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!