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Need some training advice? Here are a few articles from the experts at the Roger Clemens Institute at Memorial Hermann. Training "Recipes" Mind Over Matter Training Your Gut to Run the Marathon Not All Carbs are Created Equal Avoiding Hydration Pitfalls in the Marathon You're Not Alone if Running is a Pain in the Hip Marathon Training and Injuries Developing a Good Training Regime for Marathon Preparation Are You Ready to Train for a Marathon? Finding Footwear -- Experts recommend selecting running shoes specifically designed for your foot Pounding the Pavement -- Runners' legs and knees pay the price for miles of training The First Step -- How to prepare the day before the race About the Roger Clemens Institute A great offer from the Roger Clemens Institute

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At the Roger Clemens Institute at Memorial Hermann, the Official Healthcare Provider of the Chevron Houston Marathon, highly trained physicians and staff are here to push every level of athlete to a higher level of performance. As all athletes know, there is always a way to get better. Whether it’s getting better after an injury or getting better at your game, the Institute is there for you. Individualized orthopedic care and customized treatment and training programs are delivered by experienced sports medicine-trained orthopedic surgeons, nutritionists, exercise physiologists, physical therapists and athletic trainers. Located in the new Memorial Hermann Medical Plaza in the world-renowned Texas Medical Center, the Institute offers a comprehensive suite of services to help athletes perform at their highest level including injury evaluation, orthopedic surgery, post-injury rehabilitation, athletic conditioning and training, performance evaluation, sports nutrition, sport psychology, and sports massage and acupuncture. These tips are provided to you from the highly trained staff at the Roger Clemens Institute. For information or for a referral to a physician at the Roger Clemens Institute, call 713-222.CARE.

Training "Recipes" Not Always an Apples to Apples Comparison Jon Warren, M.Ed. Head Coach, Rice University Men’s Track and Field When making cookies I can take a recipe, regardless of whether it is Wolfgang Puck’s or my next door neighbor’s, and follow each step explicitly. One cup of sugar to the greatest chef in the world is still one cup of sugar. Many marathon training programs found in magazines or marathon expos are often ones that detail workout “recipes” for top level runners. As a coach, I very much enjoy hearing the exact details of what a superstar marathoner did leading up to a record setting race. However, unlike baking cookies, in these training “recipes”, sugar is not always sugar. The recipe cannot be followed exactly. The ingredients of such recipes often need to be tweaked a bit before they can be used in baking a slower runner’s training program. Some ingredients in a superstar marathoner’s training recipe might include the following: • Weekly mileage • An interval workout • A standard long run Each of these must be adapted to meet the needs of the slightly different (and, yes slower) runner. They cannot be done exactly as written. Confusion usually occurs when runners and coaches mistake speed and distance for effort and duration. Specifically, lets look at the above three ‘recipe ingredients’ and compare an average marathoner (4:22, roughly 10 minute pace) to an elite male marathoner (2:11, roughly 5 minute pace). Weekly Mileage If the top level runner runs 100 miles per week it will take him about 10 hours of actual running to accomplish this. If the average marathoner attempted such mileage using a similar effort (not similar speed) it would take him or her over 20 hours or more of actual running. The average marathoner would benefit much more by adapting the time the elite runner spent on the road for his or her training and not the mileage. The average runner would be better served by adapting the 10 hours rather than the 100 miles. An Interval Workout Again, when comparing more challenging sessions (for example an interval session of 5 X 1 mile repeats with 3 minutes rest between each mile) it is a good idea to take into account effort and duration instead of time and distance. The top level runner might run the mile repeats at approximately 4:30 each. If an average marathoner ran 5 X 1 mile with 3 minutes rest, he or she would run each mile in about 9 minutes. Running hard for 4:30 and running hard for 9 minutes are two completely different workouts. The workout sheet may say “5 times a mile with 3 minutes recovery”, but one’s body does not adapt equally to such different running durations. The average marathoner would reap a better benefit by running 5 repeats that are about 4:30 long. These would most likely be ½ mile repeats. The Long Run Sugar is unquestionably not sugar when trying to adapt an elite runner’s training recipe for use by an average marathoner. The long run is usually the step that is followed verbatim and this is a mistake. An important thing to remember is that a top level marathoner’s racing goals and training purposes are completely different than an average marathoner. Completing the distance of 26 miles is not a challenge to top level runners. These folks run a 24 mile run in training to prepare them to race very, very fast; not to help them simply finish. So, how long (not far) an average marathoner should run in their long run definitely should not be something that is gleaned from an elite marathoner’s training recipe. The time spent running should be based on physiological principles that prepare the athlete to best achieve their goal – often which is to simply make it to the finish line in one piece. I recommend a max long run of 3:30, regardless of distance covered. A great cookie recipe followed to the letter will most likely lead to a great cookie. A great marathon training recipe, however, if followed exactly, might leave a bad taste in your mouth.

