Atrophy from a 2.5 Month Hiatus from Running

I just did my second run since having to stop before my hernia surgery about 2.5 months ago.  I thought it would be interesting to share the areas of atrophy I've noticed - including some unexpected ones that may not qualify for atrophy in the medical sense so much as in the metaphorical sense.  These are really based on my observations from the second run alone since the first was so low impact that it hardly counts as a run.  It was more of a walk/job medly. The second had real running in it, with my pace getting down to the 7 minute mile mark, and even dipping below a couple of times, but averaging more like 7-8 when running and 12-14 when walking in between running intervals.

The Expected
Skeletal Muscles
This was no surprise. You stop working muscles, and they get weaker and smaller. I can see it all over my body in terms of size and definition. I also absolutely feel it today, one day after my first real run.  Stairs are a bit tough, and I didn't move with what would describe as grace this morning (though a 35 min elliptical session helped add some grace back into my step).  While it stinks, this isn't a huge deal, and I will get it back. One of the nice benefits of my high protein diet is that I see my muscles rebound really well once I start working them again.

Cardio-Respiratory
This was also no surprise, yet definitely upset me more than losing muscle. You expect your muscles to shrink, but I don't think most people include muscles like the heart and those you use to breath in that bucket.  Well, they do.  Like any muscle, reduced use will result in reduced performance and/or endurance. I definitely don't have the oxygenation capacity I did before my surgery, which is clearly showing up in my endurance.  I could do a 5k run in the heat, hop in the shower, and be back into playing with my three year old easily. Let's just say I needed a minute yesterday, and I didn't do 5k (overall, or at a running pace). I also couldn't sustain as fast a pace as I did, and my slow intervals included walking with some serious huffing/heaving breathing, whereas they used to be jogging without any real labor in my breath.

I will get this back, too.

The Unexpected (aka Metaphorical Atrophy)
Feet
I could have called this atrophy of calluses, too.  Basically, my feet have really toughened up from running.  While much of the surface of my mid foot pads are still tough, after my run, I had a blister on the bottom of each of my feet in roughly the same spot (just in front of the ball of my foot). And during my run, there was definitely a feeling of sandpaper underfoot.  High grit sandpaper, but sandpaper nonetheless.  This will get better as my feet toughen up again, but man do those blisters hurt!

This may technically qualify as atrophy, but I don't know.  I'm not a doctor, nor do I play one on TV.

Time Perception
This last one is definitely a metaphoric atrophy. That run seemed to last forever yesterday. I run a 0.6 loop in a local park, and I would eat those loops up before without even really noticing. I would lose count of how many I had done. Yesterday, I was acutely aware of each loop and how long it seemed to be.  I kept being surprised when my Nike+ Running app would announce my progress in 5 minute intervals, and I had only done X minutes each time.  So even though I knew my last check was 5 minutes earlier, I was still shocked it was only 5 minutes later. I kept hoping I had zoned out and missed a check in or the app had crashed, and I was magically 20 minutes farther along than I thought.  No dice.  It didn't help that it was 93 and humid, but my last 5k was in 90 degree direct sun and was more like 6k because I didn't realize I had passed my goal.

This will get better too.

None of this scares me or frustrates me more than in a little way just because I need to claw back the progress rather than continuing on from the great place I had been.  It's ok - I will get there soon enough, and probably sooner than I think since I'm much smarter about how to do it now than when I did it originally.  I have enlightened.my.body.

Work Through the Pain to Stop Hurting

For those who have been following my recovery from hernia surgery, skip this intro bit.  For those who haven't, I had double hernia surgery in June, and was doing really well with my recovery.  My two week check up ended with my surgeon telling me, "You can run in a month."  Awesome.  Then the next day (July 6th), I turned to the right, and felt like I ripped every stitch and was in misery nearly all the time for the next two weeks.  Her response to that, "Take a week off from any exercise (I had been doing fast walks and some work on the elliptical) and let things cool down.  Then just do slow walks for the next month, and see what happens."  Obviously, I was less than thrilled.

