The Importance of a Good Recovery Plan

By Dr. Michael Cerami

As runners, we spend a lot of time thinking and planning our adventures. Whether it’s an early morning street run before work or finding a new trail to explore, the challenge and excitement of something new keeps us active and moving.

One thing we do tend to neglect though is the boring necessity of having a good recovery plan. This article will give you some specific ideas of how to take care of your body so you can continue to run happy.
Recovery is vital to replenishing your body’s reserves so you can rebuild muscle tissue and be able to adequately perform for your next run or workout. Even if you feel “fine” after your run, you should consider trying a few of these simple ideas and monitor your results. We’ve had many athletes and patients that integrated just a few of these changes into their routines and were amazed how much faster they recovered as well as having more energy.
Let me share some things I do and ideas I learned from Dr. Jeff Spencer; one of the team doctors for Team Radio Shack at this year’s Tour de France and a member of US Postal and Discovery teams 8 Tour wins.

Magnesium: Some of the latest research is changing the way we view muscle soreness. The old idea of soreness being caused by lactic acid buildup is no longer valid. There are good indications now showing that muscle soreness is being caused by calcium leaking into the muscle after exercise. Magnesium (spray or oral liquid) is helping reduce this post exercise soreness by blocking the calcium from entering the muscles. We recommend 5-10 sprays per leg post long workout and 1 oz. per day in liquid form.

Ice baths: Cooling your core temperature and soaking your muscles with an ice bath can dramatically speed your recovery. The water should be between 58 and 65 degrees and you should try and keep your lower body submerged for 15 minutes. It’s a bit challenging at first, but after a few sessions you’ll get used to it.

Proteolytic Enzymes: Inflammation builds up in the athlete’s body after exercise as fluid in the connective tissue between the muscle layers. As the pressure increases, it compresses the blood and nerve vessels which also travel through the connective tissue, this pressure causes your pain. Proteolytic enzymes help break down this congestion quickly so it can be flushed out of the body. These enzymes should always be taken on an empty stomach and are also extremely effective in treating acute injuries. NOTE/ PRECAUTION: Theses enzymes are not recommended if you are taking any kind of blood thinner. Check with your primary care doctor if you have questions.

Fish oil/EPA: We recently posted 2 articles on our website about the importance of fish oil. One references research from the journal Surgical Neurology and shows how taking fish oil regularly can substantially reduce inflammation. The 2nd article answers questions about why you need to take a good quality product to get results.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online at www.utahsportsandwellness.com

Sport defines us

By Dr. Michael Cerami

As I was riding up Big Cottonwood Canyon last week, I was wondering why I put myself through this pain on a regular basis. Why can’t I just get used to hanging out on the sofa and rubbing my dogs belly for hours at a time? What’s the matter with me?

Then it hit me. Sport defines us. Yes, I’ve heard other people way smarter than me say that before and it kind of made sense. Then I thought about it a little more with the right mindset. You know, like on that killer hill where you are huffing and puffing and your brain won’t work but good ideas and thoughts connect anyway on a subconscious level?

We are all in a competition; it’s called life. And it’s a test to not only see if we survive but how well we do. Every living thing on the planet is taking the same test every day or a nanosecond at a time. Evolution defines us as we are constantly being tested through our adaptation to our environment. That’s what we as humans do; we need a purpose biologically and socially. It’s normal to continue that process as a conscious choice through sport.

It’s interesting that we, as humans, are the only species who get to use sport as a fun test because it’s an open book test and we are the ones doing the grading! Just finished your first mile without resting? Excellent, you get an A! Broke 8 minutes per mile on your trail run last week? Awesome! Rode 100 miles last week? Yahoo!

In life, it might take 80-90 years to get your final test score. In sport, you can grade with any style, and you can get that grade any time.

When I was in my thirties, I was a tough grader with no bonus points EVER given. I had high expectations and dang it, they needed to be met. In my forties, I had to prove I was still young and did as much as possible to hold on to my past.  Now, in my fifties, I grade on a curve and there are all kinds of extra points available to up my score. Points for King of the Mountain (err…getting up the mountain),  20 mile run weeks, completing 5 races in a year, keeping my weight down and still having fun, not taking things too seriously, and more.

When you have finished all the personal testing you could come up with, maybe it’s time to go to the next level, see what you are made of: Competition through racing. Try it. Sign up and see what you can do. Feel the energy of group focus on a goal. Feel the extra power you can generate from within.

