Authors at Google: Dr. Jordan D. Metzl, "The Athlete's Book of Home Remedies"


Uploaded by AtGoogleTalks on 21.08.2012

Transcript:
>>Rich: Alright guys, thank you all for coming and whoever is on VC thank you very much as
well. I wanted to introduce you all to Dr. Jordan Metzl. He's here today to talk about
his book "The Athlete's Book of Home Remedies". It's a terrific companion book for you guys
to make sure that you're not going to hurt yourself like I did. But he's going to be
here today to talk about all of his tricks and wizardry. But I wanted to read you the
dedication of the book: "This book is dedicated to the millions of athletes who wake up each
morning at 5:30 with no fanfare and drag themselves out of bed to keep fit. Whatever your level
or ability, may the information in this book help you pursue your goals. The most important
thing you can do every day is to keep moving forward." So with that and without further
introduction, I want to introduce you to, and it is his birthday so please be gentle
on him, Dr. Jordan Metzl.
[applause]
>>Jordan Metzl: Thanks. Rich, thanks so much and it's great to see everybody. What a cool
place. I mean I feel like I'm not nearly cool enough to be here. But it's a pleasure to
be here, to be down to Google. And I take care of a lot of you guys when you hurt yourselves,
up in my office and it's a pleasure to down here and people conferenced in out in California
or wherever else you are; the concept we're going to talk about today is how to keep yourselves
moving and active and injury free.
So with that, I'm going to talk about this, which is about a three year project I did
called "The Athlete's Book of Home Remedies" the concept being that I want you to stay
active every day of your lives, starting now for as long as you go. And so we’ll talk
about some of the themes about that.
First thing is my website here, which is available, for the last five years I've been doing the
medical column for Triathlete magazine. Have pretty much one pagers on everything related
to running, endurance sports, anything, shin splits, bonking, knee pain and those are kind
of free. Also have a number of videos available on my site, and there's a newsletter we put
out about four times a year. We don't send your email to anybody, so no spam, I promise.
Although guys' spam filter's pretty good so I don't think it matters anyway. But, certainly
happy to have you guys sign up. There's a little registration tab. I'd be happy to have
ya.
Now, let's talk about what we're going to talk about today. And that is that exercise
is very much medicine, exercise keeps you going, exercise keeps you young, it keeps
you healthy. And I want you to exercise every day. Now, part of that is what do you do to
make that happen. So, this is a picture of me at the Iron Man several years ago. I try
and do one marathon and one Iron Man a year. For those of you who don't do Iron Man, you
don't have to do the Iron Man but if you're interested, it's about a 2.4 mile swim, 112
mile bike ride and then a marathon. And the first question is, why the hell would you
do that? And the answer is that I deeply believe, number one in goal setting and number two
that basically it is about meeting a goal. Everyone needs something that pushes them
further than they think they should go. And yes, fitness is a great thing to think about
in theory, but without a goal to do that, it's very difficult to make yourself take
that next step.
So if you're goal is doing a big swim, doing a ballroom dance competition, doing a 5k walk
in the park, whatever it is you wanna do, the goal, you should set a goal for yourself.
So we're gonna talk about how you meet your goal and I always have this, this is actually
my screen saver at work. For example this morning, just to try and get down I had about
15 patients in the office, the last guy was like "dude, I've gotta go to my thing, I'm
late, come on" and started yelling at my nurses. Well, I don't get many of that in New York
but every once in a while I do and I then I just look at this and my god, this was mile
17 of the run. I'd already done the swim, the bike. It was about 90 degrees, the sun
was going down and I was like I got 6 miles to go, I'm gonna finish this thing and most
importantly my brother, Jamie, who I do these with, is about a mile behind me and I'm gonna
beat that guy for the first time ever. So I was pretty psyched about it, and so that
was my goal. And so, I think the concept of this kind of stuff is it gives you some place
in your own psyche, of like I'm having a tough day at work, I'm having a tough time in my
life and yet this is a goal that I've been doing. So, I deeply believe in that stuff.
So I think the concept was actually outlined by the Roman poet, Juvenal, many thousands
of years ago. Who talked about, 'It should be prayed that in the mind, the mind be sound
in a sound body'. So, copore, 'mens sana in corpore sano', sound mind in a sound body.
They go together and here in this great environment where you guys have created such an incredible
workspace to be creative and think about things, I know in the place out in California there's
exercise facilities as part of what you do out there. You're all encouraged to be active
and healthy, and that's part of healthy mind. And so I think these things go together very
much so I applaud you for the way you set that up.
Let's look at the United States. 1985 in the United States, states reporting 10-14% obesity
are in the darker blue, less than 10% in the lighter. But let's look at the United States
86, 87, 88, 89, 90, 91 now darker blue, 15-19% 92, 93, 94, 95, 96, 97 now greater than 20%
98, 99, 2000, 2001 greater than 25% obesity, 2002, 2003, 2004, 2005 now greater than 30%
obesity in the South East, 2006, 2007, 2008, 2009. So basically, if you want to be thin,
move to Colorado. That's the bottom line of this. But as you can, we’ve had this march
of obesity across our country. And this is an epidemic affecting everybody and part of
the problem with the way we set up our health care in the United States, and if you've been
following this, we're going to hear more about this in the next day or two from the Supreme
Court.
But we have a fundamental flaw in the way we do business in the United States and that
is that our system which spends billions of dollars, more than you know about 15-16% of
the GDP, estimated to go up 17-18%. The problem is we treat disease. So if you come in to
see somebody with a heart problem and you come in for your annual visit, they put you
on medication that's paid for by your insurance company. Then it goes on over time, and you
need several tests that’s paid for by your insurance, you get a catheterization, that's
paid for. You eventually get open heart surgery, that's paid for. Your cardiac rehab, that's
paid for. Yet we spend almost no money paying to prevent the problem before it happens.
And so we have this concept of incentivizing disease treatment, we basically treat and
pay for disease, which is totally counter intuitive.
