Tuesday, November 27, 2012

Grand Canyon R2R2R

It’s a bit mind blowing that I had never even seen the Grand Canyon before running it. Growing up in northern Utah I was only about 9hrs from the north rim. R2R2R stands for rim to rim to rim, meaning going from the south rim of the canyon, down to the bottom of the canyon, to the north rim of the canyon and then turning around and doing it again back to the south rim; a double crossing. While there are a fair number of people that do this run every year, this in no way means that it is easy. In many write-ups I have read it is considered the “right of passage” into ultrarunning.

The near-full moon.
When my crazy brother-in-law, Isaac, got into running he wasn’t messing around.  Having been running increasing miles for the previous year, and a member of the family, made him the perfect running partner for a Thanksgiving weekend canyon crossing. There is always the tug from both the adventure end of the vacation and the family end of the vacation which sometimes gets me into trouble.  When Kimber suggested that I run the canyon with Isaac I was all in. A few years ago I had planned to do it with the Utah gang but medical school didn’t really care about those plans and it didn’t happen.  

It turned out to be a grueler, one of those runs where you just never really feel great.  But, we couldn’t have asked for better weather, the trail wasn’t all the busy and we were pretty psyched to do it. So we ditched the family post-Thanksgiving festivities in Phoenix, AZ the night before and headed north.

Predawn stoke and chills.                                                                          Man on a mission.
Climbing the north rim wondering why it's taking so long to gain elevation. 
Phantom Ranch, second time through......wasted. Mile ~35, just before having to climb out the entire south rim. 
 Timeline; 11/24/12
·         3:20am – Awake and drive to Grand Canyon from Flagstaff, AZ.
·         5:15am(0:00) – 6780K ft elevation, Drop into canyon south rim via South Kiabab Trailhead
·         6:50am(1:35) – ~2100ft elevation, Reached Colorado River at bottom of canyon.
·         7:10am(1:55) – 2100ft elevation, Phantom Ranch, ~10min break
·         9:15am(4:00) - 4700ft elevation, North Side, ~10min break
·         10:15am(5:00) – 5200ft elevation, North Side, ~10min break
·         11:02am(5:47) – 7780ft, North Kiabab Trailhead at North Rim, ~30min break
·         ??:??pm(??:??)- ~4000ft elevation, Cottonwood Campground, , ~15min break
o   Coming down ‘Box Canyon’ into Phantom Ranch felt like it would never end, winding down next to the Bright Angle Stream.
·         2:55pm(9:40) - 2100ft elevation, Phantom Ranch, ~30min break
o   We walked/stumbled up the entire south rim and finished under a near-full moon lighting the entire canyon.
·         7:17pm(14:02) – 6780ft elevation, South Kiabab Trailhead of Grand Canyon South Rim

*Elevations are from my Suunto watch and aren’t exact because I haven’t calibrated it, but the change in elevation is pretty accurate.

 Isaac getting water at our first pass through Phantom Ranch (L), heading up the north rim (M) and at the north rim (R).

·           - 14hrs 2min total time.
·           - 10,710ft elevation gain, 21,420 elevation change
·           - 41.8 miles rim to rim to rim (43 if you add in our crappy parking spot away from the trailhead).
·           - Amount of sleep night before run: 2.5hrs(Nate)/1.5hrs(Isaac)

Ways to Improve Time (in order of importance as I see it)

·         Dial in hydration and nourishment. I need to do a lot more research into this but I think I brought too much protein and not enough simple sugars. Late in the run my stomach started feeling nauseous and I stopped eating and drinking very much.

I ate less than half of that. Protein overload!

