Facing up to some uncomfortable truths

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Recovery is such a slippery beast. I’m realising that I’ve been disordered for years, in a way that I simply never understood. And I’m starting the long and uncomfortable process of unpicking the depths of the thought processes that underpin my attitude to food and exercise.

I was really moved by Amelia Boone’s post about her anorexia and eating disorder recovery and it prompted me to do some self reflection about my own behaviour.

http://www.ameliabooneracing.com/blog/uncategorized/therecoveryineeded/#comments

I want to list the things that I remember doing and thinking because seeing them written down will make me realise that they aren’t “normal” and I don’t want to be that person again. This is part of the problem: I truly believed everyone struggles with body image and food like I do. I truly believed that my body and its muscularity or lack of fat was my worth, and that anything I did to jeopardise this made me worthless.

  • standing in the bathroom of a restaurant on my 40th birthday chanting “pig pig pig pig pig” at my reflection because I ate an entire portion of seafood.
  • deliberately scheduling runs so that I would be running over lunchtime, meaning I could skip a meal and feel like I’d discovered a brilliant way of controlling my appetite.
  • feeling constantly guilty about being hungry. I never allowed myself to be satisfied so even after eating I would still feel hungry. And I felt guilty because “why should you be hungry, you are just greedy”. But at the same time, if I did eat until I was full, I’d feel extremely guilty for being “a pig”.
  • competitive under eating in company. Always having the smallest, lightest thing on the menu.
  • calorie counts on menus are terrible for me. I will always make sure that I order the thing with the lowest number of calories if at all possible. I wish I never had to learn how many calories are in stuff because once you know that crap you can’t erase it.
  • checking my watch many times a day to see what the calorie count says. Feeling deeply inadequate if it is “too low”.
  • standing in the shower after a run, in pain because I’m running through injury yet again, telling myself what a fat, slow, useless pig I am because I’m hungry yet again and my run was slower than I’d hoped.
  • seeing all the bodies of professional athletes and comparing myself to them, or even comparing myself to myself in other situations and always coming up short.
  • taking appetite suppressing stimulants – I’m not proud of this but I did. They made me manic and gave me heart palpitations.
  • using cauliflower instead of grains or pasta so that I could eat more volume for fewer calories.
  • watering down my almond milk/protein powder
  • eating huge breakfasts (for some weird reason, I’ve never restricted breakfast), and being obsessed with it because it feels like my only pleasure
  • avoiding eating in company if at all possible. Hiding in the cleaning cupboard at work to eat my Tupperware portioned lunch (oh the shame!). Cancelling dinners and lunches with friends because I can’t cope. Getting very stressed about going out with my husband to restaurants
  • always feeling that I would have to leave food on my plate when in company whether I was still hungry or not. I was not allowed to eat the whole plate because I was scared of being seen as greedy
  • I have not had a birthday cake or a chocolate bar for well over a decade
  • there is a restaurant that I love, and they do a dessert of buffalo milk yoghurt, spiced orange and cardamom and pistachios which is close to the best thing I’ve ever tasted. I do eat it, but the guilt I feel afterwards is crippling. And I always make sure I don’t finish it
  • I took a deep breath a month ago when on holiday and ordered an ice cream for myself. One scoop of mango in a pot. I had to throw it away.
  • feeling like a failure because I got my period (this was before I lost it completely – what an idiot I was!)

 

I don’t write this to be all “poor me”, but to acknowledge that it was my reality for so long. And I assumed it was the same for everyone. That this was what you had to do to be “healthy” and a “good athlete”. That being miserable and hungry was a sign that I wasn’t strong enough and that the people who had better bodies than I did were better people, stronger, more admirable. My own deep-seated feeling of inadequacy was the basis for all of this, as I had built my fragile self image on something that was so transient and impossible to sustain.

But exercise is healthy…..right?

