Late 5K race fatigue issues - High School Girl

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Michigan Guy
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Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Mon Nov 07, 2016 3:39 pm

My daughter is a XC athlete and just finished her junior year. As a freshman, ran three races around 18:55 as bests. As a sophomore, had one race about 18:25 and two around 18:40. As a junior, one race about mid-18:40s and several around 19:05.

She runs into extreme fatigue issues during 5K races. This does not happen at every race, but it happens often enough (about 30-40% of the time). At about 12 to 15 minutes into a 5K race, she will feel a burning pain in her thighs/hips, feel weak, dizzy, and nauseated. She will attempt to keep running, but she sometimes slows down to a staggering, wobbly walk; other times, it’s just slog it the rest of the way in. Her arms start to flail out to the sides. She mentions that her vision starts to go black and that her legs just go numb. I have pulled her out of a race a couple of times. After the races, she is lightheaded, unsteady on her feet and often vomits a couple of times. She recovers after about 10-30 minutes.

She has no known medical problems or food allergies. We check her iron-ferritin regularly, and it is good (greater than 55). She eats well and has a balanced diet. She is not underweight. She is not diabetic. Gets good sleep (8-8.5 hrs).

During the spring and summer, she made it up to 45 miles per week for 5 weeks, similar to freshman and sophomore years. Mostly Tinman-based training with 6 X 800m CV repeats and Tinman tempos of ~4 miles as the weekly workouts, other mileage is easy to moderate with occasional strides.

We have looked for patterns of all sorts (prior workouts, foods, carbohydrate intake, sleep, illness, menstruation, temperature, time of day) and have been unable to identify anything uniformly common to these race events. During XC races over the past couple of years, she mentioned a few times that the fatigue seemed to be associated with hills in the last mile, sometimes just very small hills, but again it does not occur uniformly.

This type of problem does not seem to be unique to my daughter. A friend of mine mentioned that that the following post showed up on a XC Coaches Facebook group (to which I do not have access): "Looking for some help very talented jr girl has trouble finishing races. Had all types of test no big results. She gets dizzy, lightheaded, and tightens up. She either has to drop out out or fades badly slows almost 2 mins in last mile."
https://www.facebook.com/groups/xc.coaches.network/

This is not identical to my daughter’s events, but there are strong similarities.

I'd be grateful for any guidance you have to offer.

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Re: Late 5K race fatigue issues - High School Girl

Post by wuxcalum » Tue Nov 08, 2016 10:03 am

My first guess is that her ferritin (iron reserves) are low. This is usually referred to as "low ferritin" or "sports anemia". You should take her to the doctor and get her levels checked. Usually you have to specifically ask for this test as most pediatricians see it as unnecessary. As a general rule, over 50 is ideal, under 30 usually starts affecting performance negatively, and under 20 really has a major impact on performance. For example our girl who ran 19:30 for 3 miles last year as our #7, started running in the 21:00 minute range this season and fell to #15 on the depth chart. She got her ferritin levels checked and was at a 17. She started supplement with liquid iron and within 3-4 weeks was feeling better and began climbing back up the depth chart. By about 8 weeks, she was our #7 again and ran 19:35 at the state meet. I have had at least 10 more stories like this in my 8 years as a coach. Sadly there are probably another 15 or 20 cases that went undiagnosed over that same time period if not more.

Please see this article as a reference.

http://www.runningwritings.com/2011/11/ ... iency.html

Jimmy

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Re: Late 5K race fatigue issues - High School Girl

Post by toughnessbucket » Tue Nov 08, 2016 12:01 pm

I had an incoming freshman boy who ran 4:54 on the track as an 8th grader. This summer he was struggling to finish workouts with the varsity boys and sure enough his parents checked his ferritin levels and it was a 6! My point is can also be a problem for boys as well as girls.

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Re: Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Tue Nov 08, 2016 12:07 pm

wuxcalum and toughnessbucket,

Thanks for your messages. We have been tracking her ferritin levels for three years. The levels are good, about 60. We have made sure that the clinical lab is definitely testing for ferritin, not just for hematocrit, hemoglobin, or TIBC (total iron binding capacity).

Here is another good reference regarding ferritin levels:
http://www.runsub5.com/single-post/2015 ... W-FERRITIN

Daughter is also on Vitamin D supplement and drinks plenty of milk.