Mind Over Matter Psychological tips can help you finish strong By Kristin Anderson, Ph. D. Psychologist and sport psychology consultant for the Roger Clemens Institute Running a marathon is a tremendous physical feat, but it also requires a certain degree of mental discipline. Just as you train your body to compete and persevere over the long haul, you need to train your mind to help you succeed. Establish a pre-race routine Create a ritual to complete before each time you run, including before the marathon. This might include doing warm-up/stretches in a certain order, listening to a particular piece of music or repeating an inspirational mantra. Spend a few minutes visualizing the course, including the sights, sounds, weather, other runners and the crowd. Imagine running and finishing the race successfully. Plan your thoughts Running a marathon allows a lot of time to think, and you want to make the most of your thoughts. Before the event, plan what you will think during the run. The best approach is a balance between the two types of thinking: association and dissociation. Association zeroes in on bodily sensations, such as breathing, muscles, energy, fatigue and pain. Use it to run faster and relax and get into a rhythm. Dissociation takes you away from your bodily sensations. It is useful to relieve boredom and reduce awareness of pain and fatigue. Tips for association: Focus on breathing. Get into a rhythm. Breathe in for a certain number of steps and then breathe out for the same number of steps. Imagine tension, fatigue and heaviness leaving your body as you exhale; imagine lightness and energy filling you as you inhale. Relax. Start at the head and move down your body, focusing on each area. If you notice tension, breathe into it and feel the tension leave as you exhale. Monitor your body. Use this feedback to adjust your pace if necessary. Tips for dissociation: Listen to music. Pick tunes that pump you up and generate a positive mood. Fantasize. Imagine winning the lottery and how you will spend the money. Count. Pick an object, such as Nike hats, and count how many you see as you run. Alphabetize. Choose a category, like animals or famous athletes and then go through the alphabet naming one for each letter. Use your creativity, but be sure to keep your thoughts fun and light. Avoid thoughts associated with stressors such as tension at work or in a relationship. Talk to yourself The mind has a will of its own, and it can say outlandish, hurtful and negative things. Try not to fight it -- just notice the thoughts, let them go and consciously redirect your mind to positive and helpful thoughts. For example, instead of saying, “I can’t do this. What was I thinking? This hurts too much. It’s not worth it,” just notice those thoughts, let them drift out and say, “I can do this. I have trained hard. I know what I want and what I’m doing.” Prepare for "The Wall" Visualize before the race what this is like -- that feeling of utter exhaustion and perhaps panic and doom. Visualize getting past it, knowing that you can and will succeed. Plan to remind yourself, “This is inevitable. This is part of the process. I’ll get past this.” Anticipate the letdown You won’t always feel your best during the long marathon. Prepare a coping strategy and a few encouraging phrases like, “I’m okay. I’m doing fine.” Set specific goals Break the race into quarters and set goals for each quarter. Expect a variety of feelings and emotions -- both good and unpleasant -- to occur at all stages. Anticipate that anything can happen but plan and expect to get past whatever presents itself. Have fun Keep a list ready to remind yourself why you run marathons. Repeat and visualize the fun and sense of accomplishment and wonder at what your body can do. References for this article included: Sport Psychology—Thought Control by L. Crust Mental Training for Peak Performance by S. Ungerleider

Training Your Gut to Run the Marathon Written by Roberta Anding, MS, RD/LD, CSSD, CDE Sports Dietitian for the Roger Clemens Institute You bought new shoes, ramped up your training and worked on your hydration. As it approaches race day, one question remains. Did you train your gut? Surveys of marathon or distance runners indicate that approximately 25% of athletes experience some form of gastrointestinal (GI) distress during the race. Why are runners more prone to digestive problems? Running, particularly long distances, directs blood flow away from the gut to meet the demands of running and to help rid the body of heat. Additionally, the butterflies you feel at the beginning of the race are caused by stress hormones that can also influence the rate of stomach emptying. While part of the reason your stomach may not cooperate is the inherent physical demand of running, you can still minimize the gastric distress that can threaten race day by following this rules: Hydrate. Blood flow will be directed away from your gut and dehydration can reduce blood volume further. Adequate fluids early in the race can expand blood volume and maximize your GI hydration needs. Fiber: Friend or foe? Fiber, although healthy for day to day consumption, can be irritating to some athletes. Water insoluble fiber found in wheat bran, for example, can stimulate the gut to empty faster than you would like. Try choosing lower fiber foods, such as rice or pasta instead of 100% whole wheat breads. Discover hidden gut enemies. Artificial sweeteners ending in “ol” can cause osmotic diarrhea. They are found in sugarless gums and candies and cause gas cramping or diarrhea. Caffeine during these gut stressful times can also cause diarrhea, so moderate your consumption. Train with race day foods. As you amp up your miles, practice eating your race day meals. Good race day foods include those high in carbohydrate and moderate in protein and fat, such as oatmeal, bananas and scrambled eggs or egg whites. The key, however, is to eat the same foods on race day you have been eating during your training runs. It is never a good idea to introduce a new food on the day of the big race. Time, preparation and practice will help your avoid these common training pitfalls.

