Understanding Post-marathon Heart Rate

I am a 38-year-old female, 5’4 and 107 pounds. I have been running competitively for 9 years. I ran the Boston Marathon in April, starting and finishing uninjured. My time was 3:45 due to heat and my heart rate was normal.

In the past few weeks it has been difficult to keep my heart rate below 172 bpm when I run, even when I’ve dropped my pace by a minute. Before the marathon I ran tempos at a 7:10 pace with a heart rate between 170-174 and felt fine. My last pre-marathon long run was 22 miles at a comfortable 7:35 pace. Yesterday I ran 12 miles, slowing down to an 8:30 pace and my heart rate was over 170; I felt miserable.

I have never had this problem before and am very frustrated. Is it over-training/not enough recovery or lost fitness? How do I get my heart rate to drop and still maintain fitness?

Carol Ann Gibbons
Oakland, California

Congratulations on surviving a very warm Boston Marathon. Running a marathon is stressful on the body. Add in the travel required for you to get to Boston and the stress is increased.

Heat is very stressful on the body, especially early in the season; add to that the exertion of a marathon and this is quite taxing. All of these stressors take a toll on the body. Your body's response will be similar to those seen with over-training: increased resting heart rate, and heart rate with exertion. Sleep disturbance, recurrent mild illness, loss of appetite and fatigue may also occur.

It can take weeks to months to recover from this stress. Since you are struggling through your training, I would recommend 2 weeks off from training. You are not adding to your fitness by suffering through a slow (for you) workout but you are continuing to tear down your body. Let your body recover. Get more sleep. Make sure that you continue eating well as your body needs the calories to heal.

Hang in there. You are not going to lose much fitness by taking some time to recover.
 
Cathy Fieseler, MD
Tyler, TX

Is Alkaline Water a Sham?

Advanced Hydration Technology
Alkaline drinking water is slightly alkaline on the pH scale. This mild
level of alkalinity is perfect to help maintain the 7.35—7.45 average pH level that is optimum for your blood...pH is a factor that has a critical effect on your blood’s capacity to uptake, carry and deliver oxygen to all parts of your body...A lower pH means blood is leaving your lungs with less oxygen, delivering less oxygen and eliminating waste less efficiently...

—Xtreme Technologies (Coeur d’Alene, Idaho) sales literature

I've recently been told that water, either bottled or tap, probably has a PH level too low for good health and that we should purchase enhanced waters, PH level testers, etc. What is the real story on this issue? If true, what recommendations do you have for purchases?

Karen Brennan
Jonesboro, AR

Sometimes nature provides for dissolved elements in potable water which can influence water's total benign presence. If calcium is dissolved, which can happen with some mineral waters, if anything, it would be slightly basic with a pH greater than 7.0 The body can handle this but in general its biochemical processes prefer slightly acidic chemistries.

Most waters, whether tap or bottled, are not acidic enough to warrant any concern. Too acidic, and our teeth would start to mottle, pit, and crack over time...not seen as far as I know.

Ed Nessel, MS, MPH
Viera, FL

I am no authority on bottled water, but if I remember back to high school chemistry, tap water is very close to neutral pH (i.e. 7.0). In either case, the pH of any water is certainly higher than orange juice or vinegar (ascorbic acid and acetic acid) and nobody worries about ingesting those.

Besides, whatever you ingest is going within seconds into the stomach which has a pH of 2 or 3 (if I remember my medical school gastric physiology). I doubt that ingesting any amount of water would significantly affect the pH of our stomach contents. If anything, Pepcid or any of the H2 antagonists would be far more effective at raising the pH of the stomach contents than artificially altering the pH of ingested water. This sounds to me like classic Madison Avenue pseudoscience. "I just happen to have a product in the back of my wagon which is guaranteed to cure your (fill in the blank)."

Klaud Miller, MD
Evanston, IL
There does appear to be an optimal pH level for drinking water. It is just above the neutral point of 7.0.  However, most public health supplies meet that standard and there doesn’t appear to be any need for concern.
 
D.C. Huddy, PhD, CHES
Athens, WV

I know of no credible scientific studies that indicate that the pH of water is important. The stomach is highly acidic anyway so any water you drink is not likely to make a difference once it enters  the highly acidic stomach. If you want a lower pH water, simply buy regular water  and add lemon juice to it and save yourself some money.