Sport is so great because it allows us to see what we’re made of anytime and anywhere. It’s so easy and so rewarding and we can take it as easy or as hard as we want to. What else can you say that about?!

I hope to see you out there breathing hard and smiling. That’s what my dog and I will be doing. (She can wait a few years for the extended belly rubsJ)

Special thanks to Dr. Jeff Spencer for the kernel idea for this blog. Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online at www.utahsportsandwellness.com

What is BPA? Why it shouldn’t be in your water bottles or food containers.

By Dr. Michael Cerami

Here’s some information and a suggestion to change a few things in the home that will likely improve the health of you and your family.
There has been a lot of talk over the past few years about the plastics in our food containers. Plastic containers, bike bottles, plain water bottles, metal cans (lined with plastic), baby bottles and many more have been shown to have chemicals that act as hormone disruptors. Hormone changes in this case usually are an increase in estrogen and a decrease in testosterone.
The short title for this chemical is BPA or Bisphenol A. The latest information suggests that no children should be given food or liquids with BPA in the container and adults might want to avoid the chemical as well.
Overview:
Bisphenol A (BPA) is widely used in epoxy resins lining food and beverage containers. Evidence of effects in animals has generated concern over low-level chronic exposures in humans. Bisphenol A is used extensively in epoxy resins lining food and beverage containers and in plastics of many consumer products. Studies have noted that BPA has well-documented estrogenic activity, causes liver damage, disrupts pancreatic function, disrupts thyroid hormones, and has obesity-promoting effects.
Identification: Plastics that are recyclable have a triangle on the container somewhere which displays a number in the center. It is likely that containers and water bottles with numbers “3 and 7” contain BPA and should be avoided. You may have bike bottles that have been hanging around the house that you have been using which you can replace with a variety of “BPA Free” labeled bottles that are readily available.

Action Step: Check your running water bottles for the correct numbers in the triangle and replace any that display the numbers 3 and 7. Try and stay away from canned food liners that contain BPA; (Good news: Many food manufacturers have started to replace the BPA in their canned foods). Don’t ever microwave your food in plastic containers. Consider replacing all of your storage containers with a glass alternative. Pyrex makes a neat glass product that has a sealable top with a pop up vent (to let the steam out) if you choose to use the microwave.
Research and brief summary; partially from JAMA: Volume 300 No. 11 September 17, 2008
1) Bisphenol A is used extensively in epoxy resins lining food and beverage containers and in plastics in many consumer products.

2) “Widespread and continuous exposure to BPA, primarily through food but also through drinking water, dental sealants, dermal exposure, and inhalation of household dusts, is evident from the presence of detectable levels of BPA in more than 90% of the US population.”

3) Studies have noted that BPA has well-documented estrogenic activity, causes liver damage, disrupts pancreatic function, disrupts thyroid hormones, and has obesity-promoting effects.

4) “Weighted mean BPA concentrations adjusted for age and sex appeared higher in those who reported diagnoses of cardiovascular diseases (including coronary heart disease, heart attack, and angina) and diabetes.”

5) These authors found that higher BPA concentrations were associated with diagnoses of cardiovascular disease, diabetes, and clinically abnormal concentrations of the 3 liver enzymes (GGT, alkaline phosphatase, and lactate dehydrogenase).

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online at www.utahsportsandwellness.com

Anatomy of an Injury and Recovery

By Dr. Michael Cerami

It shows up without warning, it sneaks up on you, it ruins your season, and it gets almost everyone eventually. No, it’s not the latest horror movie preview for the summer blockbuster; it’s your running injury.

Most of the running symptoms I see at the office are (in order of most common) are knee, foot/ankle, leg and hips. The breakdown usually begins from a bio-mechanical weakness and then develops over time into a compensation that will cause soft tissue inflammation. If un-attended or covered up with medication the problem usually gets worse as the body starts recruiting alternative tissues, muscles and ligaments to try and stabilize the dysfunction. Long term damage can result in muscle or tendon tears and arthritis of the joint surface.

I believe the knee is the most common injury for runners because of the rotational loads put on it from two areas; the feet and the hips. 85 percent of the population has pronated (rolled in and down) feet, while it’s not always clinically significant, it does create an internal rotation of the 2 lower leg bones. This, along with the 3 dimensional bi-lateral movement of the pelvis, can create twisting in the knee joint from the top and the bottom causing pain throughout the leg and knee. In my experience, distortion of the kinetic chain or alignment of the lower leg can cause everything from a patellar tracking problem to IT Band syndrome, Achilles Tendonosis and plantar fasciitis.