Well, I got through the 'no activity' week and saw my pain diminish slightly, but it was still really strong.  Then I went into the slow walk thang, and was OK, but not great and pretty bummed.  I found that my pain was less intense but much more frequent.  I was really discouraged.  I wrote about all of this in a blog post.

(OK, if you knew all of this, start reading again)

I decided to reach out to a family member who had gone through two hernia surgeries, including an open double operation like me.  I asked about her recovery, and she said a few things that helped.  She had pain like mine, and it wasn't there from day one, like mine.  It lasted through to about month three.  And the thing that got her through it was the elliptical.  The reason was that it was a smooth, non-jarring way to stretch the scar tissue, build muscle and keep her fit and strong.  I couldn't say that about walking on a treadmill at a slow to moderate pace (3-4 mph).  I decided to ignore the advice I got from my doc, and add some elliptical into my morning 'PT' routine.  I started with five minutes with very little resistance (5 out of 20 on my Life Fitness equipment).  It felt great - no pain, no awkwardness, and no more issues afterward than I had before.

Today, I replaced my entire morning walk with 30 minutes of elliptical work at 7 out of 20, and felt good again.  In fact, the rest of the day, I can say this is the best my incisions have felt in nearly a month.  I decided to go for a brisk walk outside this afternoon (in 90+ degree heat!), and ended up jogging (8-8.5 minute mile avg pace) half of it (1.2 miles) in two intervals with 14 minute mile walks in between, and really wasn't in any more pain than when I was walking for the other half.

What hit me is that I did the right thing in reaching out to my family member and then judging my body and what is best for it myself.  For one thing, I needed the piece of mind I got from having someone who had been through this tell me that they lived it, understand what I mean, and they got better.

My surgeon didn't have much of an explanation and didn't seem to think she's heard of this from other patients (she's done this surgery a lot, and has literally a perfect track record of zero recurrence, so she knows her stuff).  My surgeon is great and really listens and cares, but she only knows my situation based on how I describe it and how she interprets that.  I also feel like doctors inherently will tell you to rest rather than work through it in a different way (maybe due to liability and fear of getting sued?).  That's not to say you should blindly ignore medical advice, and it's hard to know when to listen and when to decide you know better what will work for your body, but it's important to know that you can and should at least challenge advice a bit and see if another approach is out there which could work.  Know your alternatives.

Lastly, what hit me is that this was an example of what I blogged about from chapter 3 of Tread Lightly by Pete Larson and Bill Katovsky.  It's a great chapter on injuries - avoiding them and how to recover from them.  Larson talks about changing what you're doing to use different muscles and apply different forces to your body than the those you get in the exercise that hurts you.  Moving to the elliptical was a bit of this - it uses my body differently from what I was doing (more jostling/jarring motions) while allowing me to go through the necessary process of stretching my scar tissue so I can get back to normal.

So, a bit of reinforcement to my prior blog post, and a bit of advice about recognizing when you know your body better than someone else and that it's OK to get a second opinion, whether from another doctor, a family member or even yourself.

Fit Isn't Invincible

This may seem obvious, but it does warrant discussion.  Being in great shape does not make you invincible.

As I've mentioned before, I recently had double hernia surgery with the full open method (rather than laparoscopically).  I got in as good physical shape as I possibly could to try to aide and speed my recovery.  I had developed strong abs and a solid core, with a six pack for the first time ever in my life. As a result, at my two week check up, the surgeon was really amazed at how much progress I had made, and told me I could start running at the six week mark.  Awesome.  That was Thursday, July 5th, meaning I'd be running in early August, and able to enjoy some summer runs.


Friday, July 6th, while sitting on the floor next to the tub that my son was having a bath in, I turned my torso toward him so I was looking about 70 degrees from where my legs were (basically, not quite looking dead on sideways).  WOW.  That hurt like crazy.  The only way I could describe it was that someone had taken a dagger and shoved it in my pelvis on the right side.  I thought perhaps my son had snuck a shiv into the tub and made a play to break out of our home. No dice. He only had a piece of soap in the shape of the letter "O" and a cup he kept putting the soap into and then dumping it out while yelling at the soap for being silly.