Now we do some great things in America, like companies like this, but we do have some problems
in the way we think about things. In Germany, for example, if you have a cavity, you have
to go every six months to the dentist. And if you have a cavity and you've been going
to the dentist every six months, the state pays for your cavity. If you have a cavity
and you've not been going to your annual six month checks up, you have to pay for your
own cavity. And so the concept of incentivizing good health behavior makes a ton of sense,
yet we really don't do it. So since our government chooses to incentivize things like home ownership
or marriage or kids, we incentivize different behaviors just based on our tax hood. We've
not, we're not at the place yet where we incentivize wellness, though I hope we are at some point.
At this point the responsibility is all of yours and all of yours out there. And so you
have to think about incentivizing wellness because exercise is very much medicine. So
with that, I'm gonna show you why the case for medicine is so significant with this great
video which I brought along for you guys particularly because I know you'll appreciate how this
is done. So let's look at this for a couple of minutes to then get to the basis of what
the book is about. Now, on this— there it is down there.
>>Dr. Mike Evans: Hi I'm Dr. Mike Evans and welcome to this visual lecture I'm calling
"23 and a half hours"-
>>Jordan Metzl:--Any suggestions from back there? Alright hold on, we're gonna, I want
this to work so badly I'm gonna just minimize this. We are having some technical issues,
let's watch this quickly on this thing.
[Pause]
>>Jordan Metzl: This will enlarge that?
>>Mike Evans: Hi I'm Dr. Mike Evans and welcome to this visual lecture I'm calling "23 and
a half hours" So I have a big interest in preventive medicine, you know which can mean
a lot of things from cancer screening to eating more fiber to having a good social network,
and I mean that in the old sense of the word, weighing less, drinking less, smoking less,
controlling your blood pressure, cholesterol and so on and so forth. So all these things
are incredibly important, I wouldn't want you to minimize your efforts in any one category.
But I want to know what comes first, what has the biggest impact, what has the biggest
return on investment.
[Cash register cha-ching]
>>Mike Evans: What makes the biggest difference to your health? So I did my research and I
found an answer at least for me and it's tricky, cause you know all these things are sort of
overlapping. But I picked up this intervention because of its breadth, it worked for so many
different health problems and that's what I found so cool about it. So just to kinda
walk you through a quick list, so this intervention in patients with knee arthritis who receive
one hour of treatment three times a week reduce their rates of pain and disability by 47%.
In older patients, it reduced progression to dementia and Alzheimer's by around 50%.
For patients at high risk of diabetes and coupled with other lifestyle interventions,
it reduced progression to frank diabetes by 58%. Post-menopausal woman who had 4 hours
a week of the treatment had a 41% reduction in the risk of hip fracture. It reduced anxiety
by 48%. In a big meta-analysis, patients suffering from depression 30% were relieved with low
dose and that bumped to 47% as we increased the dose. Following over 10,000 Harvard alumni
for over 12 years, those that had the intervention had a 23% lower risk of death than those who
didn't get the treatment. It's the number one treatment of fatigue and of course, the
kind of outcome of choice there, my favorite outcome is called quality of life which is
really all of the above.
[Ascending harp chord]
>>Mike Evans: And really about making your life better. And this treatment has been shown
over and over again to improve quality of life. So, the question is what's the medicine
and what is 23 and a half hours? So, the medicine was exercise, mostly walking.
[High chime]
>>Mike Evans: So not triathlons and let me just put it a different way. What I think
I'm asking you to do is if you think about your typical day so there's 24 hours and so
you might spend most of your day, you know this varies obviously, but you know couch
surfing -
[Boxing bell, computer keyboard keystrokes]
>>Mike Evans: -sitting at work, obviously sleeping. And what the evidence that I'm going
to show you kinda tells me is, the best thing you can do for your health is to spend half
an hour of being active-
[Clock ticking]
>>Mike Evans: - maybe an hour and that if you can do that you can realize all the benefits
I've described in the previous slides. So let's just take a quick walk through some
of the literature. So Steven Blair, he's a professor at the Arnold School of Public Health
at the University of South Carolina, and he looked at this in what's called the Aerobic
Centre Longitudinal Study, which followed over 50,000 men and women over time and along
the left side of this graph is something called Attributable Fractions which is kinda fancy
word but it's the estimate of number death in a population that would have been avoided
if that specific risk factor had been erased. So for example, turning a smoker into a non-smoker
or couch potato into a daily walker. And along the bottom is the typical risk factors, you
can see that hyper-tension's incredibly important and so on so forth, but the one that was most,
that kind of implied the most risk was this sort of mysterious CRF, which is Cardio Respiratory
Fitness, which is really low fitness. So low fitness was the strongest predictor of death.
And this important that most of the trials we see, to be honest, are funded by Pharma
or other companies because they’ve got a drug for hypertension or high cholesterol
or diabetes, we rarely see fitness thrown into the mix and so it's nice to see a trial
that's not so siloed.
[Bicycle bell]
>>Jordan Metzl: The concepts of that, the concepts of that I think are very helpful.
And I apologize if our, I may have to switch back and forth here a couple times. This was
made, our hospital does not support iBook yet, so unfortunately I had to design on my
old Dell.
Alright, so, we're gonna talk about what I do now. So hopefully I've convinced you that
you gotta move. You gotta move every day and it's gonna be helpful for you, it's gonna
be helpful for everybody around you, it's gonna be helpful for your job, for your life
for everything that you do. That you'll set some goals for yourselves and make that happen.
Now let's talk about some of the pitfalls of what you and so that you don’t get hurt
and then at the end I have promised I will answer your injury questions. So I'm sure
we have plenty of runners and people with plantar fasciitis and iliotibial band syndrome
etcetera. here. And you get to ask your questions as soon as you're done listening to this stuff.
Alright, so what's my job? Well my job is basically to make sure people make good decisions
about their fitness and activity. And I took this picture when I was out giving a lecture
in Wyoming last summer. And so I was out in Jackson, Wyoming and I saw some bright lights
down the road. And in fact there was a rodeo down there. So I walked down there and I was
like alright, well I live in New York City but I can appreciate a good rodeo probably
as much as the next guy. And they had like the horses and the bulls and all that stuff.
But the first thing, the next night I went back there actually, I saw the demolition
derby the first night. The second night they had one pen full of kids and one pen full
of sheep. And my immediate thought was whatever combination these two things are gonna combine
is probably not gonna be a good combination and in fact, they would take one kid, put
a bicycle helmet on this kid and put him on top of, or her, on top of a sheep, put a rope
around the sheep, open the gate and they had this Wyoming fan favorite called mutton busting.