If you are having running injury problems I suggest a 3 part approach with an honest self-assessment:

1. How bad is the injury or symptom? What are the best and worst case options? Can you recover by just stopping running for a while? Have you been over-training?
2. Specifics: Have you had the problem diagnosed it correctly? Have you researched the problem on Google, or YouTube and tried some stretching or exercises? Have you seen a professional? If so, what have you been told?
3. Time: How long have you been having problems, what have you tried on your own? Do you have any options left?

Try and work though the details like you were problem solving something at work or at your house. For me; I’m going to try things on my own first and if I fix it, great; I feel proud of myself. I also recognize there is a time to call in the experts when I understand and realize that I can’t figure it out on my own. Whether it’s tools or expertise; sometimes you just have to call in a professional.

Do your research and ask around for a referral from friends or other athletes. You may need to see a few people to find one that works for you. Healing and repair of the body (unlike house plumbing) is not an exact science.

Finally, be positive but realistic. Make a commitment to follow through. In my experience there is almost always a solution to fixing running injuries fairly quickly whether you are 6 years old or 60 years old. BUT (and it’s a BIG BUT), you have to be willing to do the work and spend the time necessary to find and correct the source of the injury and give the body 2-6 weeks to repair.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no charge consultation one Saturday per month at The Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online atwww.utahsportsandwellness.com

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What’s going on upstream?

By Dr. Michael Cerami

If you found a bunch of dead fish washed up along the shoreline of your favorite river, what would you think?  This is a suitable analogy for how I view patients that come to see me; no, not that they are washing up into my office; but that their symptoms are an indication of something going wrong elsewhere-upstream.

Patients usually present with at least one problem or symptom. For many of them there are a multitude of issues that must be addressed. These usually fall into 2 categories: Symptomatic- what the patient feels, and Functional- what the examinations reveals. I find that going upstream to find the source of the symptom is the most effective way to help people get well and then to sustain that change. Otherwise we are just pulling dead fish out of the water all day long.

Treating only symptoms can be very seductive. It’s pretty easy to find (Where does it hurt?), cheap (take some anti-inflammatory meds), provides some instant relief (thanks doc I feel better) and allows the patient to continue to do the same thing that caused the problem.  This approach is similar to painting your house without sanding, scraping and priming first. It looks great for a while- then the paint starts peeling off and it needs to be done right which adds additional time and costs.

The good news is that with an effective analysis and examination the body can repair much faster than people realize. This is true whether you see a professional or not. The place to start when you are injured or have a problem is upstream.

If you are injured, try to take into account not only what has happened recently (twisted your ankle, pushed too hard while you were dehydrated), but look at a broader scope, over the past few weeks or even months and be honest with your assessment. It’s likely that many things contributed to the injury, not just the most recent event.

Try and not get locked into thinking about your issue only one way; either with a certain time frame or by being stuck on the area that is hurting. Expand on the possible causes and give each one of them equal leverage. Think multiple possibilities. This may not be easy, but it will give you a much better understanding of your body. The longer a professional is in practice (Doctors, Moms, mechanics, builders, nurses, technicians, etc) the more they understand the value of working through multiple possible causes and solutions simultaneously because it saves time and effort. I’ve recently had a few athletes with knee injuries where the solution for correction was in realigning the hips and the feet and had nothing to do with the knee itself. If I had gotten locked into thinking just about the knee, we might not have been able to solve their problems as quickly.

Because you are going to have your body for a lifetime, you should practice observing and understanding how all of the pieces of your life, health and exercise fit together. You don’t need to overdo it and blame all of your problems on your parentsJ, just try and observe with a bigger perspective regarding time and think more globally regarding your body. Once that’s accomplished, use your intuition to implement some possible solutions and see what you notice.

If you can create a better map for your life by looking upstream a bit more every year, you’ll start understanding your body better, stay healthier and avoid injuries.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no change consultation one Saturday per month at The Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online atwww.utahsportsandwellness.com

Life’s Complicated…yes, and so are you

By Dr. Michael Cerami

After many years of trying to explain the complexity of symptoms to patients, I came across an idea that seems to be getting traction.

