What can I do to alleviate exercise-induced asthma?

NOTE: Coach Jenny has some advice for Jessica, too. Read on for the Running Doc's own reply...

I've always had a slight case of sports-induced asthma. I'm usually fine until I hit a hill. It doesn't happen in training, only when competing. And it has happened while running and also the bike leg of a triathlon. If I hit a decent-sized hill, I start wheezing and it feels like my windpipe is the size of a straw. Am I not breathing correctly, or is there anything I can do to prevent/alleviate this? - Jessica H.

Thanks for the question, Jessica. Exercise-induced asthma (asthma brought on only during exercise) is very common and I hear stories about this all the time.

In a previous blog I discussed the causes (triggers) of exercise-induced asthma. One important trigger is rapid movement of air across the bronchiole muscles, which irritate them and cause them to spasm down.

The fact this only happens on hills makes me wonder if you are attacking the hill correctly. You may be over-exerting on that hill, making you breathe harder and hence irritate the pathways leading to the bronchospasm. For that reason, I have passed your question on to Coach Jenny, who knows best how to "make friends with the hill." Following her advice has made tons of people like you stop wheezing during their hill workouts or races.

The other question is: Why only during races? This may be due to the natural anxiety of competing and at the hill, where you are most worried (consciously or sub-consciously), you are breathing harder than you need to. Again, following Coach Jenny's hill-friendly plan, you will be prepared and less anxious, leading to less wheezing.

I hope these tips work. Please let me know.

Enjoy the ride.

HAVE A QUESTION FOR THE RUNNING DOC? E-MAIL IT TO RUNNINGDOC@RODALE.COM.

Please help me with my elbow pain!

As a triathlete, I figured the last thing I'd ever have to worry about was tennis elbow. Then I came back last week from a 10-day vacation with an elbow so touchy that cycling was painful, swimming wasn't much better, running hand movements and even turning a doorknob was a big pain. I played all of three games on the court while I was away. Is this my reward? - Ronald A. Northport, New York

Ronald, tons of runners and triathletes come into my office after a vacation with the same complaint. As 25% of the athletes who play tennis just occasionally find out, it doesn't take a lot of tennis to irritate the muscles that run from your wrist, up along the forearm, to your elbow. They were meant to help you do a lot of things, like twist a doorknob or turn a steering wheel, but not to take the shock of a ball whizzing into a tightly strung racket at 30 mph. And even if they were, the tiny point of bone to which they're attached at the outside of the elbow, the lateral epicondyle, focuses the full force into a comparative pinpoint. You've asked those muscles to do more than they are capable of doing: tendinitis—ouch!

Diagnosis is simple. Hold your arm straight out, make a fist with your palm down, and try to tilt your hand up while holding it down with the other one. Pain on the outside of the elbow? That's it. We may want to x-ray to be sure nothing is fractured, but chances are it's just a miserable lateral epicondyle.

Conventional treatment—ice, rest, an anti-inflammatory like Advil, and sometimes a splint—will eventually eliminate the pain, but it's not the cure. Those muscles are used every day, so there's no such thing as giving them complete rest. The problem smolders because the conventional treatment works on the symptoms, not the cause.

The answer is to build up those forearm muscles so they're the strong, flexible shock-absorbers you're asking them to be. When they become strong and flexible enough to handle what you asked them to do in the first place: the pain ceases. The following exercises can do this, and they're not tough or time-consuming. Start as soon as the pain allows.

(Note: Consider a corticosteroid injection a last resort. At best, the shot can produce the illusion of being cured. At worst, it weakens the already overworked tendon that glues the muscle to that tiny point of elbow bone.)

EXERCISES: With a 2 1/2- to 3-pound weight, once or twice a day, do each of the following for 50 reps, or until it hurts too much or you're too tired to go on.

BOTH ARMS

• Curls—Make sure you come to full extension at the elbow.

• Reverse curls—Curls, with your palm facing down instead of up

• Wrist curls—Elbow locked down at your side, palm facing forward, bend your wrist up as far as you can.

• Reverse wrist curls—Same as above, palm facing backward

• Unbalanced rotation—Hold the dumbbell by one knob, straight out at arm's length. Rotate it 180° like a windshield wiper. (One 180° swipe counts as one rep; at first, you may have to hold it in the middle until your strength builds.)

STRETCHES
Do five repetitions, 10 seconds each, six to eight times a day:

• Arm straight out, elbow locked, make a fist with palm down. With free hand, push down on top of fist, resisting.

• Same as above but palm up. Push down on palm, resist.            

Enjoy the ride.

HAVE A QUESTION FOR THE RUNNING DOC? E-MAIL IT TO RUNNINGDOC@RODALE.COM.

Weighing in on carrying cell phones in races...

Note to readers: I was reading the following question in the new "Ask Miles" blog...

Dear Miles,
I normally carry my cell phone during  long training runs (for safety reasons, mostly). Now that my marathon is  approaching, I'm wondering: Is it OK to carry it during the marathon itself? -  Alex, Palo Alto, CA

...and thought I would offer my own take, as a medical director of marathons.
Runners who carry cell phones, if used to listening to music on training runs where the running field is less dense may miss something on the course, a hazard or a pothole. I always tell my patients that during a race, using music is not advisable. Instead take in the scenery and enjoy the experience. 

As a medical director, however, I have another concern. If a runner sees a participant or spectatot in need of medical aid, the  natural good thing to do is call for help. How do most people do this? They call 911. Most events have medical on scene so now there are two ambulances and sometimes a fire truck (with paramedics) trying to get to the same runner  through crowds.
If you care to bring your cell phone for an  emergency, ask the organizer what the number for emergency aid along the route  is. All Medical Directors I know are grateful for more eyes on the course. So  having that number would help your fellow runners. 

When calling in an emergency be prepared to give:

• An exact location, as best you can.
• The runner's bib number (so that if someone else calls in a runner, two resources are not sent to the same person).   
• A brief description of the runner and what you perceive the problem to be.   
• Whether the patient appears to be breathing or not.

Finally, do not hang up until told to do so. The hardest thing at my end of the phone is being told "Runner down at 51st Street; help!" and then...click. Obviously I have more questions to get help there quickly. We are all nervous when first seeing an emergency. Just take a deep breath and follow the directions above.

If you and others do this when carrying a cell phone, we will all have a safer environment to run in!

Enjoy the ride.

HAVE A QUESTION FOR THE RUNNING DOC? E-MAIL IT TO RUNNINGDOC@RODALE.COM.