about the same time but my descent was a wee bit sketchier than his – proper thick patches of ice on the road, some gritted hairpin bends and a strong wind gusting my front wheel around. Hairy! My competitor got a good 400-500m on me through the first part of this proper mountain pass descent, but I picked it up after a long drop down to the plains north of the hill with a wind to my back helping me across to Fairfach. We were so close that when the battery in my speed sensor died and I stopped to check it I saw him whizz past me as a big clear arrow passing through my little black arrow on my Garmin!
I got ahead again and stayed ahead (I think) on the long, gentle climb up towards Maesybont, then dropping down south again back into the wind he caught and passed me. The pillock took the wrong turn though (ha – I remember that) and hat to turn around so I got ahead again. All the way back to Gorseinon there were only a few metres between us, and we were sat at the lights together (virtually) with just a few km to go, after almost 90km of riding. We were back and forth all the way home; he got through a roundabout quicker than me and I hat to wait, then I took him at the next set of lights, and we got home almost together. All of that had mentally helped keep my heart rate and power nice and high to the end. Competing against yourself? You’re fit!
I went straight out on a little bricked run and left him behind with a virtual cup of coffee.
In the Garmin desktop software you can compare rides and runs too. Check out this pair of graphs from the ride last year and the same route today. Funny how average and maximum heart rates are so similar over 4 hours. The distance discrepancy is from the wrong turn I took last year. Following the red and blue lines on the elevation chart you’ll see how close the two riders were, 10 months apart. I reckon I had it windier today. My heart rate in the second half of the ride looked a little lower today, and was a little higher on the way out, probably reflecting the difference in wind conditions.
2 Black Mountain Rides
It was a cracking ride and good fun with my virtual buddy. If you’re a solo rider like me and have a Garmin thingy for your bike (or for running) than I really recommend that you have a crack at the Garmin virtual partner function. You can set it up at a set pace for a set duration or distance but that’s a bit dull. Race yourself against old files!
Garmin virtual partner blog entry.

January training

Swansea Bay dawn
I’m now in the third block of training for the 2012 season, and feeling pretty good. Knackered, but good. This will be the last block of the traditional “base” phase of training, so I’ve just got 3 long rides left.
It looks like we’re moving on from the mild, wet weather of the winter so far into a colder, but sunnier period. This Sunday looks like it will be chilly between 2C and 6C. If I start early, what do I wear? I’ll be starting in the dark, but when the sun gets going it will get warm, and I’ll probably be going up over the Black Mountain. Decisions, decisions. Big lobster gloves or normal gloves? A reflective lining layer or jerseys?
I got used to the mild weather and the damp. I should try and think what I was wearing in the ice of last winter. Better too warm than too cold, eh?