99% of people that come to see me are in pain of some sort. Their pain could be showing up in their back, their hips, knees, feet, neck, shoulder, butt, hamstrings, headaches, or whatever. I always struggled on how to explain to patients that their problem (in most cases) didn’t happen at the same time the pain appeared. To be more specific, the cause of the problem is one thing, the awareness of the problem or pain is another. It’s very normal to link both events together.

Remember way back when you were a little tike and you first smashed your 2 little fingers with a red brick you were playing with and it hurt like !*#$%? Well, that’s what I recall as my first lesson in pain and at that point my little brain started putting it together … brick…heavy…fingers…soft..brick on fingers = instant pain= “When I do this, this happens”.

As we get older we equate the initial awareness of pain with the start of the problem. “I woke up with the Flu”, “All I did was pick up the razor and now I can’t move my back”, “Everything was fine yesterday”, “I haven’t done anything different”, and even “I felt good last week and now they tell me I have cancer”.

Somewhere along our life’s journey we started thinking that we are more like our cars and computers than like the living environment that surrounds us. When you break something mechanical, the results are immediately obvious. Smash your car; you see it. Hot water heater fails; you feel it. Computer crashes; you yell at it. Just as importantly, these things seem pretty straightforward to repair.

In contrast, when a living thing or system starts to have problems, the symptoms may not be apparent for days, weeks or years because there’s a sub-threshold adaptation process occurring that we can’t see or feel. The cold you woke up with probably started 4 days ago (when you were exposed to a virus) and just reached threshold (awareness) today.

Think about it. The grass isn’t going to turn from lush green to brown overnight if your sprinkler system broke in the middle of a hot summer is it? And when you discovered it, the mechanical sprinklers should be pretty easy and quick to fix, but how many days or weeks will it take to get the lawn healthy again?

Complex systems are usually able to do and perform a lot more than simple systems. And since we ask our bodies to do just about everything imaginable and we’re about the most complex things on the planet, observing subtle changes can be difficult at best.

I propose that instead of thinking on/off, feeling good/feeling bad we consider the idea that we remember we are really Human Beings (living) not Humans doing (mechanical) and therefore will go through millions of changes and adaptations in a lifetime.

This will help us make better decisions on how to develop long term strategies to take care of our bodies and develop expectations that are more in line with the rhythms of nature. This seems much more sensible than the distortions of the quick fix mechanical approach we seem to default to.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a no change consultation one Saturday per month at The Salt Lake Running Company (700 E store) by appointment. He can be reached at 801-486-1818 or online atwww.utahsportsandwellness.com

Jeff Spencer Lecture Preview: You’ll say, “A well spent hour”

By Dr. Michael Cerami

I thought it would be a good idea to share my experience with Dr. Jeff Spencer as he has played a significant role in my personal and professional life.  I hope it gives you a good idea of why I thought it was important for him to do a presentation to our local community at the Salt Lake Running Company next week.

I first met Dr. Spencer years ago at a convention where he was presenting to over a thousand of my colleagues. I was immediately captivated by his ideas on energy medicine and how he explained the importance of removing “interferences” in the body to get athletes to

perform at higher levels.  He was taking parts of what I knew from 20 years of clinical experience and adding cutting edge information that I was reading about in my personal life to improve my fitness and performance. I distinctly remember that he had a system to identify and correct problems in the body that pulled all different pieces together, and he had the resume to back it up as he had worked with dozens of world champions.

As his lecture continued, a light bulb went off in my head, “I need to talk to this guy!” I was post 1 year ACL reconstructive surgery and not where I wanted to be with my recovery. Maybe he had an answer. I waited for my opportunity as the crowd slowly dissipated around him and asked him if I could talk about my “problem”.  Jeff was very accommodating and immediately asked a little more about the injury and my history;  he then had me perform a few tests  he’s developed to identify the possible cause of my problem and why I wasn’t able to engage the muscles effectively even after extensive rehab.

Without going in to all of the details, he checked a few more things and then did two cold laser treatments on me. That treatment, along with two additional sessions a couple of weeks later, literally changed my professional paradigm and my personal life. I just couldn’t believe something so simple and so quick could make such a dramatic improvement. When I got on the bike later that week, I could feel that my left quad was actually fully engaging the power stroke into my left pedal. That hadn’t happened since the injury as it was just going around for the ride previously. I finally had two legs to bike with again! I was totally jacked.

