Never has the term ‘a blessing in disguise’ seemed so pertinent to me as this week, when I finally conceded that the pain in my hip and lower back was severe enough to take a break from running and get some professional advice.
Okay, so maybe ‘a blessing’ is a slight exaggeration, but sometimes it takes an injury, or a similar setback, to realise that there is something awry in your training regime, bio-mechanics, running form, or in my case, all of the above, and to give you the incentive to get on and do something about it.
A year on from my last big injury (and hopefully a year wiser), I’m being a lot more pragmatic about what I should and shouldn’t do in terms of training while in pain. Yes, I want to make sure I’m fit for the marathon in April, but I also want to be able to walk, sleep and swim pain free, and, most pressingly right now, I want to be in good shape to go on my skiing holiday, which is less than two weeks away.
So this weekend I went to see a physiotherapist and, after being diagnosed with hip bursitis on my left side (that is, the inflammation and swelling of the fluid-filled sac that acts as a cushion between the tendons and bones of my hip), and a very tight ITB on my right (read more about ITB issues and treatments here), I’ve agreed to take a week off from running.
After working through the range of movements in both of my legs and studying my gait, the physio concluded that, despite all of the work I’ve been doing to strengthen my core and glutes, when I get fatigued during training they are still not firing as they should, and as a result my back and hips are taking the strain. I’ve been given a series of exercises that work deep into my stomach muscles, as well as those in my bottom, to begin to redress the balance and try to undo some of the bad habits I’ve formed. To help with the immediate pain, I also had my first ever session of acupuncture.
I hadn’t gone to the therapist expecting to undergo this treatment and I have to admit to being quite in the dark about the science behind it, so I was keen to grill him with questions as he put the needles along my ITB and into my feet.
Although the narrative for how acupuncture works differs depending on whether you are coming from an eastern or western medical tradition, the general process is that the needles act to stimulate the nerves and muscles tissue and, depending on your view, either lead to the release of pain-relieving substances, such as endorphins, or restore the free flow of Qi through the body’s meridians, in both cases reducing pain.
Some further reading suggests that although the exact mechanics of how the process works are still not fully understood from a western perspective, there is enough evidence that it is sufficiently efficacious when it comes to pain relief to be offered as a complimentary treatment on the NHS as well as in private practice.
From my personal experience the acupuncture had two primary outcomes: the first was psychological in that I felt that someone was actively doing something to help relieve the pain I was feeling, and this alone left me feeling more positive about situation. Secondly, where my muscles were particularly sore or tight, I could feel them spasm and fill with a dull ache as the needles entered my legs and hips, but this then lessened as I lay on the bed and although my hip was still sore after the treatment, the other muscles in my legs felt less tender post-treatment.
I was sufficiently curious about the process to book in for a second session this week and in the meantime I’m keen to learn more. I am also on a course of ibuprofen and icing, alongside my rest period, so it will be difficult to tell what ultimately brings the inflammation down, but providing the final outcome means that I can run the Finchley 20 next week I’m happy to try out being a human pincushion for now.
Black hole training
As it happened, this recent injury also coincided with my discovery (via the Ben Greenfield podcast) of the concept of ‘black hole training’ (also known as running ‘junk miles’), that is performing all of your training sessions at a single intensity – hard enough that you feel that you’ve done something worthwhile, but not really hard enough that you are going beyond your lactate threshold or elicit any significant training response. This type of training is characterised by 3-5 sessions a week, normally for between 45 and 60 minutes, running the same routes, at the same pace, pretty confident you know how you will feel at the end of the session.
Sound familiar? It did to me, and I was horrified to discover that this is in fact the absolute worst kind of training for improving performance and maximising fat loss. Moreover, it is the kind of training most associated with injuries.
On top of this, studies have shown that this kind of training may also lead to hormonal disruptions including testosterone deficiency and low libido in males, oestrogen deficiency and low bone density in females and a disruption in your appetite.
Now, had I not been suffering with an injury at the time of hearing all of this, my interest in this critique of single tempo training may have stopped there. But as I listened to Greenfield explain the mechanics of how and why this type of training is essentially bad for you, the pain shooting through my hip and up into my back (I happened to be listening while on a run), forced me to take note.
And the thing is, I’m not alone in being lost in this black hole. Many recreational exercisers, particularly those who don’t have coaches, tend to gravitate towards this comfortable middle ground, not going anywhere near slow enough on their easy days to allow for recovery and to avoid over-training, and certainly not going hard enough on their tough days to stimulate the necessary response to get significantly fitter or faster.
Rather than sitting on the exercising fence, Ben Greenfield recommends an 80/20 ‘polarised training’ approach. In a number of studies where two groups of athletes were put on programmes with the same volume of training but where one group polarised their sessions, working at a very high intensity for approximately 20% of the time and at a low intensity for approximately 80% of the time, and the other group gravitated towards a majority of moderate intensity sessions, it was seen time and time again that the athletes who polarised their training showed a more significant augmentation in overall performance, be that in running, cycling or swimming.
As Greenfield observes:
Despite the fact that it feels very rewarding to roll up your sleeves and head out to the door to hammer at or near your threshold for a morning or lunchtime run, or ride at a steady “race pace” intensity for a few hours on the weekend, or swim lap-after-lap in the pool at your perceived Ironman intensity, it’s simply the wrong way to train.
So, how do we optimise the 20% high intensity training sessions without devoting our whole lives to exercising? That is where HIIT comes in.
High intensity interval training (or HIIT) has been shown to increase your V02 max, mitochondrial density and oxidative enzyme volume and efficiency, increasing your capacity to train harder for longer. This increase in oxidative enzymes can also change your metabolism, increasing the rate at which your body oxidises fat during exercise, resulting in more efficient fat burning (as opposed to burning of carbohydrates) during exercise.
What is more, HIIT can also increase your post-exercise oxygen consumption (EPOC) (the mythical ‘after-burn’ effect) meaning that after a HIIT session your oxygen consumption, and thus the total amount of calories you burn after the actual workout, remains elevated as your working muscle cells restore physiological and metabolic factors in your cells to their pre-exercise levels.
So why not just train at a high intensity and skip the long slog cardio? It seems that what HIIT doesn’t improve, unlike long bouts of easier, aerobic training, is you maximal cardiac output – that is the measurement of the largest amount of blood your heart can pump in a given amount of time. This is why, to optimise your training – ‘maximizing your much blood your muscles can utilize (with HIIT) but also by maximizing how much blood your heart can send to your muscles (with aerobic training)’ – you need to combine long and steady workouts with your higher intensity sessions.
As Greenfield writes:
HIIT works more effectively on your peripheral muscle fitness while endurance training works more effectively on your central, cardiovascular fitness.
The good news for me is that while I can’t run at the moment, I can cycle, swim and perform a series of weight baring and body-weight exercises without pain, all of which can be combined to form a pretty efficacious HIIT session.
So what does a good HIIT session look like? I’ll save that for another post.