Took in some Cod Liver oil and butter the night before per Isaac's suggestion

·         Don’t start with knee, foot and ankle pain.  I had a minor muscle strain behind my left knee that was drastically exacerbated early on during the run. I twisted my ankle pretty bad the night before playing post-Thanksgiving sand volleyball and that combined with a weak headlamp and a horrendous trail wasn’t awesome. I wore prefab orthotics in my shoes to try to stop the pain at my left first metatarsalcuneiform joint which I hadn’t trained in long enough and they killed my foot bad enough that I took the right one out half way. When we prescribe orthotics to patients we tell them about a break in period. I need to practice what I preach.
·         Do more long training runs. When I say long I’m not totally talking about miles, but about the amount of time that I spend moving on my feet.  My longest training run since my 50 mile race(9hrs, 1.5 months previously) was only 5hrs and 29miles. I more than doubled my time on my feet which rocked me.
·         More sleep. 2.5hrs isn’t enough simple as that.
·         Get better acclimatized. Living at 0ft elevation in CA and only spending a few days at ~2K ft in Phoenix probably played a significant part.
·         Load some music onto my MP3 player. I listened to Ultrarunner podcasts for much of the run. While the interviews with world class runners was interesting I noticed that I run much better and got a bursts of energy during the wrap up song at the end of each interview.
·         Better headlamp for descent.  The South Kiabab trail is not smooth at all with logs, boulders and steep drop offs along most of the entire downward switch backs. My light even died for about 20minutes where I had to run in front of Isaac, my shadow blocking the view of each step.
·         Don't forget your lucky visor. Luckily Isaac had a hat for me to borrow that allowed us to be team Nike but I sure missed my visor. I have done a lot of great miles in that visor and it just wasn't the same..

I don’t like to ask myself if an adventure like this will ever be repeated for at least 2 weeks after the event, because I seem to forget all of the suffering and remember only the sheer awesomeness of the ordeal. But thinking about it two days after it is over, I am warming up to the idea and probably would give it another go if the opportunity arises.  While the record for the course is an insane 6hrs, 53min and 38sec by Dakota Jones in Nov 2011, thinking that I could even do it in half that time during my first attempt was fun but a bit unsettling when I didn’t. While I am happy with my finish time I’m not content with it. Time will tell if in the future I will get to take another solid stab at it.

The day before Kimber and her sister, Isaac's wife, ran their first half marathon. They rock.

Wednesday, November 21, 2012

Walking the Biomechanical Runway

Depending on the reason for being there, it is not uncommon for part of your visit to the podiatrist to include a gait and biomechanical evaluation. Gait is the way in which someone walks, their swagger. The patient is asked to roll up their pants and walk back and forth, sometimes fast and sometimes slow. The doctor meanwhile intently watches until satisfied and has seen enough. The doc will then proceed to examine you from your hips to your toes, pulling, twisting and prodding on the way down.  During this ritual the doctor is obtaining information to formulate the treatment plan.  The cool thing about a biomechanical approach to the body’s problems is that the goal is to fix the underlying cause of the problem in a completely non-invasive way. Below are a few big concepts involved in a basic biomechanical evaluation.

Bill Cosby's gait evaluation.

1.       Supination and Pronation: These are probably terms that you are somewhat familiar with but let’s just make sure that we are on the same page. Supination is when the bottom of the foot is moving to face the midline of the body also causing the ankle joint to extend and the foot to turn inwards. Correct terms for these movements are inversion, plantarflexion and adduction. Pronation, the opposite of supination, refers to moving the bottom of the foot to face away from the midline of the body, causing the ankle to flex and the foot to turn outwards. Correct terms for these movements are eversion, dorsiflexion and abduction. The ability of the foot to supinate and pronate in necessary in the function of the foot during walking and running. These terms are also used to describe the foot's position while standing.

Figure borrowed from www.orthoticshop.com. 

2.       Asymmetries:  For the most part, the body was designed to be symmetrical, in movement and structure. Asymmetries lead to inefficient movements that put increased amounts of stress on the body’s structures often leading to breakdown, causing pain.

3.       Limited Joint Range of Motion:  Every time a joint comes to its end range of motion the soft tissue is potentially being stretched beyond the point at which it is capable of recoiling.  Abnormal end range of motion also can mean that you are having non-anatomical bone on transferred energy and motion that is not dissipated by the proper joint. Simply put, the jarring of joints is bad.

4.       Pronation Affects the Entire Body: Pronation, the lowering of the foot’s arch, causes the tibia to internally rotate and is a mechanism that the body uses to shorten an elongated limb. Try it. Stand up and try to pronate your foot while standing. The only way that you can do it is by internally rotating your leg forcing you into a knock-kneed type stance. This internal rotation translates up the leg all the way to the hip leading to tilting of the pelvis. This tilting affects the spine and up to the shoulders. This path of misalignment has been shown to cause a whole host of problems, including but not limited to: patellofemoral pain syndrome, iliotibial band friction syndrome, ACL injuries, sciatic pain, and lower back pain. Pronation also decreases the amount of upward bend (dorsiflexion) in the big toe which over time can lead to bunions and osteoarthritis. 

