Sunday, April 01, 2007

Ready to Run?

Dr. Anthony Luke , Director of Primary Care Sports Medicine at University of California, San Francisco, practices what he preaches. I'm delighted that one of San Francisco's premier sports medicine specialists has agreed to share his expertise as our guest blogger.

Spring is here! Though the Bay Area allows people to run all year, many people here and around the country are putting on their running shoes and heading for their local trails. What steps can you take to run safely and try to prevent injuries?

Warm up before running. Jogging at 1/2 or 2/3 speed for 2 or 3 minutes before getting in your normal running pace can warm up the muscles which has been shown to improve flexibility and resistance to stretch injuries.

Stretch for flexibility during your cool down. Spend a few minutes stretching the major muscle groups when you are done, for example, the calf muscles, hamstrings, quadriceps, hip flexors and iliotibial bands. Research really hasn't shown that stretching before exercise prevents injuries. However, tight muscle groups have been associated with several injuries. Studies have shown that one stretch of 30 seconds is better than three times at 10 seconds and as good as three times at 30 seconds. So hold each stretch for 30 seconds at least once and move on to the next.

Strengthening. Important muscles to strengthen for runners include the calf muscles, quadriceps, hamstrings and the gluteal muscles! People often forget the muscles that rotate the hip, which are important stabilizers for the leg. Also, core stability is key so work on your abdominals. The large exercise balls are excellent training tools.

Get the right shoes. Go to a store that has salespeople experienced with runners and proper shoe fitting. The soles of most running shoes have a lifespan for around 400-500 miles.

Fluids and Fuels. Keep track of your diet. Replacing necessary energy using carbohydrate sources such as gels or bars are needed especially when you're running longer than 90 minutes. Proper hydration before, during and after running is essential. You should learn how much fluid you need during your training runs and alter things depending on how hot the weather is.

Got injuries?
If you:
1) have pain greater than 2 hours
2) have swelling
3) need to change your running technique
Take a break. Try cross training on a bike or swimming. If you rest for a week and still can' run, it's time to talk to someone who knows about running injuries. Your local sports medicine expert can help.

38 comments:

Anonymous said...

Do your stretching comments apply to all sports or just running?

Anonymous said...

How far should you stretch- to just beyond pain? Can you improve your stretching amount, and if so is it worth it to "stretch train" to become more flexible?

Dr. Luke said...

the stretching comments do apply for all sports. Certain sports of course require more flexibility than others, but in general a good balance between strength and flexibility is what is desired.

Stretching should be done where you actually feel the stretch, but not necessarily pain. Usually after around 10-15 seconds the pain of a stretch should decrease somewhat as tissue fibers lengthen. If things keep hurting, that is likely too much. You are right that you should take things gradually and steadily train. It takes at least 6 weeks of consistent training to get noticeable long-term improvements in one's flexibility. People have a range as well, so there is some limits to how much flexibility someone can gain.

becky said...

Hi, I constantly have issues with shin splints when I run, so I've kind of given up. My knees aren't great and I just don't live near a pool. I can go an elliptical, but I worry that I never get in really good aerobic shape just doing the elliptical. Any comments on other things I can do that don't kill my shins, knees, etc.?

Jamie said...

What is the ideal distance for running per week? I've heard that over 15 miles a week is unneccessary, Is this true?

Anonymous said...

I have been running for about 15 years, but in the past few years, I seem to keep getting the same recurring low-level knee injury (ITB). Each time it gets bad, I take a break from running, ice it a lot, do strength training etc until it seems completely healed, but it always seems to come back at unpredictable times. It's not just when I have old shoes or increase mileage. Is there any hope for a more permanent solution? Could it be a problem with my running form?

(I have heard similar stories from other long-time runners, with different recurring injuries)

Anonymous said...

Is it true if you run more than 3 miles you should ice your knees after to prevent cartilage breakdown. I love to run, but in 30 years do not want to do it on artificial knees!
Thanks Dr. Razavi for getting the guest blogger Dr. Luke. Great Blog!

Anonymous said...

I try to run for 30 minutes, 3 days a week. I enjoy the run initially, but as I increase my speed, I get pain in my lower rib cage area (mostly left).
Any idea as to what could be the cause of it?

I used to get shin pains, but that seems to have gone with good shoes.

- Just another Guy

robin said...

Are short runs, or for that matter, short exercise sessions, like 15 minutes of lifting in between meetings, actually useful? I've heard that if your heard rate is not at it's target for at least 20 minutes that you are not actually doing yourself any good. Is that true?

Sredni Vashtar said...

Others have mentioned knee problems. I've read that strengthening the muscles connected to the knee joint will help save the joint (true for any joint I guess). Question: what exercises can I do for the hamstrings, gluteus maximii and quadriceps that don'tput stress on the knee? I am thinking of weight resistance exercises.

Anonymous said...

I've been lifting weights and doing strenuous cardio exercise for over a decade. Now that I'm pregnant, my mother thinks I shouldn't lift anything over 15 lbs and I certainly should not workout. Everything is normal. My understanding is that if I've been working out and everything is normal, I can continue (obviously with some modifcations as I get larger)but that I should not start an exercise regime. Who is correct?