And no kids were harmed in the making of this slide, but basically these poor kids are holding
on for dear life, between kinda 6 and 10 years old and I immediately thought this is probably
not the best use of childhood fitness and activity incentivization but yet everybody
was OK in this. So my basic job is to help my patients be active and help them understand
when they're doing something stupid. And that I thought was probably something a little
bit stupid. So how do you do that? And so when I see somebody,
we see a couple different categories of injury, number one is called an acute traumatic injury.
So I just got a call on Sunday, actually in Iceland, from one of my patients who's getting
ready to be in the Olympic trials for gymnastics who I've taken care of since she was quite
small. And she landed and hurt her wrist so I was worried about an acute injury like a
fracture. And so sometimes athletes need to know, be they an Olympic athlete or somebody
just getting ready for whatever, you know, is this twist of my knee that I did something
I have to worry about and how do I know? And then, more commonly, about 90% of injuries
in sport medicine are what we call overuse injuries. So it's not one thing, but it's
I've been training for the marathon and my shins start to hurt or my knee starts to hurt
or I'm swimming a lot and my shoulder hurts. And how do you recognize when one of those
injuries is more serious? And the answer is when pain changes your mechanic of movement
then I start to worry about those kind of injuries.
So I'm gonna just make some comments on running, I know here in New York City, this is certainly
is the most common. Who's a runner here? Let's see, we've got some, yeah I know and I see
a lot of you runners in my office. And I'm sure out in California you have even more
runners. And so I'm gonna talk about running in particularly and some of the common things
that we do and I'm just gonna make a couple comments on running and then we'll do some
questions.
So what does it take to basically make you a healthy runner? And I'm gonna talk about
gear, goals, injury recognition and then lastly the important part, which is prevention. Prevention
of running injuries so you can keep moving. So we've seen a lot recently about new trends
and fads in running gear. And basically running is a great sport because it's so inexpensive.
All you need to do is buy a pair of running shoes. Just curious, who's read the book "Born
to Run"? Several in the room and so the concept of this book is basically that less is more.
That by minimalizing or giving you a pair of minimalist shoes or even this shoe on the
left here called a Newton, which tips you forward a little bit, you can basically shorten
your stride and quicken your cadence. And the answer is, the answer is that we think
that's probably true that having a higher cadence and a shorter stride is much less
injury producing. So what you should be doing is, you don’t need to be buying minimalist
shoes to do that, just try shortening your stride and quickening your cadence. And certainly
some shoes, such as like the five fingered toes shoes can help make that happen in the
short term and I can answer questions about how to know if you want to do that or not.
But the overall concept is that a shortened stride and a higher cadence is a good thing
to start thinking about for basically reducing your risk of running injury.
What about goal setting? Well I think goal setting is very helpful and some of the problems
we see from goal setting are, well first of all not setting goals at all. So you definitely
want to give yourself a goal, whatever that is, a 5k race in the park. You're lucky to
be living in New York, I was surprised how great the sports scene is in New York. For
those in California, you know, they're kinda spoiled because they can roll out of bed and
go do a big bike ride right out of their door. But we have an amazing sport resources here
in New York and probably the best running club, the Road Runners club is probably the
best road running club in the world. And just amazing races every weekend all over the place
and so it's been a great place to do. So you want to give yourself a goal and the concepts
of some of these charity programs have convinced people you can train for the marathon in three
months and not get hurt. And the answer is, that you know, unfortunately that’s a huge
part of my business even though I try and teach people how not to come in to see me.
But unfortunately these people say alright I can do the marathon in three or four months
and the answer is that most people can't, they get hurt because they don’t have enough
base training or experience. And they’ve not gone through the building phase of how
it takes to build strength, bone strength and muscle strength which we'll talk about
next.
Now what this guy taught us was that basically not every body is built for everything and
some bodies are built better for some sports than others. And so if you have a running
body, and for girls, that's probably, or women, that's probably about 5'2 and 90 pounds and
for men, it's about 5'6 and 120 pounds. And if you don’t have that body, which basically
almost nobody does unless you're an amazing Kenyan marathon runner, then you have to change
the way you train and change the way you think about what you're gonna do.
Now, I think nothing I can tell you illustrates this point as well as this video. Which hopefully
this will work. This comes every year in japan, they have the running of the Sumos and these
guys are built, these guys are built exceptionally well for sumo wrestling but they're not built
very well for running. So were going to see what this looks like, hopefully. Oh come on
dude. I gotta pull out the Sumo, I'm sorry.
[pause]
I won't pull up all but I gotta pull up the running sumo. Where is he? Here he is. So
this is what the running sumo looks like and the concept of the running sumo which is pretty
dramatic footage. In Japan they do all kinds of interesting stuff and having their sumo
wrestlers run down the street and video tape them, it's one of the interesting things they
do. So this guy's really not built for running, I'm sorry to tell you. That’s not what you
want to look like. This guy's built great for sumo wrestling but he's not built for
running. And so the concept of this is that not everybody is built for every activity.
And basically Darwinian selection will kind of tell us what you're built for. So the further,
the concept is, the further you are from the idealized running body, the more problems
you're gonna have. So the optimal training program, as far as
I'm concerned is a gradual build, some combination of mileage and strength training and cardiovascular
training all the while. You can't run every single day, nobody can. And you wanna have
a good time.
So let's talk now about injury, which is sort of the thrust of what the book's about. About
recognizing and preventing injury and so I want you to think about when an injury is
serious. And the answer is if it's a baseball player, if it's a runner, if it's a swimmer,
a gymnast, I ask my patients the same thing of any age and I take care of people from
kinda 8 year old elite level gymnast to kind of 85 year old lady that ran a marathon this
year. And the commonality of all these is they want to be active and move. And I want
them to be active and move. So, when an injury is serious, is it changes your body's ability
to do the sport regularly. So if you could throw a baseball well but then your elbow
hurts cause you're throwing the baseball improperly, I wanna see you. If you're running and your
shin is hurting so much that you can't run properly, I wanna see you. So the mechanic
of movement and the change in the pattern of the mechanic of movement is really the
key issue that I see when an injury happens. So when it comes to running, I wanna talk
to you about three things; training and your anatomy and the biomechanical factors that
go into injury and I'm gonna pull out a couple of these videos to show you.