I didn't understand.  I had been walking every day for the past 10 days, and had cut my pace down from about 22 minutes per mile to 12 minutes, and felt great.  I had been doing the elliptical for about 30 minutes on low resistance, and had built up to moderate resistance without any pain.


I didn't have much pain at my surgical sites in general (unless I pressed on them or wore something fitting rather than loose/baggy), and had brought my body fat back down to about 8% (from a high of about 11% during my recovery due to a sedentary lifestyle and more bread and fruit than I typically eat, which was basically none). How was looking to my side causing so much pain?  Worse yet, why wasn't the pain going away?  Had I ripped a stitch?  Had I aggravated a nerve?


I decided to take a break from PT, and increase my regime of icing my surgical site (as I had been doing a few times a day already).  Unfortunately, the weekend saw the pain stay extremely intense, and get more frequent.  I put a call into my surgeon on Monday, totally befuddled as to why I was in so much pain given how well I was doing and how strong I was overall and in the surgical area.


Her thinking was that this wasn't a ripped stitch, but an aggravated nerve.  The prescription was to lay off all exertion and PT for a week and call her back.  After a week, the severity had reduced a little, but the frequency was going up - I was in some kind of pain pretty much all the time.  Her advice was to keep taking it slow, but to add walking back in (though not at a high pace.  The running in August thing?  Out.  As much as that stinks, I'm ok with it. I'm more hoping for the 'no being stabbed constantly in August' thing instead.


Why did this happen, and with such a small movement? How could it have happened given where I was at? Simple. I'm not invincible. No matter how well I prepared for this, it's surgery on the human body. Heck, even if it wasn't surgery, I still could have injured myself with some stupid turn or other lame incident.


Watching the Olympics, I see the same message.  I watched an amazing German gymnast basically fold his foot in half on a dismount in a qualifying round to try to get to the medal round. And he wasn't the only one. No matter what shape you're in, or how perfectly you train, you can still get hurt.


The point is, you can't think that, just because you're fit, nothing will happen to you. Whether we're talking about injuries, or eating a sundae every night and clogging your arteries with cholesterol from it. Be smart. Be safe. But remember, you're human, so be mindful. It's all part of how you enlighten.your.body.

Q: What is the Minimum Effective Dose for Exercise X?

Q: What is the Minimum Effective Dose (MED) for any given exercise, or my whole workout?


A: Good question, as this isn't necessarily clear in The Four Hour Body. The answer is that there is no explicit answer or formula to come up with the answer for any given situation.

The MED for you will be dependent on what you're trying to achieve, where you're starting from, and what you're doing. For example, Tim Ferriss talks about doing a weight lifting routine where he works his muscles to exhaustion, and that's his whole workout - a few exercises done to the point of failure. He does go over how many sets and reps to do if this is your approach, and shares his specific workout, but the amount of weight used, which exercises done, and your own muscle endurance will mean that your MED for this exact workout may not be the same as his.

Instead of sweating the mathematics of determining your MED for a given workout, focus on the concept of the MED, which means following Principle 5 - "be smart about it". A good example I often use is in cardio workouts. I see so many people set the equipment to manual mode, dial in a set resistance level, open a magazine or put a show on the TV, put on their earphones, and turn into a workout robot for the next 30 minutes. Instead of that 30 minute workout, they would probably get the same from a 15 minute interval workout with the magazine closed, shows off, and their mind focused on really pushing themselves during the sprint or high intensity periods.

The same goes for weights. Doing 20 reps of low weight across 5 sets takes much longer than doing a pyramid (10-12 at 50-60% of your max, then 6-8 at 65-80%, and then 2-4 at 85-95% of your max).

This is what the MED is all about - using the biology and chemistry in your body to your advantage. The body will actually keep burning calories for quite a while after working out, and this 'while' is significantly longer when you train with intervals than with a constant resistance and output. So you don't need to go as long since the magic of biology will keep you burning calories from your workout more than long enough to offset the shorter duration of your workout.


This is all part of what I mean by "enlighten.your.body" - get smart about what you're doing by using your mind to change your body.

Q: Why Did You Create The trackbodi.es iOS App?

Q: Why did you create the trackbodi.es app for the iPhone? Aren't there already lots of great workout apps?