Does not seem to be an issue with workouts, just racing. I can discuss more about workout times, but may not be relevant as workouts do not equal racing.

I am skeptical that it is a nutritional cause, but I want to keep an open mind.

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Re: Late 5K race fatigue issues - High School Girl

Post by jbarts » Tue Nov 08, 2016 10:59 pm

An athlete in our conference a few years ago had similar issues. Turned out she had a very small hole in the wall of her heart and not enough blood was getting where it needed to be at high intensities (or something like that). Might not hurt to have an EKG or similar test done. I don't know any details about what they did to correct the issue, or if that is even 100% accurate as to a diagnosis, but I figured I would post as the symptoms sound similar.

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Re: Late 5K race fatigue issues - High School Girl

Post by Spider Man » Wed Nov 09, 2016 10:25 am

Just another possibility to throw into the mix ...

I had similar issues with a (Junior) HS boy last year ... He was on ADHD medication, & one of the tablets he took (once I did a little research) had the effect of preventing him drawing upon the last 10% of maximum heart-beat i.e. it imposed a sub max limit ... He performed well on most workouts but bombed in races. He has since changed his ADHD medication, & is once more firing on all cyclinders.

The point is ... check out the side effects of any medication your young runner may be on.

Michigan Guy
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Re: Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Thu Nov 10, 2016 9:51 pm

Spider, Thanks for the good suggestion. Unfortunately (or should I say fortunately), my daughter is on no medication. Only nutritional supplements = multi-vitamin, Vitamin D, and iron pills (Proferrin and FeSO4).

jbarts, Thanks for your suggestion as well. We know of no cardiac issues with my daughter. It is worth considering, due to my skepticism over a nutritional (iron, glucose) cause. It could instead be physical (blood pressure, hemodynamic effects, cardiac). There is an interesting article on Exercise-Induced Syncope at the following link. Not identical to my daughter, but more than enough to be reminiscent.
http://www.mdedge.com/jfponline/article ... their-feet
An 18-year-old woman was referred to us for evaluation after fainting on several occasions during a track workout. She’d been a competitive athlete for several years, and the episodes began 3 months earlier. She reported that they happen shortly after she started to run. She also told us that just before a spell, she had a sense of fatigue and severe leg pain.
On further investigation, we discovered that our patient would faint predictably 14 minutes into a competitive 5K run. She had recently adopted a more aggressive “early breakaway” strategy: she would run the initial part of the race at a pace of about 6 minutes per mile and slow down gradually towards the end.
We also learned that she had never fainted during weight training or when running at a less aggressive pace. Other than fatigue and extreme leg pain, she could not recall any other symptoms before falling, such as nausea, dizziness, weakness, or palpitations.
Yet another condition is known as Vasovagal Response, Vasovagal Syncope, or Neurocardiogenic Syncope. Here is an excerpt from a now-inactive link that is once again reminiscent.
My daughter has been recently diagnosed with this [Vasovagal Syncope]; she is a 16 yr old High School XC/track runner. Does anyone know why this suddenly gets so much worse? She had successful 8th and 9th grade seasons and then things completely fell apart…we had no idea what was wrong, until finally at States she collapsed/fainted at the finish line. She had been complaining about heavy legs all season, her times were horrible, and she would start seeing stars, and losing vision if the course was particularly hilly or the race was extremely fast. She is on a high salt diet and on florinef (.1 mg 2x per day). Has anyone been able to regulate their condition by using a heart rate monitor? Any other tricks that might help? She is just starting her summer training for the fall, and says hills just kill her. She ran a hilly 4 today at a medium pace and her feet were tingly, had to stop a few times and throw her legs up. I am just concerned because obviously she won’t be able to do that during a race.
I have not put my daughter through much medical testing and frankly, I am reluctant to start down that road. The battery of tests to undertake and the conditions to rule out (listed in the Syncope article) are many, with no guarantee that any etiology could be identified.

I am hoping that some experienced runners and coaches may have run across this phenomenon before and have some suggestions. The iron and medication suggestions are good, but do not match my daughter's situation.