Now, the overall concept that I'm gonna kind of impress upon you is call the kinetic chain
of the body. And you so you kinda learn the song "the shin bone is connected to the knee
bone" and the answer to that is true, that all the bones are connected and we can't change
your anatomy. So if you're built a certain way because your grandparents and their grandparents
and their grandparents all the way back, that’s who you are. I can't change how much cartilage
you have in your knee, I can't change if you have a bulging disc in your back. I can't
change if you, you know, I can't change those fixed anatomical factors. What I very much
can change in you and this talk is a lot about empowering you to change this, is you can
change your kinetic chain, and that is the muscular forces around those bone and ligaments
and tendons and muscles. The muscles are the dynamic stabilizers, the stronger your muscles,
the strong your kinetic chain.
So if you have plantar fasciitis or iliotibial band syndrome, part of what we do with you
is get you started on a good functional strength training program to strengthen that entire
chain and as that chain gets stronger, your pain will go away and stay away. So the answer
is if your back hurts from a bulging disc, don’t sit on your butt. The answer is, start
to work on strengthening. And that's a lot about what this book is about and what I'm
gonna talk to you guys about.
So injuries happen, I'm just gonna push ahead, I don’t care if I'm in pain, I'm not listening
to my body and all the sudden injuries happen. And that’s often how injuries happen and
they can be overuse injuries in the tendon such as this Achilles which as a big thickening
in the tendon like a partial tear. MRI has been very very helpful to help us diagnose
these kind of injuries. This is a big crack in the hip; this is somebody with a stress
fracture. Just saw one of those this morning. Somebody training for the Iron Man who got
a stress fracture in their hip. Again, this is not an acute injury so you won't know you
have this. You'll know that the more you do the more pain you're having. And the pain
is changing how you move because it hurts so much. And that's when you gotta get it
checked out.
So let's now talk about prevention which is kind of the thrust of what this is gonna be
about. So what are the ways you can prevent injury? And first of all you wanna gradually
build your training. We're gonna talk about running form. And then lastly were gonna talk
about preventive strengthening and the role of preventive strengthening.
So there's, this graph kinda shows how much stress you're putting on your body and the
frequency of how much you run. And the concept here is there's what's called the injury threshold.
No injury and injury. And how do we take this line and push this out so you can basically
have more frequency of running-
[Whip sound]
>>Jordan Metzl: We want that. Alight, we want that line out there. How do we keep ourselves
here –
[Whip sound]
>>Jordan Metzl: -so that we push that threshold out. And the answer is, we're gonna change
how we run and we're gonna change how much strength we have. Those are the variables
we can change.
So when you think about running, basically you're never on two feet at a time except
for at the start and the end of the race. And other than that, running is a series of
plyometric jumps from one leg to the other and there is no exact right way to run. But
basically what I can tell you is that I take care of a number of both triathletes and runners
and in my office, the triathletes are hurt much less frequently, even though they train
about four times as much. And the answer is because they do much more functional training
as part of what they do. So in this, I'm not gonna pull these out and play them, but basically
I have somebody's here who is stepping down off a box, let's make sure these are not gonna
work –
>>male voice: OK whenever you're ready step down-
Alright, not gonna work. So, she steps down off this small box, one side versus the other,
and the one leg that’s not hurt, she steps down very evenly, and the other side her knee
is all wobbly when she steps down and the answer is that as she starts to wobble in
that knee, the stability of her hips and her knee joint is affected. So she's not strong
enough on this side she's hurt with. So if you're getting knee pain from running, the
answer is you have to strengthen the muscles in the kinetic chain on that side of the body
particularly because what ends up happening over time, is that this cartilage starts to
rub on this femur bone and you start to get a lot of achiness underneath your knee called
runners knee which is pretty much the most common knee problem that I see.
So how do we talk to people about improving their running form? And we talk about things
such as running drills, running uphill I love. The concept of running uphill is you shorten
your stride and quicken your cadence and so you should be somewhere between 85 and 90
beats per minute. Meaning the left or right foot should hit the ground 85 to 90 times
per minute. Most people don’t do that. Most people over stride. So by shortening the stride
and quickening the cadence the landing force is much else.
That’s why the barefoot shoes make a difference in even some of the shorter training is that
you keep your weight over your forefoot to your midfoot instead of heel striking. Which
gives you a much shorter stride and a quicker turnover. So try running uphill and see how
different it is. In fact I teach an outdoor strength training class, I teach a strength
training class every two weeks in Central Park, I don’t know what time you guys get
up but we do it at 6:15 in the morning. And if anybody wants to come, please come up here
afterwards and give me your email and we'll send you our invitation to come try this thing.
We have about a hundred people at a time and we do this in Central Park and it’s a lot
of fun. We do some combination of running drill and preventive strengthening called
plyometric which we're getting to next. So running drill, number one, preventive strengthening,
number 2.
Stretching is way over rated. Alright, so all of you who are spending your whole life
stretching for running way overrated. Strengthening is way more important. So we see a lot of
people that stride out way, way too far in their running stride and what ends up happening
is they land with all their weight on their heel and they have these different kinds of
problems. So this, and I may pull this out to show you, but basically what we're doing
now is much of this functional motion screen and we're using a lot of the great stuff you
guys are helping us develop which is, in medicine now, taking the technology of what it looks
like to move. And I'm gonna show you, I know you guys will be into this so I'm going to
pull this out really quickly. Just to show you. I gotta get him outta the way. I gotta
close him, he's too distracting.
But just to show you what this looks like. So we're doing a lot of more of this functional
movement. And we can basically put markers on people and check where they're landing,
how they're landing, where their maximum impact is and many of our athletes that come in with
these problems are essentially over striding, so you know you can pay some, I dunno, 150
or 200 dollars to come to our hospital and get this done. Or I can just tell you now,
shorten your stride and quicken your cadence and do some strength training and you won't
get hurt. And that’s free. So try that first before you come up here and do that. But that’s
the concept of using technology which I think is pretty cool to really make, you know, movement
patterns a lot healthier and safer for people. Which is I think really neat, and obviously
you guys are so helpful with that for us. So as I mentioned, stretching, way over rated.