The Vitruvian Man, 1485. Leonardo da Vinci
Often times only parts of the exam will be conducted depending on the problem and each doctor has small differences in the way in which the information is obtained. Treatment recommendations to improve the biomechanics of the foot include strengthening specific muscles/muscle groups, orthotics and shoe types.

Monday, November 19, 2012

Insoles, Arch Supports, and Orthotics

Inserting things into shoes to reduce pain is not uncommon. The only problem is that there are so many options currently available that it is difficult to determine what exactly will give the most relief. Shoe inserts can be divided in to three basic types; insoles, arch supports and orthotics. Understanding the differences will allow those seeking relief to make a more educated decision, leading to a better chance of obtaining pain relief.


Insoles are what most people think of when they think of shoe inserts. They come in all sorts of materials from gels to foams to air pouches and usually have a small cutout in the packaging that says “Try Me” or something similar. This type of insert doesn’t change the alignment of the foot but rather just adds padding. Cases in which this may be beneficial include pain under the balls of your feet or the heel due to the breakdown of the fat pads. Fat pad break down is caused by various reasons including aging and genetics. Foot types that often show pain in this area are ones that have a very high arch.

When choosing a padded insole I would suggest picking one that has an open cell cushioning system as opposed to a closed cell. This would include materials, such as foams, that upon compression allow rapid collapse of air cells. Closed cells such as gel inserts or air pouches only displace the gel or air within the material not allowing total collapse of the material. While pushing on the gel slowly with your finger might feel great, repetitively walking on a material that doesn’t respond quickly to your foot strike will not be as comforting.

Arch Supports

Arch supports are much stiffer than insoles. While they can have a padded type covering, they are more rigid. These supports come in various sizes and offer relief by pushing up the arch of the foot.  Often times foot pain can be attributed to a flattening arch and supporting the arch can offload some of the ligaments and tendons that may be causing the pain.  These inserts however are not custom and therefore it is not possible to get a support that fits your foot exactly.

***Obtained this SOLE video from www.zappos.com. The guy states that these offer "the most custom support possible". While they are more custom than many others, I would have to say that they don't hang a hat to doctor prescribed orthotics.

While there are a lot of arch support type insoles on the market the two above, Superfeet and SOLE, are good options. They run about $40 a pair and last anywhere from 6 months to a year.  Anything that supports the arch is moving in the right direction.


Orthotics, more properly known as custom foot orthosis, have been defined as “an orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body”.  These devices are custom made to fit your feet and can be modified to target specific pathologies and deformities.  Holding the foot in proper alignment with the body has an effect on the entire limb. Orthotics are prescribed for pain in all joints associated with the lower extremity  including hip, knee, ankle and big toe joints and can even reduce back pain. Orthotics also reduce strain on tendons and ligaments in the foot which can reduce inflammation and swelling, allowing the body to heal damaged tissue. These orthotics last anywhere from 5-10 years and can be modified or refurbished as needed. They cost $300 and up depending on the area.  This seems like a lot but if one decides to go with the over the counter non-custom arch support, at $40 every 6 months, you will be paying around $400 for five years of comfort and support. Orthotic coverage by insurance is plan specific.

The type of device right for you is dependent on the severity of your problem, your activity level, shoe type, foot type, body type and many other factors. By consulting with your podiatrist you can find the right solution. 

Wednesday, November 14, 2012

Anniversary Glamping at Big Basin Redwood State Park

November 1st, our 4 year anniversary, turned out to be a bust! School and life make celebration of such events a bit on the difficult side. So to redeem the occasion Kimber and I decided to celebrate the next weekend away from home. Ordinarily an anniversary would be celebrated in some nice hotel being pampered, eating fancy food and whatnot. While we aren't completely against that, we were aching for something different. After much thought, we decided to use the anniversary funds to go on a glamping trip.  Glamping, shorthand for glamorous camping, isn’t something that either of us are very familiar with. I think that it is fair to say that I am not even a very good camper. Camping usually consists of driving to the adventurous place that we have chosen to partake in the exciting activity, stopping for fast food on the way, arriving late, throwing our sleeping pads on the ground next to the car and sleeping. Unless of course it is raining then we either set up a quick tiny tent or sleep in the car if there is room amongst all of the gear. If we are going to camp in the future with a family we better actually learn to camp, so we gave it a shot, glamorous like. We took a trip to good’ole Sports Authority and Walmart for supplies and it turned out pretty good. 