“But exercise is healthy….right?” Overtraining syndrome and Relative Energy Deficiency in Sport (RED-S) in the recreational runner: a primer for clubs and training groups

Case study:
Think about the people in your running club. There will be someone who springs to mind: the member who has to enter every race, attend every training day, join every group run and interval session and track workout. Their weekly mileage spirals up, their times improve, they might lose weight, and they get lots of praise from club mates and colleagues. Having started from a lower level, the improvements they make are exponential; every race is a PB. Before long they’ve run a spring marathon, and are now ready to take on the summer road racing circuit, before throwing themselves into cross country through the winter.
They have a basic understanding of how fitness works, and know that the progressive overload approach that they employed as a novice runner gave them huge rewards. The weight loss that came easily at first now stalls as their metabolism stabilises, and they start looking more closely at their food and nutrition. They find their way to blogs and opinion pieces by influencers or famous runners, and cut out certain food groups or restrict their eating in specific ways. Uncoached, and following patchy threads of information on the internet, they keep pushing on. Running is their thing. It is heathy. Right?
However, cracks start to appear. It might start as a calf strain, or a sore Achilles. A bit of plantar fasciitis. The kind of small niggles that all runners face. The runner has learned the habit of mental toughness – push through, keep going, no pain no gain. It is just a niggle, besides, with the club 5 mile championships coming up, stopping is not an option!
After a while, they don’t feel great on an increasing number of runs. Legs feel heavy, heart rate too high for a pace that “should” feel easy. Management of niggles becomes a second job– kinetic tape, physiotherapy, special shoes. They feel exhausted and hungry, but tell themselves this is completely normal – everyone feels tired when training for a marathon. And you have to be careful not to “eat back your calories” and gain weight. 10k doesn’t feel like sufficient running to allow for that slice of cake with friends. The mental toughness that got them through their first marathon when things started to feel hard at mile 22 now turns against them, berating them not to be weak, not to give in. Other runners run far more and are fine. So they keep going. This process can play out over months or even years, with the runner gradually piling on the training stress, not recovering sufficiently, and slowly pushing their body into a state of dysfunction.
Other symptoms start to creep in. Subtle at first, if they keep training, they become progressively worse. They realise that they are frequently waking at 3am, soaked in sweat. Their legs are cramping or aching at rest and no amount of foam rolling can get rid of the pain. Their heart rate soars when walking upstairs at work. If female, they might notice that their periods are changing, getting lighter, their cycles might get longer, and eventually they might lose their cycle completely. If male, their sex drive might be missing in action. They might feel cold constantly, or develop Reynaulds disorder or other circulatory problems. Still running, their times stagnate or regress. Eventually, they get a “proper” injury – a stress fracture or a significant soft tissue tear.
Discussion:
What has been described here is a medical condition that can effect athletes at all levels. The hypothetical runner described above could be suffering from two closely inter-related areas of dysfunction: overtraining syndrome (OTS) and RED-S (relative energy deficiency in sport). It is possible to have one without the other, but they are often seen together, and some scientists now believe that overtraining syndrome itself is a symptom or expression of the broader diagnosis of RED-S. Both are reactions by the body’s metabolic, hormonal and physiological systems to extreme stressors: whereby the athlete has stressed their body beyond what it is capable of functionally recovering from. In OTS the primary stressor is aerobic exertion without corresponding recovery; in RED-S the primary stressor is low energy availability, i.e. too few calories for the work required of the body. The main culprit for the symptoms experienced by the athlete is this state of low energy availability, which can stretch over a period of days, weeks, or even years.
Low energy availability (LEA) is a fundamental cause of stress on a systemic level, and it initiates a cascade of hormonal and metabolic disruption in the body, leading directly to the symptoms described in our hypothetical athlete case study. LEA can be accidental – when an athlete simply doesn’t realise that they are not sufficiently fuelling their body for the work required; or it can be deliberate, as a result of disordered eating, or deliberate weight management. Once in a state of LEA, the body’s equilibrium is significantly disrupted, leading to a web of issues as laid out in the infographic below:

The most significant and long term issue that can be caused by LEA is impaired bone health. This can effect both male and female athletes, although it is more easily recognised in females as the link between oestrogen production and bone health has been well studied. If a woman lacks a regular reproductive cycle, her body is not producing oestrogen, which means her bone density will be seriously inhibited. In men, the clear signal provided by the presence or absence of a menstrual cycle does not exist. However, LEA will result in reduced testosterone in men, which carries a similar impact on bone health. Low testosterone can present as low or absent libido, erectile dysfunction, depression or loss of muscle tone in trained male athletes. Any of these symptoms should be investigated in male athletes who are at risk of LEA. For athletes in general, the main consequence of LEA and impaired bone turnover is the increased likelihood of stress fractures or full fractures, especially in the lower limbs (tibia, fibula, metatarsals or other foot bones) or in the hip/pelvis area or lower back.