Strengthening, way underrated.
So then let's lastly talk about this functional strength training and prevention to make you
run better and much less injuries as well. So what I'm big into is this functional training
called plyometric training. And plyometric training is basically using your body weight
and rapid muscle contraction and elongation to essentially build functional strength.
It makes people faster, it makes them hurt less. It reduces the reaction force between
your, basically, joints and the ground so much less compression force, it protects your
joints and your body. And most importantly you don’t need a fancy gym. You can do this
anywhere.
Now, when the book came out, I did this functional strength workout called IronStrength. And
so the way this thing is set up, is it kind of talks about every injury and then I have
a whole section in the back called IronStrength which is this functional strength training
workout and video. And the video, since this is a Rodale book, has a link up on Runner's
World which free. If you just type in Runner's World and put in my name, or IronStrength
and my name, it will pull up and you'll see this IronStrength workout online. And that
correlates to IronStrength workout in the book. And basically what that’s gonna do
is teach you how to do this functional strength training on your own.
You just follow us along the first month, January this was up, we had, for us it was
impressive, I know for you guys that's like 'dude, that's nothing', but we had like 1.7
million unique views which, is that? That's pretty good isn't it? So I get a little nod
for that? Alright, thanks. I don’t know if that’s a lot, it seemed like a lot to
me. So I was impressed with that, Runner's World, I mean runners are dedicated readers,
voracious readers. So we had a lot of people looking at that stuff. And this IronStrength
workout is a really helpful tool and I like it because it takes this and makes it so that
people can kind of use on their own. Which I think is pretty cool. So I want you to try
this thing and then come try it live with us in Central Park.
So, lastly I'll just kinda make a couple comments on this and answer some questions. So the
concept of this is it's kind of a full body resource. We did both an eBook and an iBook
and the Apple, on the iPad we have the embedded videos. But the paperback is actually really
neat and I appreciate you guys having some people here and I understand there's some
kind of thing that ran out but there's a way to get more and Rich'll tell you more about
that at the end. I did bring one signed free copy for somebody and the question is who's
gonna get the free copy, the signed copy? And the answer is who here has run more than
20 marathons? Anybody?
[Pause]
[Audience giggle]
>>Male #1: Michael
>>Jordan Metzl: Michael? Alright anybody run more than 16 marathons? Michael, get up here,
dude, you just won yourself a free autographed book.
[Applause and hoots]
>>Jordan Metzl: Congratulations.
[Inaudible from audience]
>>Jordan Metzl: Good, if I hit it big time, it's signed, it'll be worth something someday.
Now for those of you, and I'm giving this to Rich this actually just came out today,
this is not related to this book topic but it's similar concept. In is it, I did this
thing with the American Academy of Pediatrics and it's called "Home Based Strength Training
for Young Athletes." It's basically encouraging parents to start strength training with their
kids. Starting at age eight and it's a high repetition light weight training. In kids
sports we're seeing problems of a lot of youth sports specialization and increase in injury
risk. And so we want parents, the best trainers are not professionals, it's parents and so
I want parents to do this with their kids.
Rich, who invited me, gets to take this home and start. How old's your daughter?
>>Rich: I've got three.
>>Jordan Metzl: Anybody old enough? Good.
>>Rich: The oldest is nine.
>>Jordan Metzl: Perfect. Alright, so the concept of kids doing strength training is something
which is, people think is that, the answer is it's great. It starts to build bone density,
functional strength and is a great thing to do. So, enjoy that.
So the concept of this book is to teach you guys how to recognize every injury you'll
get, number one. Number two, how you can take care of it at home on your own. And number
three, do you need to see a doctor? And then number four, do you need surgery? And as you
know, kind of the nexus of medicine and technology has been uniformly great. But for example
50% of the population has a torn meniscus, 60% of the population has a bulging or herniated
disc. Knowing when that herniated disc or torn meniscus is problematic and when it's
not is very difficult for somebody who's not in medicine to know. And so, what I really
want to do is educate my athletic patients and athletic minded people of how you can
make the make best decisions for yourselves. Because Dr. Google, I'm sorry, gives a lot
of information. Some of it's great, some of it's not so great. But a lot of it's out there.
And so you guys do such a great job supplying information, but it's a lot of information.
And helping people kind of disseminate what is helpful I think is very important for people.
So with that, I would say please register for my site so you can stay in touch if you
want. And I'd love to answer any questions about these topics or your own running related
issues or just sports in general or anything about the quality of life, health, and happiness.
Who's got some questions for me? Don’t be shy about your own injuries. Yeah?
>>Male #2: [inaudible] shoulder injury for strength training-
>>Jordan Metzl: Oh I'm sorry; you gotta go to the mic so we can hear.
[Unintelligible]
>>Male #2: For like a shoulder injury, doing strength training. What is the, what's the
general guideline? Is it, this doesn't seem like to be like, this never really fully goes
away. So when do you start pushing again?
>>Jordan Metzl: So some general concepts and what I'm after in this kind of book and video
is a lot about what is called functional training. What does that mean? What it means is, if
I just do bicep curls, I'm just strengthening my bicep, right? Or leg extensions on a leg
extension machine, I'm just strengthening my quad. And you know, for a long time people
did that kind of training and many do at a number of gyms around the area. But the problem
is it's not very helpful nor very efficient and it seems to kind of not do much in terms
of what's called functional. And so functional training is doing, like in our video we have
multiple body motions at the same time with high repetition, light weight training. And
so it's not like you're doing big weights but it's higher repetitions of a light weight
which, over time, builds almost equivalent strength. And so the answer to a shoulder
injury, you know, depending on what is, is that kind of get rid of the irritant in the
shoulder. So sometimes we do injections of a little steroid into a bursa or whatever
the problem is. And then do this functional training around the joint. And it's high repetition
and light weight training which almost counter intuitive to the way people think about training.
And it really seems to change that kinda way that people do it. So you can effectively
train, and in the shoulder, particularly, is very amenable, the strength around it.
And just knowing what to do should help a lot. So give it a try and let me know.