Not All Carbs are Created Equal Written by Roberta Anding, MS, RD/LD, CSSD, CDE Sports Dietitian for the Roger Clemens Institute Open any popular magazine and you can read the problems with eating carbohydrates. Low carbohydrate diets are recommended for everything from weight management to the treatment of disease. Rather than blaming all carbohydrates, think quality rather than elimination. Carbohydrate is the gas in the tank for endurance events like the marathon. The intensity and duration of the event dictates the fuel that your body uses. The higher the intensity or duration, the more your fuel source is carbohydrate. You have trained, tracked your progress and hydrated. Choosing high octane carbohydrates are the finishing touch to your race day preparation. Quality high carbohydrates are those that reach your blood stream slowly and give you sustained energy. Here are some examples of those high powered heroes: Whole grain cereal, like oatmeal Whole grain breads Low fat dairy especially milk and yogurt Fresh fruits and vegetables Practice and train with these endurance carbohydrates in order to develop a gut tolerance for these foods. After a hard run or training session recover with faster acting carbohydrates in order to re-load the muscles for the next day’s training. This concept is called nutrient timing and was first developed by the exercise physiologist, John Ivy. Simply stated, your muscles are the most hungry for food within the first 30 minutes after exercise. However, this is when most athletes tolerate foods the least. Start the recovery process with a sports drink or cold juice and a carbohydrate/protein energy bar. Topping off your tank and refueling are great strategies to improve your performance.

Avoiding Hydration Pitfalls in the Marathon Written by John Cianca, M.D., Physical Medicine & Rehabilitation Medical Director, Chevron Houston Marathon Developing a hydration plan for the marathon is a process that is individual in nature. Guidelines have been put forth by numerous organizations over the years that provide an excellent foundation for anyone to plan their hydration strategy. However, hydration requirements remain largely an individual process of discovery. I am going to outline a process that I believe will help you understand better and more reliably what you need to do to stay optimally hydrated. First, know what your typical body weight is when you are comfortable and not in a depleted or over loaded state. Weigh yourself without clothes. Let’s use 150 pounds as a sample weight for purposes of this article. I will base fluid amounts on this weight. These amounts will need to be adjusted for individual weight differences. It will require you to think through the process, which is exactly what I want you to do whenever you are considering your needs for a race or for training. Remember, optimal hydration is an individual process. Next, let’s get an estimate of your sweat rate. Urinate and then weigh yourself without clothes. Then, run for 1 hour, assuming you are fit enough for that effort. During the run do not drink any fluids and do not urinate. Once done with your run, towel off any sweat, remove your running clothes, and weigh yourself. It can be assumed that if you lost 2 lbs that it was due to sweat loss. Therefore your sweat rate during those weather conditions was 1 quart per hour. (2 pounds is equivalent to 32 ounces, which is roughly equivalent to 1 quart). You should drink about one quart of fluid to replace the losses from the run. This fluid should also contain sodium to account for the sodium lost in sweat. Since most beverages do not have as much sodium in them as is present in your body’s fluids, you should also use more salt on you food than you might otherwise. Now, here are some variables that require more thinking. First, the sweat rate you determined is only useful for those conditions that you ran in. Hotter and more humid weather will increase sweat losses. Cooler and drier conditions will decrease sweat losses. This can be dealt with by checking your sweat rate under different conditions. So, develop a habit of weighing before and after your runs. I realize many of you are weight phobic. My advice to you is get over it. If you are intending to run a marathon, you need to be seriously responsible about hydration as it is not only important to your performance, but it could save your life. Another