Overtraining syndrome and RED-S can be extremely distressing for an athlete to deal with psychologically as well as physically. Within a club culture, the fear of missing out on a social scene that has become integral to the life of a member is one reason why a runner might not be willing to take a rest or a break when they might need it. It is easy to forget the very basic tenet of exercise physiology: adaptations are made at rest – if you don’t recover from a session, you might as well not have done the session at all. Also remember that as a runner, you are probably very self-motivated. You want to run. If you find yourself dreading your run or not wanting to do it, it is probably a good sign that your body might be asking you to take a break.
If you or any of your club mates are complaining of any of the following symptoms, think about seeking advice from one of the coaches in the club, the club welfare officer, or an outside source of support:
• High resting heartrate that lasts for a number of days without obvious reason (infection, etc.)
• Sustained high heartrate on “easy” runs
• Feeling out of breath or tired walking up stairs, or feeling exhausted carrying shopping/doing normal household tasks
• Frequent night sweats
• Unexplained leg cramping or pain at rest
• Feeling of “heaviness” that lasts for a number of days or sessions
• Any menstrual disruption in women should be investigated immediately and if more than one cycle is missed, and the athlete is at risk of LAE, it should be addressed as a matter of urgency
• In male athletes, any changes to libido or sexual function should be treated as a possible red flag for LEA and RED-S.
Note that RED-S can impact all body shapes and sizes and there isn’t a specific body fat % or BMI that is “safe”. Energy availability is distinct to the individual, their physiology and work output, and not necessarily directly proportional to their relative body size, mass or composition.
Special considerations to be aware of for athletes with disordered eating and exercise addiction/compulsion:
• Comments about dissatisfaction with body shape/size, or about the bodies of other athletes
• Food restriction in scenarios where other people are eating (i.e. post run snacks, recovery nutrition etc).
• Doing a lot of fasted runs (this is particularly dangerous for women and can be very stressful on the body)
• Cutting out entire food groups without medical reason (i.e. cutting all carbs)
• Turning up to group runs when obviously injured/sick/exhausted
• An all or nothing attitude to training (if I miss this run I might as well jack in the entire training cycle)
• Comparing themselves to others and trying to run the most miles per week or top the Strava rankings week after week without rest.
If any of these symptoms or behaviours are familiar, there are resources available for advice and help below.

#TrainBrave: https://trainbrave.org/
NB: There will be a TrainBrave event in Oxford on Sunday 23rd June, sign up for free on the website. Their events are highly recommended.

Health4Performance: http://health4performance.co.uk/

Renee McGregor (sports nutritionist specialising in RED-S and eating disorders in sport):
https://reneemcgregor.com/https://reneemcgregor.com/

British Journal of Sports Medicine, most recent paper on RED-S:
https://blogs.bmj.com/bjsm/2019/04/22/relative-energy-deficiency-in-sport-red-s-recognition-and-next-steps/

Charlotte Gibbs
1st May 2019

What I’ve learned and the mistakes I’ve made

It is nearly May, nearly four months since I’ve been able to run properly. I’m no where close to being healed, but I can sense some progress, more in my own state of mind than anywhere else.

When I first was diagnosed back in January, I assumed that I would just heal up and be running again as that was what worked the previous year. This was a huge mistake. I forgot that I was dealing with a fracture in exactly the same place as last year, in a bone already weakened my osteopenia. I did everything wrong. I cross trained hard, didn’t off load the leg sufficiently, restricted my calories, and tried to run too soon. The leg didn’t heal. Then, I fell over during a trip to the Brecon Beacons (where I had no business being), and twisted my knee. That didn’t want to heal either. Finally, I realised that I was sabotaging myself every single day. I was allowing my short term compulsion to train to get in the way of healing.