Week 219 – blood circulation in the lungs

Coloured lung segments
The Christmas holidays are over and we’re back to teaching (and learning). This week we went back to the lungs and added a little detail by looking at the pulmonary vessels in more detail, and adding the bronchial arteries and veins to this. As this is a teaching week about pulmonary embolism this anatomy should be very helpful.
We recapped how the pulmonary trunk comes out of the right ventricle of the heart, carrying deoxygenated blood towards the lungs. It splits into left and right pulmonary arteries, and each one passes into the hilum of a lung. These vessels are big. They’re carrying a lot of blood that will be ‘processed’ (for want of a better word), like we see in the liver and the kidneys. This isn’t blood that supplies the lung tissue as such, it is blood that needs some gases removed from it and other gases added to it.
The pulmonary arteries divide as soon as they enter the lung, and if you look at cadaveric lungs you may see this if they have been cut away from the body more deeply. A superior lobar branch passes to the upper lobe of the lung. In the left lung the other branch passes to the lower lobe as an inferior lobar branch. In the right lung a branch descends a little way and splits to give off lobar branches to the middle lobe and the lower lobe.
The lobar branches give off yet smaller branches, known as segmental branches. Branching continues until the pulmonary arteries (or arterioles when they become small) reach the alveoli and form capillary beds at the blood-air barrier, where gaseous exchange occurs.
The interesting thing here is that the branching pattern of the pulmonary arteries matches the branching pattern of the airways. I.e. the pulmonary arteries enter the hila of the lungs with the main bronchi, and the lobar branches pass with lobar bronchi, and segmental branches pass with segmental bronchi. Note that these branches of both structures may also be referred to as secondary (lobar) and tertiary (segmental) branches.
Remember that the bronchi continue as conducting bronchioles, then terminal bronchioles, and then respiratory bronchioles (and then alveoli).
From the capillary beds of the alveoli freshly oxygenated blood passes through small pulmonary venules, which drain into ever larger vessels, until they become the pulmonary veins and leave the lungs, returning this blood to the left side of the heart. Note that the tributaries (i.e. the branching pattern) of the pulmonary veins does not match the branching pattern of the airways. It looks very similar but it is located in a slightly different region.
The bronchi, pulmonary arteries and pulmonary veins are all great big tubes entering and leaving the lung at the hilum. There are some smaller vessels there too: the bronchial arteries and veins. The bronchial vessels help supply nutrients and oxygen to some parts of the lungs. The bronchial arteries also follow the airways, and can be found on the posterior surfaces of the bronchi and their branches. The two left bronchial arteries commonly come directly from the aorta, and the single right bronchial artery often comes from the (thirdish) posterior intercostal artery, but these origins are a little variable.
At the distal ends of these branches there are anastomoses between the bronchial arteries and the pulmonary arteries. In a younger, fitter adult these anastomoses may be helpful in minimising the ischaemic effects of a pulmonary embolus blocking a segmental pulmonary artery. Much of the blood that enters the lungs within the bronchial arteries leaves within the pulmonary veins. This mixing lowers the oxygen content of the blood within the pulmonary veins a little. Bronchial veins carry some blood away, and drain into the azygos vein (on the right) and the hemiazygos vein (on the left).
Consider the branching above. The smallest segment of a lung that is supplied by a segmental bronchus and a segmental branch of a pulmonary artery (and there will be a bronchial artery along side these two) is known as a bronchopulmonary segment.
Coloured segment airways
This is handy to to be aware of. It would be possible to remove a single bronchopulmonary segment (say, because of a cancerous mass of cells) without affecting the function of any other bronchopulmonary segment. All the other parts of the lung would still have their own airway and blood supply. Also, if you know your bronchopulmonary segments and you know where a patient’s pulmonary embolus has lodged you can predict which parts of the lung are likely to be affected.
There are 10 bronchopulmonary segments in the right lung, and 8-10 bronchopulmonary segments in the left lung. Try to think of each segment as kind of pyramid shaped, with the base of the pyramid forming the outer surface of the lung and the pointy apex of the pyramid pointing towards the hilum (where the branches come from).
In between the bronchopulmonary segments are thin sheets of connective tissue. In these spaces between the segments the pulmonary veins are found, running towards the hila and out of the lungs.
Below is the diagram I sketched on the Smartboard during teaching. The black lines are the airways, the blue lines with them are the pulmonary arteries, the thin red line with them is the bronchial artery, and the other lines have labels. Amazing stuff. I hope it made sense at the time. Maybe I should draw this again slowly and it might become useful.
Week 219 Lung Circulation Scribbles