variable to consider is your fitness level. As you become more fit and more used to heat, you will actually sweat sooner and more vigorously; but it will have less sodium in it. Again, your weight can guide you as to what you need to replace for volume. The overriding tenet is don’t guess about hydration. Using your weight can give you a much more accurate estimate of what you need. Remember, optimal hydration is an individual process. Here are a few other points to consider. Drinking water only doesn’t replace the sodium you lose in sweat. Furthermore, water consumption can decrease the urge to drink while increasing urine production. Carbohydrate containing beverages don’t cut your thirst as much since they are “thicker” than water. They also don’t promote urine production as much as water; thus, they rehydrate more efficiently. However, beverages that contain more than 10% carbohydrate are more difficult to absorb and actually pull water into your gut. This may create abdominal upset when you are running which is obviously counterproductive. The same may be true of salt tablets. So I would advise against concocting your own high carbohydrate, high sodium beverages. Stick with what is available commercially and supplement salt in your diet. Furthermore, speed and size make a difference. Slower runners do not require as much fluid replacement as faster runners. Generally, they generate less heat and they sweat less. The same is true for smaller runners. Being mildly dehydrated (2-3% body weight) at the end of a run is not dangerous and can easily be corrected following the run. Over hydration is more difficult to correct and far more dangerous. Strictly speaking, dehydration is present when the body is less than normally hydrated. This does not become significant until you have lost 3% or more of your body weight. It does increase your risk of heat illness but drinking alone may not prevent heat illness. The most important step to take is to reduce heat production by decreasing pace and utilize cooling methods. Over hydration can lead to a condition called hyponatremia. In this state the body’s sodium concentration is lower than normal. This occurs when people drink too much. It can be made worse by heavy sodium losses via sweating. It becomes dangerous when the body reacts paradoxically to this overload by retaining fluid instead of excreting it via urine. Obviously, you want to avoid both of these situations; but the later is much more risky than the former. Weather is a pivotal factor in drinking behavior. When it is hot, people are more likely to over hydrate to try to prevent heat illness. The best thing to do in a hot environment is to reduce the heat production. That means slow down or stop. Find shade, and if becoming disoriented or if you stop sweating, you need to be vigorously cooled with ice. Do not assume that drinking more water is going to keep you safe. Once you have an idea of how your body will respond to varied climates and distances you can build your own hydration program. In general, try to be adequately hydrated before a race. That does not mean over hydrate before the race. Urine will be pale yellow in a normally hydrated person. For example, in the 150 lb runner mentioned earlier, if the urine is dark, you are dehydrated; if it is clear, you are over hydrated. If you are under hydrated, drink 10 –16 ounces several hours prior to your event. If your urine is still dark drink another 7-10 ounces a couple of hours before the event. During the event, drinking 4-6 ounces (1 standard cup) every 20 minutes is a reasonable estimate for most people; but if you have your data from training based on your weight you can be more precise with your plan. You can also make adjustments based on your running pace and climate. Once you have finished the race, rehydration, if needed, can be done over several hours if you have not lost more than 3 % of your body weight. If you have over hydrated you should restrict fluids until you are urinating normally. I cannot emphasize enough that you need to become aware of how your body responds to running under different conditions. It is as much a part of your responsibility as training is. And, remember, optimal hydration is an individual process. For a referral to a physical medicine & rehabilitation specialist or sports medicine fellowship-trained orthopedist at the Roger Clemens Institute, call 713.222.CARE.