During this time, two people in particular have helped me immeasurably.  Firstly Jill Puleo, an expert in overtraining syndrome and athletes psychology (acaseofthejills.com) .  Jill helped me address my disordered thoughts around my identity as an athlete, my fear of failure and insignificance, and my learned behaviours that can be challenged and overturned. She made me see something that I had not recognised in myself and it helped turn a switch in my head and make me more receptive to change.

Then, the manager of my gym pulled me aside and asked if I was ok. It was he who gave me some tough talking and basically ordered me to take a few weeks off; he made me realise my routine was becoming a trap, and it was ok to free myself from it. He also made me accountable by sending him photos of my meals- a strangely helpful practice as it allowed me to get some perspective on my eating habits. Which can be summed up as: extremely healthy but not enough calories. Or protein.

In the end, I took three weeks off training, apart from cycling for my commute and a bit of yoga. No gym. No weights. No elliptical. I’ve lost a ton of fitness but, despite eating far more than I was when running 80mpw, I haven’t gained much (or any) weight. I feel that my body is actually using the energy to heal, and I feel mentally so much better. I’m not coming home exhausted and miserable all the time. I’m not sweating buckets at night any more, or being woken with severe leg pain. I still haven’t got my period back, but felt the hint of something, suggesting maybe I have ovulated. I suspect it is close to returning. The stress I’ve taken away from my body has made me see how badly I was treating it before, and I’m starting to get a feeling of how nice life can be when you eat enough and don’t get upset over every mouthfull.

I had an MRI yesterday but will not know the results for a few days, but I suspect it will show a healed tibia, but something sinister in the knee-possibly a torn or damaged lateral meniscus. We will see. It is better than in was, and I can walk without pain, and even jog a few minutes, but anything more is out of the question. I’m learning patience. Someday I will run free again, free over the fields and river banks of home; free over the turf of the Brecon Beacons; free high up in the Pyrenees. But for now I’m learning that this can’t be taken for granted, and my body is expecting me to pay back the overdraft I forced it into, and with interest.

Small, silly steps: starting to make my own sourdough bread. Somehow I feel better eating bread when I’ve made it myself. Last night I cooked pasta. I don’t think I can remember the last time I ate pasta unless before a race. I made a normal portion, ate it all, and enjoyed it. Small, insignificant steps towards a better life.

Decoding “healthy”

“You’re so healthy”.

“You look so fit and healthy”

“I wish I could be as healthy as you”

But I’ve got osteopenia and two stress fractures (not to mention the worst cold in the history of mankind, but that’s another story). How is that healthy? What are the metrics? Does fitness presume health? And why is our perception of health so skewed towards aesthetics and away from function?

On the outside, some markers of ill health are obvious: extreme high or low weight, skin problems, movement impairments, breathing issues. And being functionally fit does help to stave off a lot of lower level issues: it helps with arthritis, heart health, blood pressure, liver and kidney function. There is a line, however, where fitness blurs into something else – training for peak performance (in the context of an individual’s level of ability) can tip into maladaptive practices. Suppressed immune system (who doesn’t get sick after finishing a marathon or a big block of training?). Hormonal issues. Over use injuries.

I don’t know very many runners from the subset of “competitive amateurs”, who get it right. I really don’t. Some people can balance it for a while, only to succumb to the siren call of “do more, harder, longer”. Symptoms creep in, but why stop? It’s “healthy” to exercise! In the gym, I see hard work and dedication but I see the shady side too: overtraining, steroids, and compulsion.

So what’s healthy? I think it is possible to run 80+ miles per week and be healthy, if the nutrition is right and the mindset is solid. If it comes from a place of fear and denial, it isn’t healthy at all. Just because the body can, doesn’t mean the body should.

I think it’s possible to go hard in the gym given sufficient rest and recovery. But if six pack abs are the goal what happens when they appear? Then the pressure is to maintain them, and any loss of fitness becomes a failure. Not healthy, physically or mentally.