Notice the extension cord running to the DVD player in the tent.

Complete with sheets, huge air mattress and memory foam topper.

Dutch oven chicken and biscuits.
Boys scouts paying off. 
Huge'ole Redwood!
Even though it was a bit colder that we had thought it would be and rained most of the night we had a great time. It was pretty awesome not to have cell phone or internet service and just 'hanging out' with each other, just the two of us. I even got up and got in a 14 mile run through the beautiful trails and green. Best anniversary to date!

Saturday, October 20, 2012

Traumatic Injuries vs Overuse Injures

Sports related injuries can generally be divided into two basic types of injuries, traumatic injuries and overuse injuries. Traumatic injuries, also known as acute injuries, are high energy forces that cause the breaking of bone and tearing of tendons and ligaments instantly. Causes of traumatic type injuries include falling, getting hit by someone or something, or proving something like hurling yourself off some cliff or ramp (you know who you are).
Traumatic injury potential.  Little Cottonwood Canyon, Utah, 2010. 
Hmmm..... Beaver Mtn. 2007

Traumatic injury potential. Porcupine Trail, Moab UT 2009.
Overuse injuries present over time. These injuries are more common and occur due to imbalance in the breakdown and remodeling of body tissues. The body is amazing at adapting to the many assaults that we put it through but can only adapt at a certain rate. No matter how hard we want to believe it, the phrase “The body can achieve what the mind can conceive” is only true given the proper amount of time for adaptation. Being able to distinguish between soreness, weakness, and injury will allow an athlete to push him/herself closer to their breaking point and over time raise the breaking point. Common overuse injuries include stress fractures and tendonitis.

Overuse injury potential. Gannett Peak WY, 42 mile car to car, 17hrs. 2010.
Overuse injury potential. Tetons WY, 2010
The most common and often most effective way of treating overuse injuries is to use the PRICE principle and NSAIDs. PRICE stands for Protect, Restrict Activity/Rest, Ice, Compress, and Elevate. Common NSAIDs, meaning non-steroidal anti-inflammatory drugs, include Ibuprofen, Advil, and Naprosyn.
Overuse injuries can be very frustrating because they can take a long time to heal. The best ways to prevent getting an overuse injury are:

·         -Ease into workout regimens. The “Weekend Warrior” mentality of being inactive all week and then going 100% on the weekend puts an individual at the greatest risk for problems.
·         -Correct form. Get instruction on correct form if needed. There are tons of options online on how to do just about anything if you don’t have a mentor or trainer.
·         -Use correct gear. You don’t need to go crazy but a good pair of well fitted shoes goes a long way, and gear is awesome and any excuse to buys some is always a good idea!
·        - Listen to your body. Pain is there for a reason. Be careful about toughing it out. 

If you are not having improvement with the use of PRICE therapy principles and NSAIDs after about 4-6 weeks more intensive diagnostic evaluation should be considered which include x-ray, MRI or bone scan. 

Bone Scan

Tuesday, October 16, 2012

Dick Collins Firetrail 50

Last New Year’s, Kimber and I sent out a holiday card to family and friends that had a few of our goals to be accomplished over the course of the year. We decided it would be a good way to hold ourselves accountable. One of my goals was to run 50 miles.

The Dick Collins Firetrail 50 mile race fit perfect with 7800ft elevation change that is 100% on trails along the East Bay ridgeline overlooking Oakland and San Francisco.

Training was to schedule until about 3 weeks before race day, when ankle pain convinced me to take 10 days off in an attempt to get it feeling perfect.  When I started running again, feeling good, two days later Kimber decided to give me the flu, sore throat, foggy head and all. So, I started the race with only 16miles on foot and about 60 miles on bike under my belt for the last three weeks. Luckily these three weeks were my tapper, meaning my training was supposed to decrease.  I was taking naps and gargling salt water up until the night before trying to get over being sick!

Start time was 6:30am and check-in before that. There were around 250 participants and we all packed in along the trail getting instructions and encouragement. Some people were decked out with all the latest backpacks, headlamps, arm and leg covers, hand-fitted water bottles and shmansy GPS watches. I kept it semi-simple with my trusty Brooks Pure Grit running shoes, basic running shorts, shirt, my nerdy visor, Suunto watch, MP3 player(loaded with medical lectures) and a phone strapped to my arm in case of emergency. It was chilly and seemed like they would never say “go”.