>>Male #3: Yeah, I'm curious about recuperation from particularly like long distance running
or specific workout. So, in particular ice, the use of ice and ibuprofen.
>>Jordan Metzl: Sure. So basically inflammation is both a good thing and a bad thing. So inflammation
is helpful when something gets irritated or inflamed, its very helpful for us. Cause it
kinda, it's a body marker, hey, we got a problem here. When somebody does something, so there's
helpful and hurtful inflammation. So an Achilles tendon, you go out for a long run, you get
some Achilles tendinitis. Over time if that goes on and on it can actually start to, like
a cavity, start to wear down that tendon and you get tendinosis and then a chronic partial
tear. So you get a whole kind of host of problems that happens over time if something's just
chronically irritated. So there's chronic inflammation and there's kinda something after
doing a particular event. And the answer is that you know, we love the George Costanza
special. Which is getting in an ice bath, which is a very helpful way to get in something
cold for you know, if you can make it 5 minutes in an ice bath. And much like boiling a frog,
though I've never done it, but what they say if you're going to boil a frog, which hopefully
nobody here or in California has ever done, is if you just put the frog in water it jumps
right out but if you put the frog in and gradually turn up the heat, it stays in there. I don’t
know if that's true or not but that's the story. And so with cold water and ice baths
it's the same thing. Get in there and start dumping some ice in and over time as the temperature
lowers, supposedly, and I do know this, it's actually much more able to tolerate that.
So I think for post-run recovery, nothing, anything over and hour and half, nothing beats
an ice bath.
So getting into a cold bath will definitely help expedite your recovery as well as getting
a carb and fat something in your body within a half hour. That's called the Golden Half
Hour after a big work out. So don't wait two hours, take a nap and then go eat. You basically
start to, your turnaround will get quicker if you refuel that muscle glycogen within
a half hour of your exercise. So those are the things: ice and getting that fuel in right
away are the two really helpful things.
>>Male #3: Are you against ibuprofen in general?
>>Jordan Metzl: I'm not at all, I think basically for longer stuff I guess there's what I do
and what I say. What I say is, you know, probably not a great idea for big doses for sure. If
you wanna pop one here or there before you do stuff I think that's probably OK The problem
with ibuprofen and you know, much, you know many of these are sold over the counter, is
they think alright, well it's like Advil, it's candy coated, I can just take that, but
these are drugs. And if you take enough of those, you can cause a real problem. So a
little bit here and there I don’t think is usually problematic, you know a lot can
be a big issue. But they can certainly cause ulcers, too. So you have to be careful not
to do any lots of that stuff on an empty stomach.
>>Male #3: Thanks.
>>Jordan Metzl: Sure.
>>Male #4: So, you and everybody else says walking is a great regular way to stay in
shape without having to put a phenomenal amount of effort in. I don't like walking, I like
bicycling, is that just as good?
>>Jordan Metzl: So, that's a great question and the answer is that I generally find people
are the most compliant with their exercise prescription if they like what they're doing.
And so if they feel like I have to run cause this guy told me I have to walk around but
I hate it, I love biking then they're gonna not do it and nothing, anything is better
than nothing. In the relative scale of expenditure, you know hard running is the most time effective
per whatever you can do. A hard run. But if you're like hating every step and you're not
pushing yourself, it's terrible for you. So if you can get your, it's all about getting
your heart rate up. And if you can push your cardiovascular threshold and really get your
heart rate up and move, by biking, then that's terrific and there are a number of places
to do that. So if you like and you'll do it, that’s a great way. And I do think the merits
of group exercise, like spinning particularly, are very helpful and people will push themselves
a lot harder if there's a group around. So you know, getting, that's why our strength
training class is so much fun, is cause everybody basically kicks each other's butt. Which is
helpful, really makes it work a lot better. So if you can find that dynamic in a spin
class or even a bike thing, you'll get much more cardiovascular out of that.
>> Male #5: Hi, thanks for coming out today.
>>Jordan Metzl: Sure.
>> Male #5: Well you know, IT band. Just, it is what it is but, to make that a general
thing, are there any pains that you would say are OK to push through? Or any time you
have a pain should you just stop when it occurs.
>>Jordan Metzl: Two good questions and I'll answer the second part first. And so the pain
issue is when your IT band pain is changing your running mechanic, then it's time to stop.
If it's a little bit achy here and there, I don’t worry about it. So my telltale thing
is if pain changes your mechanic of movement is number one. Now IT band is basically a
muscle called the tensor fasciae latae muscle that runs on the outside part of your hip
across your hip joint and your knee joint. And the typical person with IT band syndrome
is somebody that comes in saying "I'm running about, you know, two, three miles or a mile
and about 10-15 minutes in I feel like somebody's jabbing something into the side of my leg"
and that's typically classic IT band syndrome. And the answer is number one, flexibility.
So I have a whole thing in this IronStrength workout section called the Foam Roller Workout
and anybody friends with a foam roller? Several of you, good. And so the foam roller is a
great at home deep tissue massages that you can do pretty much every day to loosen up
the muscle, the IT band along the outside part of the leg. The second part, then, is
building this functional strength. And in the book in our IT band section we have what's
call the Big Butt Bonus. And it doesn't mean your butt's gonna get big, so don't worry.
But it means your butt's gonna get strong. And in the Big Butt Bonus section we have
all these glute strengthening exercises to basically keep your pelvis stable. The video
I didn't show you of this woman stepping down off the box, you know she was somebody who
had a lot of IT band problems and as she was kinda running, her hip was dropping on the
hurt side and her pelvis was unstable when she was running. And that caused some chronic
IT band problems over time. So strengthening is hugely important. And the final thing is,
there's a little fluid filled sac called a bursa, which can form between the tendon and
the bone and sometimes we have to give a little shot of cortisone in that IT band, just in
that bursa. But again, if you don’t fix the mechanical factors, it'll just keep happening.
So, IT band is very fixable, it's very frustrating for a lot of runners but very fixable with
the right stuff.
>> Male #5: Thanks.
>>Jordan Metzl: Sure.
>>Female #1: Hi, what about an injury or a pain that is there only when you rest, not
when you actually exercise?