RED-S, osteopenia and me

This is hard to write. But I want to get it down and be completely honest about it. I’m at home now, complete with a pair of crutches, a diagnosis of osteopenia, and stress reactions in both my left tibia and fibula. How did I get here? That isn’t a straightforward story and it involves plenty of cognitive dissonance, denial, and disordered thinking.

I wanted to be fast. I love to run, to be fit and strong and cover long distances with ease. I wanted to look like a runner, light and lithe. I didn’t want to eat extra calories unless I deemed them absolutely necessary. 13 miles on the trails and hills wasn’t *quite* enough to justify the recovery drink I’d packed because 250 calories was a bit *excessive*, surely? Maybe if I’d done 20 miles, then I would have it. But *other runners* run that on water or nothing, and I ate a gel half way round so *surely* I don’t really need those extra calories?

After all, I look heavier than other runners, don’t I? I only ran 10 miles in the morning so better have a small lunch, only two rice crackers with your salad- don’t want to be a pig. Feeling hungry- why? You had a huge bowl of oats for breakfast (at 5 am, it’s now 12 and you’ve run for 90 mins and done a gym session) why on earth would you be hungry? Clearly you’ve got a problem with food, no self control, too much appetite. Eat a bowl of olives before dinner, then an entire pack of stir fried vegetables. Why do you eat so much? Why can’t you just eat normally like other women? It can’t have anything to do with the fact that you’ve run 80 miles plus 6 hours in the gym this week …. but other women do so much more, you’re just making excuses…surely?

I felt happy running not least because it allowed me to feel I could eat a bit more, and I love to eat. And I wasn’t thin, I’m not underweight. What’s the fuss about?

I missed a few periods – so what? It’s just a bit of stress. I’m not thin, it can’t be that, I’m not thin enough for it to be a real issue.

I’m feeling fast, but I’m tired. I’m getting a strange numbness in my feet when I run and I’m always cold. Just a few more runs and I’ll take a day off. That day comes and I rest but the guilt comes flooding in – why am I hungry? I’ve done nothing. I’m so tired I slept instead of cross training; why am I so lazy? I don’t need that food, I haven’t earned it and besides, I’m not thin so I can’t afford to eat like that.

The pain in my leg wakes me at night. I recognise it, like a snake bite aching across my lower leg, throbbing at 3am. A phone call from the sports medicine specialist asking me to come in for a talk about my DEXA scan. I admit the pain and get sent for an X-ray. There, both bones, shadowed and bowed like a line that has been erased clumsily and been redrawn with a crayon.

You need to maintain a BMI of 22. He tells me this, when I felt big at 19. You need to offload your leg completely and eat 2g per kilo body weight of protein per day minimum, plus as much calcium as you can get down.

Everywhere else in January the message is lose weight, cut back, trim down. Messages about how society is getting fatter abound. I know I can eat a huge bowl of cauliflower for half the calories than in a small portion of pasta; I like the volume, the feeling of abundance so I go for the vegetable, but feel guilty anyway for eating all of it.

But I’m tired of it. I’m fed up with running in pain, fed up of the tiredness, of the guilt and the criticism. I’ll come to terms with having to be bigger and maybe I’ll recover well and not injure myself again. I’ll allow myself the recovery and the nutrition and the rest and maybe, just maybe, I’ll finally be the athlete I’ve been preventing myself from being, because I’ve been trying so hard to run the most, train the hardest, be the fittest.

Don’t be like me. Osteopenia is not fun. Stress fractures really fucking hurt. But what hurts the most is I knew it; I know all about RED-S; I’ve read the articles, listened to the podcasts, gone to the seminars. I *know* that amenorrhea is a waving red flag; but deep down I felt it was a badge of honour – “look how hard I train!” I thought I was special, my body would cope. Nope. I’m just as weak as I always feared, just not in the way I assumed.

Scafell Skyrace

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The Scafell Skyrace comprises of 42km (ish) with 3000m (ish) of ascent and descent, following a point to point course that traverses some of the very best landscapes of the English Lake District, including England’s highest mountain Scafell Pike.  It is a beautiful and truly tough test of endurance, and it came close to breaking me.