A: Great question, and one I've been meaning to write about for a while.  The basis of trackbodi.es is about the first principle of my 10 Principles - "track it". 'It" can be anything, which is the whole point. trackbodi.es is meant to be a way to track performance in any situation - both for working out and for your body. That's where its name came from. It's not just a tie into newbodi.es, but all about tracking your body - whatever it is about your body you want to record and track.


There are apps that are single-minded that are great that I recommend to lots of people - RunKeeper, Nike+ Running, etc. They are meant to track one thing (in their cases, running), and do it well with lots of tools (GPS w/ mapping, pedometer, calorie counter, real time feedback on performance) and a whole ecosystem around them. But if you want to do a different exercise, they either don't work at all (like for weight lifting) or are sort of half-baked (like for biking - it works, but it calls it a run, the whole lingo is off and it may miss some key metrics while recording others that are irrelevant). They also don't do anything with or for your body metrics - like tracking weight loss, body fat percentage changes, blood pressure, heart beat rate, changes in skin caliper readings, circumference of key spots on your body, etc. If your goal is physical fitness and health, you should track both what you're doing and what it's doing for you in moving you toward your goals.


There are apps that are meant to be all things to all people. I've looked at quite a few, and spoken to some of their developers about working together. When I say, "all things," what I have really seen is, "many things." I don't see any that cross workouts and body stats beyond maybe a place to put in your weight.  Weight is good to track in some cases, but it's irrelevant in others. I watch mine, but my goal has nothing to do with it, and I could just as easily throw it out. I need something that records body fat, circumference (of five locations) and skin caliper pinches (three different spots). As for what's out there, they are just not clean or easy to use, in my opinion. User interfaces are confusing, look and feel is very much overdone (lots of beveling and bling to the look, which just doesn't feel at home on iOS, and only adds to the clutter and confusion). I have tried to use several and, after investing a lot of time building a workout, I couldn't find how to get back to the point where I enter performance or use the workout I just spent a ton of time building. And after all of that, they still lacked the body metric component.


So, I wanted something that could be applied to any situation for workouts and for tracking your body. I wanted something clean and simple looking and as easy to use as possible. Is it as good at X as a dedicated app? No. Is it as feature rich as some of the generalist apps? No. I don't want it to be.

The only way I could get what I was looking for, was to build it myself.  I hope everyone will at least try the free version of trackbodi.es, and it will help them watch what's important as they go for a new goal. Tracking your progress toward health is the single most important step as you enlighten.your.body.

Success Needs No Apologies

Q: I didn't totally follow your advice exactly.  I did lose X lbs this week, but I guess I messed up.

A: You have it all wrong.  You didn't mess up.  You succeeded.  You may not have followed exactly what I suggested, but you don't have to.  There are a few lessons in this question.

1. You should not apologize to anyone else for what you're doing or what you achieved - there is only one person you are doing this for and to whom you answer - you.
2. Advice is just that - a set of suggestions from someone who (hopefully) cares and (hopefully) knows what they're talking about, but ultimately isn't you, and isn't living your exact situation.
3. Focus on the right things - you made forward progress toward your goal.

Let's look at each of these points in turn.

First, if you made progress toward your goal - whether a lot or a little - don't ever feel bad.  If you moved backward, yet know why, what you will do going forward, and are still committed, don't feel bad.  If you totally failed and don't care or want to try again or harder, only feel bad if you wish it were otherwise.

You can tell me that you thought you might get closer to your goal, but that you made progress.  I will then cheer you on and commend the great work you did while helping you figure out how to keep moving forward.  If you didn't make progress or moved backward, we can talk about why (it may even be a good thing - maybe you started lifting weights, so your weight went up, but your body fat went down, so why be upset about that?), and then talk about the next move to get to your goal.

In the end, you don't have to apologize.  All you have to do is keep going at it.  Remember Principle #3 - Don't Question It.  If you're apologizing, you're questioning.

You owe me nothing.  You owe you everything.  Don't live by other people's expectations, demands or rules.  You're an adult who has committed to your health, and are doing it with tools and support, but you are doing it.  No one else.