>>Jordan Metzl: That's easy, keep moving. That's the –
[Audience laughter]
>>Jordan Metzl: [laughs] Umm
>>Female #1: Yeah but like an acute pain, you know the sciatic?
>>Jordan Metzl: So it's not uncommon actually, people go out, they work out and they get
some pains afterwards. And so, it sounds like sciatic type pain, here's my guess. When you're
sitting on it, it hurts the most?
>>Female #1: Yeah.
>>Jordan Metzl: OK, gotcha. So pain in the butt, yeah?
>>Female #1: Yeah. [Giggle]
>>Jordan Metzl: OK, so what's happening is that the sciatic nerve, in the hip/glut section
we have two kinds of sciatic pain. Sciatic pain can come out of the back and what happens
is you get a bulging disc in your back which pushes in nerve and shoots pain down your
leg. And those hurt all the time. Or you can get the sciatic nerve running through the
butt muscle and the butt muscle, called the piriformis muscle, will squeeze that nerve
after you've worked out. And basically just shoot this pain down the back of your leg,
especially when you're sitting on it. And again, a little bit of anti-inflammatory medicine
can make that feel better but the key is building, sorry, but building a stronger butt. And the
stronger your butt muscle gets, the less that muscle will want to squeeze on that nerve.
And so, you need a stronger butt, and that's the answer. And then the last thing is I have
a whole bunch of stuff in there on some different stretching, the Figure Four stretch is helpful.
That's where one case where flexibility can make a difference to loosen it up. But to
really fix it you gotta start, those plyometric jump squats, you will first hate them, but
one you learn to love them it will make this go away, I promise.
>>Female Audience Member #1: OK, thank you.
>> Male #6: I'm asking on behalf of my wife who's a cardio junkie. Who can probably do
with some rest, because she's worked herself into a really bad back situation. So what
are some of the exercises you can recommend for somebody who really thrives on the adrenaline,
thrives on the sweat, thrives on the cardio but needs to back off a little bit.
>>Jordan Metzl: Alright, so we've got a wife at home, my wife, but says the wife at home,
alright fair enough. So the wife at home who's the cardio junkie and I will say just by way
of this, that yes there are junkies of exercise. Exercise junkies is a real thing but as I
always say, I'd rather somebody be addicted to exercising than anything. So be proud of
your wife, but that being said you know she's not doing enough functional training and so
the cool thing about this IronStrength workout is, I promise you, you're gonna go home, you're
gonna earn a lot of brownie points at home here. Cause you're go home and say we're gonna
try this together. And I promise you that when she gets through her like fourth set
of burpees, she's gonna be having more cardio than she ever had doing the other stuff.
So the nice thing about this is it's both cardio and functional strength as well. But
I generally find people who only do one set of thing without that kind of cross training
built in, get hurt all the time. And so this concept of total rest days, I really don't
buy that so much. I think you can do less and more and different kinds of stuff. But
I think the concept of functional training interspersed with cardio is so helpful. So
I think, try this and let me know. She will thank you and it's a huge work out. This'll
be as much a workout as running.
>> Male #6: It's in the book?
>>Jordan Metzl: Well the pictures are in the book and the workout's online. That’s that
IronStrength on Runner's World. Alright?
>> Male #7: Hi, thanks for the book. My biggest problem with marathons is in the closing,
you know, last three or four miles, hamstring cramps. I don't know what it is that I'm doing
wrong. I've done a lot of marathons, I've had some success but I can't seem to fend
that off.
>>Jordan Metzl: Gotcha. So muscle cramping happens for basically for two main reasons.
So I'll talk about both. Less commonly but sometimes related to muscle cramping is actually
strength. So people aren't strong enough, so I think some of this functional training
that I've been talking about will definitely help with some people. But actually, surprisingly,
more commonly for muscle cramping that's nutritional. And when people think about nutrition and
muscle cramping people think alright I've gotta eat bananas because I'm getting muscle,
who here has had bananas for muscle cramping? Everybody got force fed bananas. And the answer
is the potassium is BS, that basically we don’t have a lot of data, we have a lot
of data on sodium. And salt is the culprit for most people with muscle cramping. And
so what I'm gonna have you do, basically what's happening over time, I'm betting in your marathons,
is you're not salt loading enough and you're not pre-salt loading and when you get that
lower salt sodium hyponatremia the first symptom is muscle cramping.
So my bet is that you're what we call a salty sweater. Everybody in this room sweats a different
amount and different concentration of sodium. And if you're a salty sweater you know it
cause when you're done with a long run you kinda look like you should be like a human
deer lick or something. You've got that white stuff all over, not a good look. So you're
a salty sweater, so if you are you need to basically give yourself more salt along the
course, and so there, you know everything from pretzels to there are these little salt
caps and I want you to try some of those and I bet you that with some strengthening and
with the sodium, it's one of those two things, I'm betting. And you can try an experiment
and see, that if it's late in the race usually it's just that you're losing too much salt
and you have not kind of built up. You can actually pre-salt load the day before in addition
to your pasta, some extra salt and then during your exercise more than an hour and half,
start putting some more salt into what you do. And then some races have, Gatorade makes
a great product called Endurance Formula Gatorade, it's double sodium. And that has double salt
and that will help a lot in terms of sodium. So try some more salt and I bet that makes
a big difference.
>> Male #7: Cool, thank you. Do you recommend salt caplets or just a standard salt packet?
>>Jordan Metzl: The salt packets don't work cause when you get sweaty it just kind of
disintegrates so they make, a number of companies make these little, there's one called Saltstick,
there's one called Endurolyte and these kind of sodium containing capsules and you just
carry those along and pop one or two of those and I bet you'll notice. And you can kind,
try and think like when it's hot and humid am I getting this more? Is it happening I'm
cold, cause cold cramping tends to be strength. The hot humid cramping tends to be sodium.
>> Male Audience Member #7: OK thanks.
>>Jordan Metzl: Alright? Sure.
>> Male #8: Hi, this is a follow up on the potassium. I notice that a lot of people,
a lot of my friends who play sports basketball, football they started drinking a lot of coconut
water, coconut juice and I just want hear your take on that? And then more generally,
after you do like the functional training, the plyometric jumps, the burpees whatever,
what's your best thing to take in terms of recovery aside from eating right after? Like
amino acids, protein etcetera.