You're Not Alone if Running is a Pain in the Hip Written By: Mark Adickes, M.D., Orthopedic Surgeon Co-Medical Director, Roger Clemens Institute at Memorial Hermann If you've felt pain in your hips during or after running, you're in good company. In fact, hip pain is one of the most common complaints by athletes. Hip pain is most often caused by inflammation within tendons or soft tissues. Common problems include: Muscle strains, including groin pulls and hamstring strains Trochanteric bursitis, which causes inflammation of the bursa, or soft tissue, over the hip joint. Tendonitis, which affects the tendons around the hip joint Old injuries may be a factor Many hip problems are caused by insertional tendonitis, which is an inflammation of the tendon where it inserts into a bone. This often causes problems in the hip flexor, the muscle that helps lift the knee. Injuries of the hip abductor or external rotator muscle, which may cause weakness, poor mechanical utilization and imbalance, also are common hip injuries. Old injuries or other pre-existing issues often are the causes behind hip pain. A torn labrum, the ring of cartilage around the hip socket, is sometimes the culprit. This injury may cause a sharp pain around the groin, which may extend into the upper leg or buttocks. The pain may be sudden or gradual, and it may be particularly severe when the leg is rotated. Often, it causes a feeling of "catching" in the hip socket with movement. Hip pain frequently occurs because of a difference in leg length or a foot problem that alters the person's stride or gait. Often the abnormality of gait or foot pathology has been there for a long time and it finally manifests itself. Other times, a problem may have been caused by an injury that altered the gait. For instance, a person may develop knee pain then alters his or her gait to compensate for it. In older runners, a decrease in range of motion in the hips and back may cause motion restriction and muscle overload. Practice prevention and patience To avoid hip pain and injuries: Warm up properly before exercising Wear good, well-fitting shoes Stop to stretch during exercise Have any pre-existing leg, foot or hip problems checked before beginning training Strengthening or resistance exercises can make the muscles and tendons of your hip area stronger and help them perform properly. This type of exercise might include using weight machines or elastic bands, swimming, or walking on stairs or hills. Sometimes, a little prevention and TLC can head off hip pain before it becomes a major problem. If you are starting to have hip pain, don't push through the pain. Stop running and cross train for a couple of days. Do some gentle stretching and treat the pain with ibuprofen. Allow the area to calm down for a few days before getting back into your training regimen. If the pain is persistent and does not go away with rest and stretching, visit a sports medicine specialist. For a referral to a physical medicine & rehabilitation specialist or sports medicine fellowship-trained orthopedist at the Roger Clemens Institute, call 713.222.CARE.

Marathon Training and Injuries Written by John Cianca, M.D., Physical Medicine & Rehabilitation Medical Director, Chevron Houston Marathon Training for a marathon will expose you to injury. Injuries in running, particularly distance running are almost always the result of a process not an event. It means that the way you run is the most influential factor. Also, where you are in your training will influence what type of injury develops. In all cases, it is the underlying process that needs to be corrected in order to eliminate the injury and prevent additional problems. Treating only the symptoms is frequently not enough to eradicate the injury. This is where many people underestimate their injuries and where many health care providers miss the mark. It is often said that running injuries are the result of too much, too often and too fast training. This is true; but it is not the only axiom for injury. Your running form (biomechanics) dictates much of your vulnerability to injury; and results in some runners being more likely to be affected by how they train. Simply said, some people are built to run and others, not so much. The structurally gifted runner can endure longer more intense training better than a runner who is not so gifted. And, because they are faster, they have less exposure time (both in duration and actual impacts) than the slower runner. That being said, the less gifted runner must make accommodations and modifications in their training in order to avoid injury. Injury types vary during the marathon training program. In the first weeks of training, particularly in new runners, pain and inflammation around the foot and Achilles tendon, inside of the shins, and front of the knee are very common. These can simply be part of the process of your body adjusting to training; but this should not be taken to mean that they are normal or acceptable. And if they are persistent they need to be treated. As training progresses, there are other injuries that become prevalent. Hip pain (please link to the article below) and pain along the outside of the thigh and knee (Iliotibial band) are most common. Additionally, as you start to accumulate more mileage and longer runs, stress fractures become more likely. Stress fractures are the most serious common injury and require time off from running. Stress fractures can occur in any bone but are most common in the lower inner shin and the 2nd metatarsal (forefoot) in runners. These fractures will heal in 4-6 weeks with rest from weight bearing. However, stress fractures in the hip or pelvis are not unusual and can take 12-16 weeks to heal. Perhaps the most important information in this article regards the mechanism of any injury. Almost all running injuries are caused by mechanical strain brought about by muscular imbalance, weakness, or tightness, which makes running form less efficient and more stressful. More times than not this occurs during the landing phase of running. Specifically, as you advance one leg to make contact or as you are bearing weight on the leg, forces are such that overload occurs to a given tissue if your mechanics are not optimal. Over many miles of training this exacts a toll on the tissue that is overloaded and injury develops. It is most important to figure these errors out in order to eliminate the injury. The duration of marathon training is enough to expose even the smallest of mechanical errors. There are a few very common errors in running mechanics that cause most of the injuries. Not controlling pronation is the most common error. This occurs throughout the lower extremity, with the hip being the most common area for deficiency. Weakness in the abductors of the hip is a frequent cause of inability to stabilize the lower extremity during stance phase of running. This leads to several different compensations, all of which can result in injuries. These injuries include ITB pain, hamstring and adductor strains, femoral neck stress fractures, and patellofemoral pain, amongst other injuries. So, if you find that you are injured, think beyond your symptoms. Look at how you train and most importantly examine how you run. These two parameters are the root of most injuries. To schedule an appointment for a biomechanical gait analysis to identify potential gait issues leading to injuries call the Roger Clemens Institute at 713.704.2200. For a referral to a physical medicine & rehabilitation specialist or sports medicine fellowship-trained orthopedist at the Roger Clemens Institute, call 713.222.CARE.