I drove up to the Lakes, leaving home early on the Saturday morning and arrived at the University of Cumbria in Ambleside at lunchtime. The race headquarters were situated on the small campus, and I had booked accommodation in the student halls of residence there. I got there early enough to get out for a short hike/run, and went up the fells to see the early finishers of the Lakes Sky Ultra come in.  Their exhausted faces told a tale that I should probably have listened to more closely.

Kit checked and race briefed (warnings of limited water on the course, and an agreement to waive the waterproof trousers and headtorch from the required kit), I had an early night in the tiny bedroom, which was sweltering in the heat as the window would only crack open.

The morning saw us loaded onto buses in Ambleside to be taken to the race start in Borrowdale. I was lucky to sit next to a very friendly woman who chatted easily the whole trip and took my mind off the race ahead. The start of the race was quick, out onto the road and then along a track, before starting the climb that would lead to Windy Gap and eventually the start of the ascent to Scafell Pike. Very soon after starting, I didn’t feel great. My legs ached and my feet felt numb, and in my head I didn’t want to be there. I had started towards the front of the women but quite soon I had to slow down a lot and try to get myself in a place where I could find a rhythm and relax into the race. I felt worse watching so many people pass me, but it was either that or drop out completely and I wasn’t ready for the self-hatred that would bring! I knew there wasn’t actually anything wrong with me, I just, for some reason, was in a bad mind-set at that moment in time.

As often happens during long races, as time passed the sensations changed. I love climbing, and the ascent to Scafell suited me and allowed me to relax a bit and start to feel better. The clag had come in and it was misty and cool, obscuring the views but keeping us from struggling too much with our limited water supplies. The boulder fields on the traverse to Bowfell were tricky and, for me at least, totally unrunnable. Over Bowfell, the so-called Climbers traverse was an extremely daunting prospect, including a dizzying descent down the Great Slab, around 200m of sheer granite. I got down, and finally found my feet on the less technical descent the rest of the way into Langdale.

I was shocked to see that nearly five hours had passed, and the intermediate checkpoint cut off was tight – I had to be there in 5:45. I have never in any race before had to worry about not making cut off times. I had completely run out of water before getting there, but I got in with over ten minutes to spare. It was a huge relief to refill my bottles and stuff some malt loaf and almond butter down my throat; until then I’d had one gel and one home-made date and coconut ball, plus a bottle of quite strong Tailwind. Energy-wise I actually felt OK but I knew I was heading towards being dehydrated and my two bottles were unlikely to be enough.

The next section was a steep climb back up to the summit of Harrison Stickle, and despite having felt so unequivocally awful at the start of the race, suddenly after nearly six hours, I felt great. I got up quickly, pushing hard. The sun had come through and the summit was beautiful, with views across the lakes. I knew I had to hustle to make the final cut off, which was nine hours or 6pm. The last truly technical section of descent negotiated, and I was able to run. I had around ten miles left, and two hours on the clock. The beautiful, rolling, grassy tracks suited me, as the trail skirted past shining tarns, and climbed up again to the top of Silver Howe. The volunteers there told me I looked good and that if I ran well I could make the cut off. Dropping down again over scree and then eventually through a ferny labyrinth, I was still hopeful. Hitting a road crossing where there was water was a huge relief as I had run dry, and had a pounding headache from dehydration. The volunteer there told me that the cut off had been extended by 30 mins (a wise decision, as otherwise only around 10 women would have finished), giving me exactly an hour to cover 8 kilometers. The race was on!

Running as hard as I could for someone who had been out there for eight and a half hours, I hustled myself up the very final hill of the day. I tried to fold my poles away but found my hands had no strength to press the button that released them. I had to carry them. Never mind. Through the final checkpoint at Lily Tarn and I was close, so close! I hit the tarmac with around 6 minutes to spare and about a mile of downhill running to do. I went as hard as I could, and finally got to the entrance of the campus, where cruelly the finish was situated, up a few hundred metres of steps. Up I went, and made it in exactly 9 hours and 30 minutes.