I got there in the end

Don’t we always? Keep pushing forward bit by bit and you’ll get there. That’s what I keep telling myself every time I play golf anyway.
But I’m talking about running. I tweaked my left medial gastrocnemius muscle (calf to some of you) at the end of the 2010 season charging up a steep, rocky hill in a cross country aquathlon of all things. It settled down and I had some work done on it, and then I spent much of the winter working on cross country running and my running biomechanics. I was trying to cut down on my heel striking that slowly appeared when I got tired, like towards the end of a triathlon or a half-marathon. It slows me down, so working on that should speed me up, right? Drills and what-nots all worked, but as with many people moving away from a heel strike my calves suffered a greater loading when I ran and needed to strengthen up. I wasn’t jumping directly from a heel strike to a forefoot landing mind you – I’ve been shifting that for the last 7 years or so (with big gaps in running in there).
With the start of the new training season in 2011 a big goal was to run faster, so the training plan was to run more. The problem was that running more means less resting between runs. My calves suffered, I had tweaks and tightnesses and twinges, and ran through some of it. I had work done, we sussed out the problems. I did strength and conditioning work, stretching, and paid attention to my calves, but nonetheless racing often proved too much of a stress and tweaks and minor tears giving super-tight-tightness of my calves returned often. I missed weeks of running to repair and recover, I cut my running load, and I missed a race. My running wasn’t in good shape, but as part of a triathlon it was good enough to keep me in the standings.
Late in the summer after fairly significant damage to my flexor hallucis longus and flexor digitorum longus muscles in my right calf (and possibly others) I reassessed what I was doing. I sat down (good start), thought about the problem and its causes (good idea) and the possible solutions (getting sensible).
The new plan was to aim to run three times a week every week until Christmas, to perform daily stretches of not just the calf muscles but also hip muscles and my lower back, and to start a daily strengthening routine using Alfredson’s heel drops off a step to strengthen the muscle-tendon complex.
The aim of running three times a week over a period of 5-6 months was for a couple of reasons. Consistency builds fitness, and in my case I needed to build the fitness (i.e. strength, aerobic endurance, fatigue resistance) of the weakest links of my running muscle chain. Aiming to run every week for a long period meant I couldn’t injure myself. If I damaged a muscle I wouldn’t be able to run and I would fail. So just running for 20 minutes for 3 times a week would count. If I felt a tweak or a tightness or a pain, I could stop and walk home. That run still counted and I would be able to run again in a couple of days. If I kept trying to hit longer run targets I would probably damage something and fail to run again that week. Fail. It forced me to be sensible.
So getting three runs a week in felt like a success. Repeating this week after week felt like a success. It also made me cut my mileage right back to a very low level. I stopped running first thing in the morning and started running later in the day when my muscles and tendons had warmed up and lengthened a bit.
Slowly, the volume increased. Very slowly. To start with I’d feel the tightness in my calves within 15 minutes, so a 20 minute limit was the maximum I would run. Then on some runs the tightness would only come on a little later. Then I could start to extend the run. Slowly I became able to run for 30-40 minutes with little tightness. Then no tightness at all. My achilles tendons were also sore, but the soreness would kick in at the start of the run and then the scratchiness would die away, and some soreness would only return later.
I added weight to my body weight for the heel drops and that seemed to kick off significant improvements. In the gym I’d hold a 10kg weight and then weeks later a 15kg weight. At home I had a rucksack with weights in it. I made sure to stretch troublesome muscles (calves, hips) some time before a run, let them settle down and then run. I found that stretching my lower back with rotational stretches seemed to help. Focusing on running tall, keeping my pelvis forward, keeping my pelvis level (particularly when tiring) and pushing with my hamstring muscles all seemed to help my running in terms of less pain and soreness during runs.
One of my long term problems is my left hip abductors tiring and allowing the right side of my pelvis to drop, causing over pronation of my right foot and added stress to the tibialis posterior muscle and others. Adding a variant of a single leg squat exercise with weights in the gym helped strengthen up both sides. This squat is done with one foot on a box, squatting to lower the other foot to touch the floor, and then standing up again with the foot on the box. In this movement the pelvis tilts and the leg on the box uses the hip abductors to drop and raise the other leg. These were the muscles I needed to target and this strengthening occurred fairly rapidly over a few weeks. In a normal single leg squat you keep the pelvis level. I’ve used other exercises in the past but this one, probably with its ability to add load by putting a barbell across the shoulders, has made a bigger difference to my hip abductor strength than the others. I’ve been doing single leg squats, clams and the like for years, but they didn’t work as well as this.
Run - Weekly Duration
Take a look at the table above to see how my running volume per week changed through 2011. It started high and then dropped to nothing as I injured myself. It bounced back and died a couple of times and then I slowly, consistently, patiently built it back up to beyond 3 hours per week without pain. It’s not a huge volume, but it’s pain free.
Eventually I got to the point where I could run for an hour. Whoop! This took months, and by now I was running in dark, wet evenings, but running small hills seems to help. I added hill specific sessions to help strengthen my running muscles. Now, in January and in the third block of training for the 2012 season I’m running for over an hour at a time, I’ve added plyometric box jumps back into my gym work, I have no pain in my calves or tendons when running (and that feels freaking fantastic) and I did my first mile reps at a lactate threshold pace this morning with no calf tightness or soreness.
I feel fairly robust and healthy at the moment. Running has become easy and fun again, and hopefully I’ll be faster this year. I think I’ve learnt that no level of fitness matters if you injure yourself.