I attended a number of seminars Dr. Spencer presented and began to learn more completely how his vision of the body encompassed a larger picture that I had imagined. He talked about muscles, nerves, and connective tissue. He talked about the importance of symmetry and the concept of Tensegrity, focal loading and why many times the cause of the symptom, was NOT where the patient felt pain. In the midst of all this clinical information, he dropped in stories about the physical and mental demands of the athletes and riders he had worked with and what helped them. I came to realize that many of these professionals were struggling with many of the same things we do albeit on a different level. He provided ideas and answers on maximizing their potentials and solutions for physical and mental challenges.

As I got to know Jeff better over the years, I began to see more of his personal side when he talked about his experiences at the Tour de France and with his personal life journey. I got an immediate sense that this guy really cared about the people he was working with and the doctors he was teaching. He wasn’t removed and distant with an “I did this and that…” attitude. He had ability, heart and compassion that really comes across in his book “Turn It Up”.

I also got a sense that Jeff is on a mission to get as much done as possible in this life and therefore can come across as a pretty intense person. I’m sure that when dealing with professional athletes at the biggest races in the world you either “Step up and get the job done” or they find some else that can as their livelihood is on the line.

I encourage you to come out on February 11^th from 7-8pm to meet and listen to Dr. Spencer. I think you’ll get more than you bargained for in a lot of ways.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a consultation one Saturday per month at Salt Lake Running Company (Salt Lake store) by appointment. He can be reached at 801-486-1818 or online atwww.utahsportsandwellness.com

Dealing with the Injury Demons

By Dr. Michael Cerami

I decided to write this month about my experience in dealing with a knee injury that occurred 6 years ago. What seemed like a career ending event turned into one of the best things that’s ever happened to me and I hope it can provide some insight for other athletes. I hope it can provide some additional perspective while managing your down time and injuries.

For much of my life I was very fortunate to be uninjured and pain free. I ran a bit in my 20’s to stay in shape but really didn’t get serious until about 1990 when I was 33 years old and met my wife. I started by running a bunch of 10k’s back East where I’m from and then a few marathons with no problems. In those days you got most of your information from magazines and books about creating training plans and it seemed to work pretty well for me. In 1992 I started working with triathletes in my practice and got hooked on the sport so I started biking and swimming and completed my first triathlon in 1994.

I moved to Salt Lake in 1995 and everything was going well until the winter of 2005 when I had a hyper-extension ski injury that completely tore my left ACL.

The main thing I remember about the injury was being really depressed after the surgery because I was doing 2+ hours of personal rehab daily and getting very little results. The first doctor I saw said I probably wouldn’t be running again so the possibility of never doing another triathlon was very real. I then realized that over the years I had eventually and unconsciously identified myself as an “athlete” and was now faced with the prospect that I may be losing that identity. It was honestly very emotional and scary to think what I would be if that athlete piece of me was missing. If I wasn’t an athlete, what was I? I know it may sound trite (and it was compared to some of the other challenges I’ve had in life) but the concern really got a hold of me and it was totally unexpected.

What I eventually figured out was I can’t control what happens in my life and I’m going to have to “roll with it”. I thought I knew this already but the “gift” of this injury brought it home for me. I also understood that even though I couldn’t control the results of surgery and rehab (or the outcome of any event for that matter) I could control the effort I put in to solve the problem.

What this meant for me was taking a serious look in the mirror and telling myself that I would find the right people and do as much as I possibly could to solve this injury so I could get back to being an athlete. But (and it was a BIG BUT), if the result of my efforts weren’t what I wanted, I would have to be OK with that, knowing that I put the effort in and the ultimate outcome wasn’t up to me. In other words I could control my efforts but not the result. I wanted to be absolutely certain that 5 years post injury I could look back and honestly say I did everything I could to solve the problem. I did not want to think I should have or I could have done more.

This decision changed my life in a lot of ways. I came in contact with some amazing people and technology that not only helped me solve my knee injury but literally reinvented my professional life as well. I doubt I would have ever reached the new level of realization without what I thought was a horrible day on Snowbird. I wish you a wonderful year in your training; both your body and your mind.

Dr. Michael Cerami is an avid runner, cyclist and triathlete. He is available for a consultation one Saturday per month at Salt Lake Running Company (700 East store) by appointment. His next visit to the store will be January 22 from 10 a.m.-2 p.m. To schedule a free consultation, please call the Salt Lake Running Co. at 801-484-9144. Dr. Cerami can also be reached at 801-486- 1818 or online at www.utahsportsandwellness.com