Developing a Good Training Regime for Marathon Preparation Written by William Amonette, exercise physiologist at the Roger Clemens Institute at Memorial Hermann The decision to run a marathon is the easy part. After that comes the reality of long-haul preparation, which demands discipline, planning and focus. A training plan can help you meet your goals. The worst thing you can do is just go out and start running. You need to make a specific game plan and follow it closely to get to the finish line. If you're thinking about participating in the 2008 Houston Marathon, the following pointers may help you begin to prepare. Be sure you're healthy enough to run a marathon. Have a complete physical and discuss any injuries or health concerns with your physician. Invest in the right equipment. Good running shoes are essential. Be sure the shoes fit well and complement your gait pattern and foot characteristics. This will allow a more efficient gait. Shop at a specialized store with trained sales professionals. Make sure your shoes have adequate support and cushioning. Your feet are the first thing to hit the ground and receive the most impact force. If your shoes have inadequate support or fit, you are certainly looking at foot and back injuries. Develop a specific training plan. You need a detailed, long-term plan so you can build to peak performance in January. Otherwise, you may under train and not be prepared or over train and cause an injury or peak too soon. I always suggest a day-by-day plan that schedules every workout until the marathon. But remember to be flexible. Think of your plan as a framework, but allow room for modification. Listen to your body. If you develop muscle soreness (and you will), you need to get the muscles massaged and maybe decrease your intensity for the next training session. If you have joint pain, back off training and see a physician. As you train, you may need to make other changes to the plan depending on your health and rate of progress. Strive for balance. Diversify your workouts by cross training with another activity you enjoy. Remember that, while cross training is a good break, it's not a rest day. Cross training can be valuable when running is not possible due to injury or weather, or if you need a break from running. Schedule times of active rest when you engage in lower-key activities like golf or canoeing. Otherwise you run the risk of burning out and quitting. Incorporate resistance training. You don't need to spend hours lifting weights, but developing strength helps prevent injuries and strengthens muscles to increase speed and endurance. Extended aerobic training will result in decreases in skeletal muscle mass. The minimum you are looking for in a resistance program is to help maintain the muscle mass you currently have. Address abdomen and trunk strength. As part of your total fitness plan, include exercises specifically for strengthening your abs and lower back. A strong abdomen and trunk, or core, help avoid back pain and injuries and help the body protect against injury by responding efficiently to stress. These muscles play a key role in keeping the body upright during the gait. A fatigued core will lead to gait abnormalities and eventually to injuries. To keep these muscle strong, practice exercises such as sit-ups and crunches. Practice makes perfect. Plan to run some shorter races to get an idea of your competition style. View them as periodic touchstones to check your training and progress. One of the worst things you can do is make the marathon your first race. On race day, people get excited, which often means a poor result. Learn about yourself and practice to get an idea of how you react in competitive situations. As you train for the marathon, you may find your goal is just not attainable this year. If this is the case, consider adjusting your goals to a half marathon or 5K run.

Are You Ready To Train for a Marathon? Written by John Cianca, M.D., Physical Medicine & Rehabilitation Medical Director, Chevron Houston Marathon Completing a marathon is an admirable and challenging process. Training for a marathon is long and arduous; so, it is reasonable to make sure you are up for the task prior to beginning the journey. It is very common for participants to begin training for a marathon with little to no running experience. So it is important to make sure there are not any health obstacles before you begin. If you are not regularly participating in physical activity, it is essential that you see your primary health care provider to have a physical exam and any necessary laboratory tests to screen for potential problems that could impact your training. It would also be very useful for you to be seen by a physical medicine & rehabilitation specialist (physiatrist) or orthopedist who specializes in sports medicine and running injuries, preferably one familiar with running injuries. This visit should screen for muscle weakness or imbalance, joint disorders, and assess your running style, or gait analysis. You should also discuss training plans and common injuries. Armed with the knowledge of how to train according to your physical capabilities, many of these injuries may be preventable. Additionally, ask about strategies for optimal hydration, which is critically important to your health. No other issue is responsible for as many race day problems as hydration. Finally, ask which running shoe is best suited to your foot and type of training. Make sure you understand what you need. The next point to consider is how you are going to train. If you have never trained for a marathon before it can be a daunting task to devise and carry out a training schedule that is safe and effective. I would recommend joining a reputable running club or training program. If this is not an option for you, then, partner with a friend or group of other runners to train together. Running with others is a way to stay focused and motivated. It is also a way to get feedback and direction about your training. However, whether in a formal program or just running with friends, your training will need to be adjusted for your individual needs. Be careful to stay within your capabilities, realizing the need to push yourself. Lastly, a coach or an online training program can be very helpful; so, whether alone or in a group, either of these options can guide your progress Lastly, if you are a novice runner, strongly consider running shorter races prior to undertaking a marathon. At a minimum, this should be done during the time you are training for your marathon. However, I would recommend that you give yourself a year or two of running shorter races prior to committing yourself to a marathon. This will give you the experience you need to be safe and successful with your marathon aspirations and it will make your journey all the more enjoyable. For a referral to a physical medicine & rehabilitation specialist or sports medicine fellowship-trained orthopedist at the Roger Clemens Institute, call 713.222.CARE.

