ATC 287: Are We Overdoing It With Anti-Inflammatories? The Bright and Dark Side of Inflammation, Bone Density and Stress Fractures, and What to Do For High Hamstring Tendinopathy

May 24, 2019
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Intro

  • Congratulations to the Gibson family on their healthy baby girl, Coralee!
  • Welcome to Julie McCloskey—a Registered Holistic Nutrition Coach (RHN) based out of Missoula, MT—for filling in for Tawnee while she’s on maternity leave. (She’ll be back this summer!)

Craig Moss

Inflammation: Good or Bad?

Hello my fitness family — Can you explain inflammation to me? Is it good or bad?  I know you need it to help the healing process but then why take anti-inflammatory things like CBD or eat an anti-inflammatory diet?  

Is some good but too much bad?  If so then how do things like CBD play a role?

Do you need to know how much natural inflammation you have from foods and stress to accurately take any anti-inflammatory drugs/supplements?

What the Coaches Say:

  • Inflammation is the immune system’s response to an irritant – the body’s response to any damage (a repair process)
    • Releases inflammatory mediators including the hormones bradykinin, histamine, and IGF-1. They cause small blood vessels in tissue to become wider allowing for more blood to reach the injured tissue (turn red, feel hot).
    • This increased blood flow allows more immune system cells and proteins to be carried to the injury in order to support the healing process.
    • And also these hormones irritate nerves and cause pain signals to the brain as a protective mechanism.
  • You cause damage if you reduce inflammation at the onset.
  • How long has the inflammation been there? Acute good, chronic bad. At what point is inflammation bad? Not sure. Look for visible signs of inflammation, listen to your breathing, energy levels. CRP blood test, <1mg
    • Your approach to inflammation should be based on what’s causing the inflammation in the first place. Inflammatory foods require a different approach than a sprained ankle, for instance.
  • Stay away from all anti-inflammatory products after a hard workout, including curcumin, boswellia, and NSAIDs (well, stay away from these always!)
    • CBD: Our bodies all have something called an endocannabinoid system that works to balance our hormones, which in turn regulates our endorphins, thyroid, adrenal function, and immunity among other things. CBD is a cannabinoid, and as such, it “switches on” the receptors of the endocannabinoid system, improving its performance which is why people have such a wide range of benefits from taking CBD – it normalizes so many processes in our bodies and brings them back into alignment. That said, you don’t just want to take this concentrated formula right after a hard workout or a sprained ankle. Let your body respond to these acute instances on its own. Best to use CBD if you have low grade general inflammation and need some relief as you work to figure out the root cause.
  • In general, stay away from inflammatory foods including sugar, processed cheese, factory farmer meat, and even caffeine.
  • Be especially careful to eat an anti inflammatory diet in the off-season after you finish a high volume block of training and/or a race.

 

S.S. (wishes to remain anonymous)

Time for a paradigm shift?

Before I start, let me say this: your podcast is my favorite – I look forward to it every week!  And congrats to Tawnee – I’m sooooo happy for you and wish you all the best!!

So here we go.

I’m a 39yr old female with goals of staying healthy, active and strong for the long term.  My ‘favorite’ form of exercise is outdoor running  (I’m totally middle-of-the-pack, 55ish min 10K, 2ish hr half to give you an idea) but I also like the feeling I get from doing some weights too.  I eat a whole foods paleo-ish diet, have no weight problems (130-135 lbs for years) and have Hashimoto’s (controlled) and Raynauds.

For the past few years, my exercise routine has been to get in about 5 or 6 runs/week, 30-60 min, trying to keep my heart rate under 140 most of the time.  I would run fasted in the morning thinking that this would overtime improve my fat burning and help me to improve my pace at low heart rate.  My other reason for the way I was training was to try to keep my exercise-stress low as I’m a bit of high sympathetic-type of person.  I would also do a bit of strength work (push-ups and squats, mostly body weight).  This was convenient and worked well with my work/family life and I enjoyed getting out in the mornings.  I had no injuries for years.  However, I was not getting any faster and was not feeling very strong. 