6:15am check in and number pickup. Stars were still out on the drive over. 

On the start I tried to just keep the same pace that I would if I were doing a long training run. But my “training run” pace had me passing the majority of the pack. Oh, well…I heard a couple talking before the race that they were going to keep a 13-15min/mile pace or something. Not acceptable. I felt a bit weaker than normal but, all considering, I felt pretty good for the first 26 miles. I got through about 2.5 General Medicine lectures as I ran, preparing for an upcoming exam. At about mile 23 the trail takes a 3 mile decent dropping roughly 1200ft to the turnaround point. I met Kimber and Richard Byler, my pacer, along with my requested two large Baja Blast Mountain Dews and a 5 Layer Bean Burritto from Taco Bell. My legs were pretty destroyed at that point.  I was to schedule, hitting mile 26 at 3hrs 45min.
Richard paced me in our power walk up the ridge line and for the next 11 miles. Aid Stations were available every 3-5miles and I had high times and low times. It helped a lot having someone to talk to and take my mind off the run.

Mile 26.

Me gusta Taco Bell!
Mmmm...5 layer burrito and Baja Blast.

Mile 37.
At 6hrs 20min, mile 37, I met Jeremy Koons and he paced me all the way to the finish.  Things got pretty difficult.  Luckily the majority of the last quarter of the route is downhill. Every slight hill often required me to kick down into power walk mode. At the last aid station (mile 45.5) I was on the verge of passing out swaying and stumbling as I was grabbing food from the huge table of random calories.  I remember being a little nervous when I saw the paramedic watching me, thinking he might pull me or make me stop. My energy sources at the beginning were mainly Gu power gels but near the end I was downing Coca Cola, oranges, grapes, bananas and mini PB&J.  It was hard to gauge how much I should be eating because I didn’t have much of an appetite but knew I needed fuel. It would have been helpful to get my blood work done there on the trail to know exactly what liquids and electrolytes I needed to make me feel good, not that it was an option.

Finish Line!! Mile 50! 
The last 4.5 miles were long. The trail went along Lake Chabot and every little roll was a challenge. I kept looking at my watch knowing that a sub 9hr finish was just within reach. I never told Jeremy how close we were though because I didn’t want him to push me harder than I already was going (I know, weak!).  At about 8hrs 58min I made the last push with all my effort and rounded the corner to the finish gate. 9hr 44sec! Sub 9hrs not to be had. I collapsed on the ground. 

Me and my pacers, Jermey Koons (L), Richard Byler (R)
The rest of the day left me with intermittent cramping of my calves, quads, hamstrings and abdominals.  While we were sitting there by the finish line you could just see the muscles in my legs twitching randomly almost looking like worms in there wiggling around. I got a massage that was excruciatingly painful but seemed to help.  I pounded a whole ton of food but should have stopped before the protein shake. Later that night Kimber described me as “vulnerable” as she helped me take an ice bath after vomiting all of the finish line food into the cammode.  Why do I do these things? Why not?

Their name, Monster Massage, fit them perfect. 

Got a free shirt and jacket out of the deal. Love the swag!
Final race stats:
·         50 miles
·         7800 ft elevation change
·         9hrs 44sec finish time
·         Placed 39th of 254 participants
Thanks Kimber, Richard and Jeremy for being my support crew!!!

**all photos compliments of my beautifully awesome wife Kimber.

Tuesday, October 9, 2012

Goals of this...

As the name implies, the plan for this blog is to create a place where I can share things concerning mountains and feet. For the "mountain" part I plan on sharing the more adventurous and challenging things that I have been up to.  

Like this.
Or this.
The "feet" part will include information pertaining to podiatry and medicine with the hopes that this blog can someday in the future be used as a tool to educate my patients on various foot related topics as well as allow them to get to know my "non-doctor" side. This won't be an issue until May 2014 however, as I won't be graduating until then, assuming everything goes as planned. 

Like this.

Or this.
I'm not sure exactly how this is going to go as this is a project that will require me to constantly be updating it, and spare time isn't really found to often in the life of Nate Hansen. Thanks for reading.