Finding Footwear Experts recommend selecting running shoes specifically designed for your foot Wearing proper foot attire is an integral part of a successful exercise plan. It is especially important that runners wear the correct shoes because of the repeated pounding the feet take when an athlete takes to the track, street, or treadmill. Running is a high-impact activity, and a pair of good shoes helps with impact absorption as well as protects the runner's joints. Different types of feet require different types of shoes to maximize performance and prevent injury. With the Chevron Houston Marathon quickly approaching, Danie Nguyen, a physical therapist with Memorial Hermann Sports Medicine and Rehabilitation, offers some important information for runners who are getting ready to lace up their shoes for the race. "Running shoes are very advanced in technology and materials," said Nguyen. "They can be divided into three categories: cushioning, stability and motion control. Although all good running shoes have each of these elements, some are more customized than others." Running shoe categories Cushioning: This type of running shoe offers more impact absorption for the runners’ feet. The feet of runners who have high arches often are rigid and underpronate (or turn), and therefore have a harder time absorbing impact. Cushioning shoes are constructed using a slip-stitch last. Stability: Stability running shoes are designed for runners with over-pronation tendency. They offer more support for athletes requiring stability in their mid-foot. Motion Control: These shoes can be beneficial for runners with excessive rear-foot pronation. Individuals with flat feet or hyper-mobile feet would benefit from this type of running shoes because they offer runners better position and alignment to minimize excess motion. Both motion control and stability shoes are constructed with a combined slip-stitch and board-last that provide more firmness to the shoe. "A physical therapist can determine which type of shoe is best for you after conducting a quick, biomechanical foot assessment," said Nguyen. "Then, a knowledgeable sales person will be able to assist you in which brand of running shoes is appropriate for your foot." Nguyen also commented that the price of good running shoes is a result of the high technology available in today's shoes. It is almost as if each running shoe is custom made to fit the specific needs of an individual's feet. Wear and tear Experts recommend that serious, committed runners replace their running shoes every 500 to 600 miles or every six months. "Running shoes are also excellent for walkers," said Nguyen. "They are very comfortable and lighter than other shoes. They can be expensive, but good running shoes are worth it for the specific support features that are built into them." When it comes to the various surfaces that runners face--concrete, asphalt, outdoor tracks, treadmills or indoor tracks--Nguyen says that makes no difference when a runner is shopping for shoes. "The most important thing is to match the right type of shoes to the needs of the runner’s feet," said Nguyen. "Brand names or a friend's recommendation aren't what matters when it comes to selecting a shoe. A proper fit is key to a good shoe." On your mark… Nguyen recommends breaking in a new shoe at least a month before a marathon, which leaves participants in the Chevron Houston Marathon plenty of time to get their new shoes ready for the 26.2-mile race on Jan. 13, 2008.