Second, I'm only sharing advice based on what you tell me going in and what I know and have observed. You are a human - your body is different from every other body out there, and the exact food you eat at the exact times you eat it relative to the exact motions you use to expend it are particular to you and only you. Advice isn't perfect or omniscient. It will lead to results tending toward what it is aiming for in most cases, but it won't be exact, and it won't always win. Sometimes we need a little trial and error to figure out the biology and what your life will accommodate. The closer you stick to the advice, the easier it will be to fine tune, but you are smart and motivated and might know what's best for you and your situation better than I do or than I could given how you explained it to me. Tweak, interpret and go for it.

One thing I keep telling people I work with is that they have to make this sustainable. I don't advocate the short term diet or exercise approach. I don't like the idea of getting fit for some event (e.g., wedding, high school reunion, etc). I only advocate being healthy for life.  If you have some medical condition that means you need to get X in your diet, and my advice suggests omitting X, then we best keep X in. Even Tim Ferriss talks about how he has a glass of wine each night despite knowing he'd be better off without the sugar.  He is a wine lover, and has decided that the trade off is worth it for him. From my experience, grain-based carbs (bread, pasta, pastries, cakes) are the most detrimental to success for me. Would a slice of multi-grain bread with lunch ruin everything? Probably not. Would it slow down results more than if you skipped it? Most likely. If that's all you have access to for lunch, should you skip it? No.

See, you need to figure out what is sustainable relative to the advice you get. While I can help you fine tune the advice to be sustainable, only you can ultimately judge what you can really keep up with.

Lastly, what are you apologizing for when you make progress? This is very simple - don't apologize. Ever.  Understand why you didn't get where you wanted to get, and then get there next time thanks to your learnings. But to be sorry for moving ahead only works against the reinforcing energy of success.

So, don't apologize. Appreciate. Understand. Move ahead.

Enlighten.your.body.

Why a Minimal Runner Can Go Minimalist Faster

I've been reading a ton on running styles and shoes, and spoke to a friend who is both a runner and physical therapist about minimalist running. One thing keeps hitting me as totally against my experience - that you need a lot of time to adjust to minimalist running style (something other than heel striking, such as midfoot or, better yet and what I do, forefoot striking).

For me, the first time I ran in Vibrams, I was forefoot striking, and, while I was a bit achy in my calves for a few days, it wasn't this agonizing pain that people seem to be warning of. I would likely have had other muscle pain (and lots of joint pain) had I used a heel strike, the preferred form for most runners since most runners use traditional, raised-heel, cushioned shoes.

So how come I was able to jump right in and forego this adjustment phase? I think the answer is that I didn't really have anything to adjust from. I didn't run. Period. I didn't even really run down the block, save for darting after my son here or there for 20 feet. So I had no pre-existing notion to overcome on how to run, nor did I have any built-up muscle memory to unlearn.

These are both really powerful factors one needs to face when making the transition, and I think both are used as excuses by so many as to why minimalist style running (or barefoot running) "doesn't work" for them. The reason - they have existing barriers to entry, if you will.

It's like a business strategy case where you want to compete in a space where it's hard for others to come due to some barriers to entry (e.g. high regulatory costs like in pharmaceuticals, expensive equipment needed to get going like in aerospace or automobiles, limited resources like in mining, etc). For minimalism to break into the economy of your workout, it needs to overcome your comfort with what you already developed for running style both mentally and physically. That's a tall order. But it is doable.

While I don't want to be too preachy or forceful about it, I do think people need to approach it with an open mind and at least try before simply dismissing it as something that "can't work" because of XYZ that's specific to them. Just be sure if you do try that you really try. "Try" doesn't mean take off your shoes and run the way you always have (i.e., with a heel strike) and then stop and say it isn't for you. "Try" means running with a midfoot or forefoot strike, with your feet acting like a spring or really good set of shock absorbers. If you heel strike barefoot, you will definitely be worse off since not only is your skeleton taking some serious impact and translating it into your ankles and knees, but it's now not getting the benefit of the force disipation that the cushioning of your traiditional running had been providing.

Get minimal, get springy, give it a go, and see what you think. You just might love it.