John McPhail, MD
Okemos, MI

Electrolyte Loss is Often the Cause of Cramps

When I reach mile 12 or so of a half-marathon or long run, my right calf cramps up, and has for years. What do you think of electrolyte replacement drinks, which promise an end to cramping. Information I’ve read in the past seems to indicate that the causes of cramping remain uncertain and therefore I’m skeptical of a surefire remedy. I’d like to cease experiencing these calf cramps but I shy away from electrolyte overloading. After all, I use Gu and PowerBars, yet the cramps remain.

Dave Ramankutty
Glen Arbor, MI

Your problem is common, as is the belief that electrolyte loss is responsible. Theoretically, loading with an electrolyte replacement beverage might minimize the losses and shifts, but I am unaware of any controlled studies looking at this drink and rates of cramping. If your kidney function is normal (and one would think that it is if you’re running half-marathons) there should be no harm in giving the drink a try prior to long runs.

William M. Simpson, Jr., MD
Charleston, SC

I’ve found that if a person’s calcium intake is too low, especially when their phosphorus intake is too high, they may be vulnerable to calf cramping.

Sarah Harding Laidlaw, MS, RD
Mesquite, NV

The majority of research leads knowledgeable exercise scientists to conclude that exercise leg cramps are a result of deficient fluid, sodium and other trace minerals, and/or overheating of the body. Meeting fluid and mineral requirements would not be overloading. The Gatorade Sport Science Institute’s publication has a well deserved, highly regarded reputation, and I advise you to read further about electrolyte replacement and muscle cramping there: www.gssi.com.

Earl J. Carstensen, MD
Aurora, CO

A Clicking in the Calf

I am a 48-year-old triathlete. In 1996 I had a knee operation to remove a cyst and then turned to triathlons shortly after. I competed in Ironmans and trained without many injuries until 2005 when I had another meniscus operation. A few months later it began.

I was out running and my right calf muscle kind of clicked or popped. There was no pain just a click feeling. But I had to stop my run and walk home because it got painful after that. Because I had similar injuries in the past I knew I just had to stop running for some weeks and it would be okay, and it was. I started training again and was doing hill sprints, track work and lots of tempo work, no problems. And then one day while I was just jogging to the track it clicked out again. Being only a few days before a race I was so frustrated I packed it all in and stopped sport completely for the next 4 years! I did nothing and got fat and unfit.

Then last January I started to run again, very slowly, more like shuffling really. And in the next 3 or 4 months it happened three more times, twice in the right calf and once in the left calf. I let it heal for a couple of weeks and by October was full into triathlon training again. My right calf popped again and I went to doctors but got no real help, just creams to put on my calf, tablets, the offer of injections and usually “take a couple of weeks off and you’ll be right.”

While out cycling one day one of my training partners recommended a sports physiotherapist to whom I went. He diagnosed that my pelvis was a little crooked and was probably the reason for the injury.

It popped again in April, and now I also have orthotics in my shoes and have changed my running style to a more Chi kind of style. Three weeks ago it popped again. The funny thing is I can do fast running and it is either okay, or it may pop. Or it also may pop just doing slow running. I am at an end now, I do not know what to do. I love running and I don’t want to stop it.

Peter Rocha
Gaithersburg, MD

An exact diagnosis cannot be made without examining you, but you most likely have strained the gastrocnemius and/ or soleus—the 2 big muscles in the calf. You probably were not fully extending (straightening) your knee following surgery. This would place stress on the calf muscles; a strain occurred due to this. This type of injury usually occurs at the musculotendinous junction—where the muscle starts to become tendon. In the calf this is near the bottom of the muscle bulge.

Rest may allow the pain to resolve, but you have not described any type of rehabilitation exercises for your calf muscles. Due to persistent weakness, recurrent injuries occurred. Over time, your gait abnormalities can cause problems from the feet up to the back. This could produce the pelvic alignment issues that you are describing.

To strengthen the calf muscles, stand on a step with your heels hanging over the edge. Lower your heels (this should not be painful) and then rise on your toes. Perform 30-40 reps. Repeat this exercise with your knees bent. As your strength improves, increase the speed of the repetitions. You can then progress to performing these exercises on one leg at a time, starting slowly and increasing the speed over time.

Continue working on core and hip strength. A prolonged injury has produced strength deficits throughout your body.

Additionally, have your knee evaluated. The gastrocnemius begins above the knee. If joint motion is decreased, there will be abnormal stresses on the muscles.

Cathy Fieseler, MD
Tyler, TX

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