Pounding the Pavement Runners' legs and knees pay the price for miles of training When it comes to pounding the pavement, runners take the phrase and, well, run with it. As athletes run countless miles to prepare for the Chevron Houston Marathon, their legs and knees take a real pounding, easily causing painful injuries. Elizabeth Hoffman, a licensed athletic trainer at the Roger Clemens Institute sees many injuries resulting from miles of wear on runners' lower limbs. Lower-limb damage common "The most common problems are patello-femoral knee and iliotibial band injuries," said Hoffman. "Both are a result of overuse; all the training to prepare for a marathon adds up and can result in damage to the knees and legs." A patello-femoral knee injury occurs in front of the patella, or kneecap. This painful problem is more common in women because of how the female body is aligned--wider hips create a different pull on the knee. Damage to the knee where the iliotibial band (a muscle on the outside of the thigh) creates friction by rubbing against the thighbone is another common cause of injury. Older runners may suffer from osteoarthritis--degeneration of the cartilage between the joints--or chondromalacia patella--softening of the cartilage of the kneecap often characterized by grinding and popping under the kneecap. Both can be painful. Prevent and treat injuries A few months of constant running can increase the chance of incurring an injury and symptoms often creep up on unsuspecting runners. "Seeing an athletic trainer before you begin a running regimen may help to reduce the chances of suffering an injury," Hoffman said. "We can offer advice on stretching and strengthening exercises that can help your legs feel better and stronger." Hoffman said ultrasound imaging often is used to determine the severity of an injury. Some common treatments for knee and leg injuries include: Ice packs to control swelling and pain Exercise to build strength McConnell taping technique Taping or wrapping the knee focuses on the alignment of the patella, thereby reducing pain during exercise. This approach can allow runners to exercise relatively pain free. "Athletic trainers can teach the patient to do this type of wrapping on their own," Hoffman said. "Most people find it very comfortable, comparing it to wearing a big Band-Aid on their knee. It can be worn all day or only during periods of exercise, depending on the degree of injury." Although frigid weather isn't always an issue in Houston, some runners prefer to wear knee sleeves during colder months to keep the knees warm and to avoid stiffness. Ready, set, go Thousands of runners will participate in the annual Chevron Houston Marathon on Jan. 13, 2008. The 26.2-mile course winds from downtown to the Galleria area. For information about how the Roger Clemens Institute can help you prepare for the run of your life, call 713-704-2200.

The First Step Marathon's medical director advises how to prepare the day before the race The moment marathon runners step up to the starting line of a big race marks the conclusion of months of intensive training. How athletes spend the day before the race can also have a major impact on their success and stamina on race day. As the Chevron Houston Marathon approaches, John Cianca, M.D., medical director of the marathon and TIRR Rehabilitation Centers at Memorial Hermann, offers tips on how to spend that all-important day before the event. Primarily, Cianca says, runners should not do anything unusual the day before the marathon or make any big changes to their normal routine. "Runners should get good rest and their diet should support their training," said Cianca. "Additional carbohydrates could be beneficial, and the morning of the marathon runners should eat something that is a good source of energy and easy to digest. Some runners do carb-loading prior to the marathon, and that can be beneficial if it is done correctly." Hydration important Runners should ensure they are hydrated well, but be careful not to over hydrate. "Be reasonable when you are drinking water," said Cianca. "You do not 'store up' fluids. Water should help food digest for optimal performance if you are carbohydrate loading." A runner's weight is affected by hydration, and runners should weigh periodically as one aspect of monitoring their hydration. Scales are available along the Chevron Houston Marathon course. If a runner has a problem during a race, his or her weight fluctuations can help physicians better understand the problem. "We recommend that runners write their weights on the back of their bibs - along with other emergency information - before the race," said Cianca. "If a runner requires medical attention during the race, this will help the staff understand what could be happening." Writing each runner's weight on his or her bib when athletes pick up their information packets is part of a Hydration Initiative program the Chevron Houston Marathon implemented last year. Take a break Rest is key to preparing for the marathon. If possible, athletes should get more rest that usual and go to bed earlier in the days immediately before the run. "People underestimate the importance of rest," said Cianca. "Intensive training requires more sleep for the body to recover and absorb the physical stress. Recovery helps the training process; rest and training must be proportional." "Runners should do whatever it takes to feel rested," he said. "If you want to get a massage, go for it. The most important thing is to not change your training routine just prior to the marathon." Consult the weather report The last variable that comes into play the day before a race is weather, and last-minute adjustments are often required. Clothing is a main consideration and runners must take precautions to prepare for whatever Mother Nature brings the day of the marathon. Runners also must be prepared for weather conditions in the early morning when the race begins, as well as in the early afternoon as the marathon concludes. Cold weather: Preserve heat where you lose it most: the head and the hands. Wear a hat and gloves. Windy weather: Windy conditions require more cover and windbreaker material. Heat: Look for light clothing with good coverage. Humidity: Wear lightweight clothing that moves, or wicks, perspiration away from the skin. On your mark… Thousands of runners will participate in the annual Chevron Houston Marathon on Jan. 13, 2008. The 26.2-mile course winds from downtown to the Galleria area.