THEN THIS HAPPENED: I got a stress fracture on the top of my foot – I think it happened partly because I had been wearing minimal shoes which were getting old and partly because I had been doing a some harder workouts (more weights and runs where my heart rate was higher) over the weeks leading up to the injury.  

So now I’m just wearing a very stylish air cast and dragging myself to the gym to go on the stationary bike.  Boring! I’m also doing some upper body strength stuff using machines.

I had been feeling like I was in a bit of a rut and this injury is forcing me to think whether maybe it’s time to change things up  – I’m someone who likes to follow a ‘plan.’ Is it possible that the MAF-style training I had been doing was just a little too hard?  My true MAF (b/c I take synthroid) would be under heart rate of 131.  Once i get back to training, should I try my morning runs/walks with that in mind?  Or would that be a waste of my time? Could it be time to scrap that plan and focus on less days of running, perhaps running by feel rather than heart rate and introducing more days of weight training?  I can devote about an hour/day to exercise and making trips to the gym more than a couple times/week would not be ideal.

I’d love some guidance/specifics – I guess I’m looking for what might be a better strategy going forward to keep running in my life and also becoming stronger and I know you guys are the experts.  I’d like to do some 10k’s again in the future but am not into doing any half marathons any time soon because found the long runs too hard on me.

By the way – my physio has switched me to Hoka’s – so there’s one big gear shift right there!

What the Coaches Say:

  • Lucho thinks your switch-up plan would actually be a bigger stressor.
  • Synthroid increases your HR regardless of your exertion, so Lucho doesn’t think you’re currently running too hard.
  • If you run too slowly then you can increase the vertical force on your feet and run more on the mid-foot, which can increase stress. Running by feel and doing what’s natural is the least stressful.
  • Synthroid is a known bone density reducer so that might be the root of the stress fracture problem rather than your running routine. Your intensity was appropriate for a healthy athlete of your caliber.
  • Minimalist shoes maybe factored in to the problem. Consider rotating your shoes and running minimalist every other run. But Hokas for your comeback are great! You don’t want to over-stress that bone as it heals.
  • When you come back (the first 6-8 weeks) start with only two runs and increase strength training, which will help your bone density.
  • Home workouts could be great for you: kettlebell, pull-up bar, and TRX are all relatively inexpensive and can kick your butt!
  • Once you build back to your pre-injury volume and pace you can start toying with changing up your routine.
  • Julie warns you to be careful about fasted morning workouts if you’re a sympathetic dominant person. Fasted exercise will only exacerbate this system! Eat a little bit before those AM runs.
  • Make sure you’re getting sufficient sleep (7-9 hours) too to help keep your sympathetic system in check.

Roy H.

Hamstring Turned Glute Pain

For over a year I’ve been running with a hamstring niggle that matches almost exactly Lucho’s description of High Hamstring Tedinopathy in ATC 257 (April 6 2018 – Building Durability and Toughness, Too Fast For MAF, Hamstring Niggles, When Resistant Starch Backfires, Ground Contact Time, and More!

During the episode Lucho said (@ 55:20)  “What you gonna feel is a dull ache, possibly a tightness, if it spreads up into your glute – glute medius then you might be in trouble….”

Well, that is the particular thing I’m writing about – since my dull aching hamstring tightness has indeed migrated up into my glute. Can Lucho offer any advice about what to do in this situation please?

What the Coaches Say:

  • Glute max isn’t a big concern, but the glute med and psoas are more problematic.
  • Do 7-way hips, psoas exercises, hanging leg raises, and especially 45° hyper extension (commonly called back extensions). Glute Ham Developer machine (if you can find one at the gym) would also be great. Make sure glute med and glute max aren’t compensating while you fix the hamstring.
  • Overstriding and heel striking tend to be the culprits that cause this problem.
  • You should start doing isometrics for the hamstrings; i.e. back plank.
  • Also try concentric exercises to strengthen the head of the hamstring.
  • If you don’t fix your mechanics, it could take years to fix this injury.
    • The good news is that the risk of avulsion of that tendon is pretty small, so you can keep training (technically).