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Re: Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Thu Nov 10, 2016 9:56 pm

Another description of Vasovagal Response.
https://en.wikipedia.org/wiki/Vasovagal_response
Episodes of vasovagal response are typically recurrent and usually occur when the predisposed person is exposed to a specific trigger. Prior to losing consciousness, the individual frequently experiences early signs or symptoms such as lightheadedness, nausea, the feeling of being extremely hot or cold (accompanied by sweating), ringing in the ears (tinnitus), an uncomfortable feeling in the heart, fuzzy thoughts, confusion, a slight inability to speak/form words (sometimes combined with mild stuttering), weakness and visual disturbances such as lights seeming too bright, fuzzy or tunnel vision, black cloud-like spots in vision, and a feeling of nervousness can occur as well.
Vasovagal syncope occurs in response to a trigger, with a corresponding malfunction in the parts of the nervous system that regulate heart rate and blood pressure.

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Re: Late 5K race fatigue issues - High School Girl

Post by Tinman » Thu Nov 10, 2016 10:55 pm

(1) Are the warmups before races hard enough?
(2) Is she pacing too fast the first 3 minutes of the race?
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Michigan Guy
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Re: Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Fri Nov 11, 2016 4:33 pm

Tinman, Thanks for your reply.

I do not think that she is pacing the first 3 minutes too fast. In competitive races, she is not up front at the 1/2 mile mark and usually trails by 5 seconds or so. That is my impression. In non-competitive races, she will be in front at the 1/2 mark, but not a lot.

Hard enough warm-up? Probably not. She usually runs/walks the course with her team and the team does not do a hard warm-up at all. Could you comment about a hard warm-up?

I'd additionally like to ask these questions:
If a runner is weak in late race hills, then they are lacking ______________________.
If a runner is weak in late race hills, they should be doing more ____________________________ in training.
To make a runner stronger in mile three during a 5K, they should undertake more _______________________________.

I would hope that her situation might be the result of certain training deficits or specific fitness weaknesses, rather than medical/health causes.

It might come down to "work on your weakness". If she needs to significantly increase her hill work, what would be the best approach? How, What, When, Why?

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Re: Late 5K race fatigue issues - High School Girl

Post by FTIR » Sun Nov 13, 2016 10:12 am

MG seem to be on top of this but I have trouble seeing how something that happens intermittently "She runs into extreme fatigue issues during 5K races. This does not happen at every race, but it happens often enough (about 30-40% of the time). " is predominantly based in something that is MISSING in training, unless it is rest. Could it be that she might have a problem "training through" races? Do the good and bad days correspond to certain types of workouts before the races?

Just a thought.

As for running the first 3 minutes too hard, she might not be running too hard for what she is capable of but just out too hard because she is not warmed up enough, yet. (see below) This type of thing could certainly be intermittent given a good or bad warmup for any particular day and/or a need for different amounts of warmup base on if the race is at 9 or 10 am vs midday vs after school.

As for warmups, this is not the best quote on here but back in 2008 Tom wrote, "You have a specific amount of stored pcr, and you can use it up very fast, moderately-fast, or at a moderate rate, basically. Thus, if you want sprint full effort, it'll be used up in the first ~4-6 seconds, most likely. If you use the moderate-fast approach, think ~12-16 seconds. If you go the moderate route, the 20-30 second range is about right, in my experience. It depends mostly upon these factors:

a) rate of use;

b) the number of fast twitch fibers you can activate.

For runners who don't have a lot of fast twitch fibers, doing a hard warm up (for shorter races) is esential, to accelerate the slow component of oxidative phosphorylation). That is you can kick your use of oxygen into gear faster when you do a hard warmup.

People who have a lot of fast twitch fibers and who have trained them already have an advantage - they can provide ADP and Pi to the mitochondria of working muscles at a high rate at the beginning of exercise, thus signaling the mitochondria to get in gear and use oxygen. People who don't have a lot of fast twitch fibers or who have not trained their fast fibers well, and who fail to do a hard warm up, won't have their mitochondria working rapidly to use oxygen at the beginning of a race; so they will suffer oxygen debt and elevate acidosis more so than otherwise."

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Re: Late 5K race fatigue issues - High School Girl

Post by dilluh » Sun Nov 13, 2016 7:18 pm

I never went out too hard in races before training with Tinman but he did teach me the principle of getting in a rigorous warmup, particularly for short races. It helped immensely from the first time I tried it. I think most people are not warming up enough before a 5k to run their best race. It requires considerably more effort than one would think and as someone who isn't a fast twitcher, that first mile feels a lot more smooth with a proper warm up. I also found that my racing was more consistent with the training I was doing when I did a proper warmup.