It was a truly brutal race, and I struggled far more than I thought I would. But I am probably more proud of this finish, for all its mediocrity in time and placings, than I am of any win, because I truly had to fight for it, and I didn’t give up, even when the cut off looked impossible to make. We do these races to test our bodies in extremity, and this race did that and more. A day in the mountains changes you, and this day tested me and for once I was not found wanting. I wish I could figure out why I felt so bad at the start, but perhaps it doesn’t matter. What matters is the fact of the finish and the process of moving through the landscape to get there. Everything else is just details.

Nearly there…

I can’t believe that I’ve actually made it through a training block and am tapering for a goal race, uninjured and feeling relatively fit. It has been a long time since I’ve made it to the start line of an important race. This coming weekend I’ll line up at the start of one of the Skyrunning World Series races: the Ring of Steall Skyrace in Scotland. I’ve been looking forward to this one for a long time. It’s relatively short in distance, around 30k, but really tough, and if I get under 5hrs 30 I’ll be very happy indeed. Actually, if I finish I’ll be happy. 

I am still nursing pain and scar tissue in both Achilles’ tendons and they can be very sore when I start running but once warmed up they feel ok. I’ve taken the pressure off myself with the training and been much more organic than before, not chasing a certain distance goal each week. I peaked at around 80 miles two weeks out, and then started a fairly aggressive taper. But I’ve adveraged around 80 kilometres per week, far less than usual, although my climbing has been fairly consistent week on week. I’ve also slowed right down and waited for the speed to feel easy instead of forcing it. Suddenly it was there and I ran a 10 mile tempo last week at under 7 mins per mile, a decent pace for me. 

On the road, I’m wearing Altra Escalante shoes, hands down the best road shoes I’ve ever had. Altra have totally nailed it with these shoes.  They are light, super responsive, flexible and soft around the foot, while being just cushioned enough for long runs (24 miles on concrete paths in France!). They are like the holy grail of running shoes. So impressed. Trail shoes are a bit of a problem. My Altra Lone Peaks are not grippy enough for a very technical skyrace, so I’ve gone for Salomon Speedcross 4s, but they are so narrow. They do make my feet ache, but I think it’s because I’ve been exclusively wearing the Altras. So for the next few days I’m doing everything in the Speedcross to try to get my feet used to them before the weekend. I did wear them training in the mountains for around four hours and they were ok, and the grip they give on the descents makes it worth it. 

Taper madness is a thing, I’ve got a cold and feel rotten. Wish I could fast forward the next few days and just start the race! 
Planned gear: Salomon advanced skin pack; Montane minimums jacket; North Face waterproof trousers; Salomon s-lab skirt; Lornah sports top; merino wool base layer. Salomon Speedcross 4 shoes, Sunnto ambit peak 3 watch, pezl head torch. 

How I got back to training again

After developing Achilles tendonitis in both legs, I’m finally back training again. I think that I managed my rehab quite well, and have managed to get back to running around 60k per week at the moment, feeling easy. I’ve also started open water swimming once a week, and have increased the time I spend on the bike to make up for the decreased time spent running.

I have had some help with my gait and have made some tweaks to my form, and it seems to be working. Why did end up with both Achilles strained? It seems to have some connection to the way I flick my toe up behind me when I run, and I’ve been concentrating on trying to keep my ankle in dorsiflexion in the flight phase to help keep the contraction of the tendon to a minimum. The tendons on both legs are thickened and scarred, and they do get stiff in the mornings, but with careful warmups and stretching I am able to run without pain.

This is me on the treadmill during my gait analysis test. The good news is that I don’t overstride, and I do keep my landing leg well under my centre of gravity. I have a good incline forwards and my hips are neutral and not rotated. However, the rear view shows that I have a lot of upwards oscillation, which leads to a lack of efficiency. Most significantly, when my foot comes behind me (as can be seen in the side view), my foot goes into plantarflexion and I point my toe. This means that as I then come back to land on that foot, I have to over exert the calf muscle and, by extension, the achilles tendon.  This movement pattern may have been caused by the injuries I have been dealing with, specifically my shin issue and foot problems, and the theory is that if I can change this one thing, the rest of my running form is good, and hopefully I will be able to increase my mileage again without risking injury. So long as I am careful.