>>Jordan Metzl: Alright two good questions. So first with the coconut water craze. I mean
I think coconut water is great it's basically isotonic so it's kinda not high sodium, it's
kinda neutral. I think eating is fine, coconut water is fine if you like and you're gonna
take it. It's probably a little more nutrient rich than obviously water which has essentially
none. But it's not like a magic formula. So people are always looking, oh I need this,
it's not a this. Just food is fine, too. But if you like that there's no down side. And
if you're gonna take it, it tastes good, no problems. It's a little expensive but no big
deal.
In terms of post-injury, post-workout foods, fuels. I really don’t like the kinda powders
and all that. I know there is a whole big industry of these synthetic powders but I
just think anything that has like a half-life of six years on the shelf is probably not
a good idea. And so I think just natural, natural occurring foods. I mean get stuff
that's on the perimeter of the supermarket. Anything that's in the middle that doesn’t
expire until 2016, you know, stay away from I think in general. And it doesn't matter,
it's totally you know much like the guy asked about biking, it's whatever you will take
is fine for me. That it can be scrambled eggs, it can be you know yogurt, blueberries and
granola. Whatever it is that you like, do it. And there's no magic answer to that, basically
naturally occurring food I think is the best. Some combination of carbs and protein, scrambled
eggs is great. Anything you'll do is great. Alright, no magic answer.
>> Male #9: Hi I'm trying to get back into a more aggressive athletic routine and a bunch
of chronic injuries are sort of resurfacing. Do you recommend from a medical standpoint,
establishing a baseline whether it is trying to figure out whether it’s a meniscus or
a ligament or you know, whatever the joints are. I mean, is a baseline something to seek
medical help with to then figure out if it's getting better or worse?
>>Jordan Metzl: That's a good question, I mean the answer to that is that I would start
doing stuff and start building some strength and see if there's a one pinpoint thing that's
the exact thing every time. If just kind of everything hurts cause you're doing more,
that tends to be kind of functional except if there's one thing that's actively limiting
your ability to be active then I would get that thing checked out. But I'm sure you have
a meniscus tear, I'm sure you do-
>> Male #9: Yeah.
>>Jordan Metzl: -just because many people do. So and if we get an MRI it'll show up
and what happens is people get surgery all the time because they have a meniscus tear
on their MRI and they're no better and they've had a piece of their meniscus taken out and
they're actually worse off. And so you know I think the key is to start doing some of
the stuff I'm talking about, see how it goes, see what happens to that pain. If there's
one particular thing that's problematic, then we can look at that further.
>> Male Audience Member #9: OK
>>Jordan Metzl: Alright?
>> Male #10: Hey Jordan, thanks for coming in.
>>Jordan Metzl: No prob.
>> Male #10: I try to bike at least every day to work to and fro and I have lower back
pains. What do you suggest doing? Stretching before or after or both?
>>Jordan Metzl: Good question. So you know, how far are you biking and where are you coming
from?
>> Male #10: I do about six or eight miles each way.
>>Jordan Metzl: Oh nice, and you're coming from where abouts?
>> Male #10: Brooklyn.
>>Jordan Metzl: So coming over the bridge and stuff. So you know number one is back
pain from biking can be a couple things. Number one if you're doing serious biking like this
guy maybe, bike racing or stuff, bike fit is very undervalued for you know, making your
bike comfortable. If it's kinda commuter biking and you're going back and forth which is a
great way to get around and I think getting around New York on bike is, I'm really excited
for the bike sharing program which is gonna start in July here. Which is gonna be, anyway
you guys probably know about this stuff but it's gonna be terrific.
>> Male #10: Great.
>>Jordan Metzl: And I think that, you know I have a whole bunch of stuff in the book
on what's called core strengthening, isometric planks. To build up what are the core muscles
around your middle. And most often bikers don't do enough middle strengthening and so
you kinda end up like an Oreo. You kinda have this soft inside so you gotta start strengthening
the middle. Those core muscles support you when you're sitting on your bike seat and
it makes that pain go away. So start some of the core blaster exercises I have, some
of the core strengthening and you can do it at home. Try you know a few times a week and
I bet your back feels a ton better from that.
>> Male Audience Member #10: OK, quick question. Post long bike, chocolate milk or coconut
juice? >>Jordan Metzl: Take one of each. I mean,
chocolate milk's got -
>> Male #10: That's a bad combination.
[Audience laughter]
>>Jordan Metzl: Yeah it probably is. I personally, chocolate milk is probably better cause it's
a got a little more fat content and a little more carb content. So I think maybe during
long ride coconut water and post long ride I'd go with chocolate milk.
>> Male Audience Member #10: OK, thanks.
>>Jordan Metzl: Sure. Last question.
>> Male #11: Hi, I don't remember if the book addresses this in detail, I read it a while
ago. Any tips for running heat? Because summer is much nastier here in New York rather than
California.
>>Jordan Metzl: Yeah, so you know running in New York City in the heat is a real issue.
I mean, California is lucky in that sense but you know, the biggest problem I see if
you're running in the heat is acclimatization. So I have many fewer problems with people
running in the heat in August than I do in June when we get a hot day when it's been
kinda cool. So the body takes about a week to ten days to acclimatize to heat. And so
when it gradually builds up over time, like it is now here, you know, you need a little
more hydration, you probably need a little more salt. You need to kind of pre-hydrate.
You have some of these more common muscle cramping issues. But in general your body
gets to, it acclimatizes to heat over time. The problem is if you're up here and you say
listen I'm gonna go for a getaway to Miami and it's kinda 45 here and it's 80 there,
and you get off the plane and go for a 10 mile run. Those are the people that end up
with a lot of kinda of more significant. If you go run the Miami half marathon, that weekend
I always see people the next couple days with bad muscle tears because they've just been
running in the cool and they're not acclimatized. So heat tends to be the problem with acclimatization
and then you know, some of the sodium and some of the dehydration stuff as well.
>> Male #11: Thanks.
>>Jordan Metzl: Alright, so I just wanna say in conclusion thank you guys so much, a pleasure
to be here. I know I was competing against Justin Beiber on Friday, but you learned some
good stuff here. So I really appreciate being here, thanks a lot. Bye-bye.
[applause]