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Re: Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Wed Nov 16, 2016 6:18 pm

FTIR, "MG seems to be on top of this..." You're giving me far too much credit. I've done a lot of searching and thinking on this, but still have no idea what is going on with this phenomenon.

Here are a number of video examples of female runners experiencing fatigue problems at the end of races (varying from 3200m to 6000m).

Holland Reynolds – San Francisco University High School, California
https://www.youtube.com/watch?v=4Evj2ecqDi0

Arden McMath – Arlington H.S., Ohio
https://www.youtube.com/watch?v=S3MWOJUUrYY
https://www.youtube.com/watch?v=kqiMfOGGBLs

Annie Dunlap – Baylor University
http://www.runnersworld.com/races/sport ... mpionships

Madeline Adams – Boston College
http://ftw.usatoday.com/2016/10/boston- ... ship-video

Alexa Efraimson (see 1:20 of video)
https://www.youtube.com/watch?v=mZU6qLGBElw

This is not unique to females.
Reuben Reina – 1996 Olympic Trials (start at 7:50 of video)
https://www.youtube.com/watch?v=qOOyivTAvoU

The purpose of most of these videos is highlighting the human interest and sportsmanship aspects of the runners’ struggles. Unfortunately, none of them really give any information on the physiological cause of the phenomenon. This is generally referred to as “hitting the wall”, “bonking”, “tying up”, “shutting down” or other colloquial terms.

Numerous internet sources suggest that glycogen depletion should not occur during 5K races. Is this incorrect, or does the fatigue have a different source?

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Re: Late 5K race fatigue issues - High School Girl

Post by PeterMichaelson » Wed Nov 16, 2016 8:20 pm

The Reuben Reina meltdown was just that. It was very hot during the trials, even at night. I was there as a spectator. At one point the announcer joked (I'm making up the numbers here): "Temperature in the shade, 96 degrees. Temperature in the sun, 109 degrees. Temperature ON the sun, 10 million degrees!"

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Re: Late 5K race fatigue issues - High School Girl

Post by Michigan Guy » Fri Dec 02, 2016 10:52 pm

Received the following comments from John Davis of the Running Writings website http://www.runningwritings.com/
The situation you describe is very strange. I have seen similar phenomena before, very rarely.

I know of one high school runner who was experiencing severe fatigue issues during races and hard workouts, especially ones that involved uphills, but he had no vomiting, lightheadedness, or nausea. He would get burning pain in his legs and numbness, and have to slow to a very slow jog or drop out completely. After a long, long time of messing around with time off and PT and all sorts of other attempted treatments, he underwent testing for compartment syndrome and discovered that the pressure in his anterior compartment (basically the sheath that contains the shin muscles) was very high, like 4x the high end of the normal range. I suspect this was the cause of his problems, but can't yet say for sure—he underwent compartment release surgery but is not back to running yet. A compartment syndrome test can check for this—it involves running on a treadmill until symptoms occur, then checking pressure in both the anterior and posterior compartments (shin and calf) using a needle pressure gauge. Any competent sports orthopedist should be able to refer you for this test.

Another potential cause we were looking into with this runner was arterial impingement problems. There are two arteries, the iliac artery and the popliteal artery, in the front of the hip and the back of the knee, respectively, that can get "pinched" or narrowed by endofibrosis, leading to a drop in blood supply. This can cause numbness, poor coordination, and loss of strength. These are very rare; I have only read about them, never known an athlete who has them. They can usually be diagnosed by a metric called the ankle-brachial index. A doctor compares the blood pressure in an artery at your ankle with the blood pressure in an artery in your upper arm. If they aren't close to the same number that means there's something constricting blood flow in the leg. The only catch is that I believe this test must be performed soon after exercise which induces the problem also. It might take a more experienced sports doctor or even a vascular doctor to figure this out, assuming it's the cause.

To explore if this is a heart-related issue, the athlete should undergo a stress test on a treadmill while hooked up to a EKG machine to monitor heartbeat to see if there are any irregularities that could be causing this. A heart rhythm irregularity that occurs only or primarily during intense exercise could be another possible explanation. A cardiologist who deals with heart issues in young people might be the best person to see for this kind of test.
The differences among runners revealed under the stress of intense running is surprising.

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