I am being careful. I am running six days a week, but four out of these six runs are done at a capped heartrate of 148bpm. Which for me is a pace just above 8 min miles on a flat surface. This feels very easy and I can work on my form without getting fatigued. The other runs are either a speed session or a hill session, and a long run done at a steady pace but at a higher heartrate and over hills and technical terrain. I’m training specifically for the Ring of Steal Skyrace in Glencoe in September, which is short (under 30k), but with a lot of altitude gain and quite technical. I have a friendly hill, which is exactly 1km in length and climbs 50m, so not a huge climb but a good stead rise. I can do repeats on this hill, going up as hard as I can, and down as hard as I can. This seems to be a core session for me at the moment and right now I’m up to 4 repeats: I’ll increase the reps gradually as the time goes on.

I am not entered for anything else apart from the Skyrace at the moment, although I will do a sprint triathlon in a few weeks, mainly because I’m enjoying swimming at the moment and think, why not! I’m enjoying feeling fit again, and trying to keep it sensible. While I’m running less, I’m actually training more as I am cycling and swimming, but I feel less broken down. The easy running is interesting for me as I will admit to finding it boring, but it is also vital to my training and health and I will learn to embrace it.

It is really difficult 

A photo popped up on my Facebook “on this day” feed a few days ago. It was taken a few days after I had run the Edinburgh marathon. I looked like this: 

Today, after three months of curtailed running due to injury, I look different. My stomach has rounded and my hip bones don’t stick out, my arms are more muscular. I’ve tried to keep up my physique through cycling and strength training but it isn’t the same as running consistent high mileage weeks. I am no heavier on the scales but don’t look as tight and it is hard to accept. But I have to learn that I can’t keep my body at that point (11% body fat) indefinitely. I need to give myself the chance to heal and get stronger. Maybe I’ll achieve that level of fitness again, but I hope that if I do it will be with a better understanding of the costs that come with it. 

Eat your carbs, women athletes!

Since the podcast episode I did with Chris Sandel of Seven Health  came out, I’ve had so many lovely messages of support, and questions from people who recognise their own issues in my experiences. It is touching to hear so many positive comments, and amazing to realise that what I went through is not uncommon, if not much discussed. I’ve written before about the sanitised Instagram life that becomes the veil for people’s true struggles, and bringing it into the open in such a public way seems to have encouraged others to interrogate their relationship with exercise, body image and food.

Out of the various messages I received, there has been one common  thread: “should I eat more carbs?”. It is astonishing how many athletic women have become subsumed in the rhetoric of low carbohydrate/ketogenic eating that was never designed for female athletes. Women who, like me, are training multiple hours a day, and are restricting their carbohydrate intake, and are not recovering, not adapting, and on top of all that, are feeling guilty for not being able to sustain their restrictive diet. It is crazy.

Low carbohydrate diets are not designed for people who are currently in training for endurance sport. They work very well for sedentary, overweight people who need to shed excess body fat. They work brilliantly to help with metabolic disorders and certain other illnesses. They work well for someone who runs a 5k a few times a week and does a few sessions in the gym. Athletes have different nutritional requirements. There are some athletes who can perform on this sort of regime: they tend to be male, they have a very very good relationship to food, meaning they are able to respond appropriately to their hunger cues and eat sufficiently to sustain their bodies, and they are able to be flexible. They have stable hormonal balance, and are able and willing to eat what is required. Basically, for this way of eating to work for an athlete in any way, it is necessary to be a) male, and b) not othorexic in any way at all.

Sadly, a lot of the athletes who gravitate towards this way of eating do so because they are already inclined towards disordered eating and are looking for a “fix” to their eating issues. If they are also female, this can lead to disaster.

Eat food. Real food, that is nourishing, filling, fueling, and in sufficient quantities to sustain your energy throughout the day. It isn’t black and white. Quality, good tasting food, balanced into carbohydrates, protein, vegetables and fats. Don’t eat stuff that isn’t recognisable as food. If it is real food, eat it.