Anonymous said...

hi, thanks for your input! do glucosamine and chondroitin or other supplements help? any you take or recommend taking?

Carmelo Lisciotto said...

Do you reccomend a pre-stretch warm up period?

Carmelo Lisciotto

Anonymous said...

What is the optimal mix of strength training and running? Or better phrased -- what is the minimal amount of strength training I need to do per week? I love to run and will often skip my strength training so I can run longer, but then don't gain improvements in my running so will mix the strength training back in then cycle back around to skipping them. If I do 2 days a week of strength training is that sufficient? Can I get away with 1? Do I need to do at least 3?

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dr. luke said...

Thanks for all the great questions. I'll try to break down the responses.

Becky - shin splints if they're on the inside of the shin bones just over the ankle are due to heavy stress on the bones. Running isn't bad but you may need to gradually train your bones to take the stress. This can be done slowly for example running 10 minutes then finishing your workout on the elliptical. You can then gradually increase by 10% of your time or volume each week as a rule of thumb. Over time, your body should adapt unless there's some other reason that your leg can't take the stress.

dr. luke said...

Jamie,
15 miles is not necessarily the limit. As you know the marathon distance is 26.2 miles. It all depends on your goals. If it's running for fitness 15 miles a week is 3 miles 5 times a week. at a 10 minute pace that's 30 minutes of running which is a good exercise program for fitness.

dr luke said...

Iliotibial band problems are tough. If you've been working hard at this, then sometimes there may be a biomechanical issue. Stretching is the mainstay for fixing the ITB. The stretches are tough to figure out sometimes and someone who is familiar can show you these. UCSF will be having a RunSafe program where we look for these biomechanical issues to suggest improvements for injury prevention. Look for information on our website later in May 2007.

dr luke said...

Abdominal complaints with running aren't uncommon. Abdominal stitches or cramps can occur though usually more common on the right than the left. Abdominal exercises and stretching can help. Work on your core and your breathing and see what happens.

dr luke said...

Robin,
Short episodes of exercise can be beneficial. If you're trying to get some exercise, 3 bouts of 10 minutes can burn as many calories as 30 minutes straight. for buidling cardiac endurance, if that is your goal then you would have to exercise longer. Just think about what kind of exercise goals you have and train doing similar things. Bottom line any exercise can be beneficial.

dr luke said...

Sredin,
Try the exercises lying down. You can work the hip muscles (gluts, hamstrings etc.) without loading the knee while standing. Swimming and pool exercises are also good. Finally weight machines can decrease the amount of force directly on the knee. Hope this helps.

dr luke said...

Exercise is safe in pregnancy. The rule of thumb is that you can do what you were doing right before you became pregnant, so if you're fit then you can maintain your exercise program. However, it's not necessarily the best idea to start a new rigorous program while you're pregnant. Check out the Canadian Academy of Sport Medicine website. there's a position statement on exercise and pregnancy which is good. Remember to talk to your obstetrician before starting any exercise to make sure there aren't any risks you're not aware of.

dr luke said...

Unfortunately, glucosamine and chondroitin sulfate has not had much positive results through research. However, there does not seem to be any harmful effects. It's not a necessity but if you want to try it, I have found patients who feel it helps. If you don't find any improvements after 6 weeks, then you can reconsider.

dr luke said...

Before you exercise, warm up is key. If you want to do a few stretches that's fine. You can do short ones to warm the muscles up. I don't usually recommend long stretches (i.e. 30 seconds) before running.

dr luke said...

There is no real equation for what is the right balance between cardio and weights. All depends again on your goals.
For a runner, one to two weight training periods can be great. Just remember no heavy leg workouts before a long run. Make sure you schedule enough time for recovery between workouts.

dr luke said...

Sorry Mehdi. Maybe another person who speaks your language may be able to help with your question. Happy running!

Daniel said...

I have heard from many sources that running on hard surfaces like concrete is more dangerous than soft surfaces lite dirt (or asphalt which lies somewhere in the middle). However, I haven't heard a good explanation of whether this still holds when the runner is wearing running shoes with padding.

My thinking is that this depends on how much padding the surface (say asphalt) provides compared to the shoe. If the asphalt provides only a small part of the padding, and the shoe provides most of it, then I'd think that switching to concrete, or even some infinitely hard surface, wouldn't make much of a difference to the total padding. However, if the asphalt really provides a significant pad compared with the shoe, then of course switching to a harder surface would make a big difference.

Does my reasoning make sense, and if so, how important is the surface assuming you're using good running shoes?

dr luke said...

Daniel,
The surface is extremely important and even with good shoes can present a problem. The ground exerts a force back onto your body as you hit the ground. The harder the surface the more force that is returned. Your shoes can absorb some of the force but eventually some of it will reach your body. The more you can reduce forces on the body, the better. Concrete is around 2.5 times more dense than asphalt. So good shoes and better surface especially if you have problems with shock to the legs.
Happy running!

Anonymous said...

Keeping good new shoes on my feet has kept away a lot of my aches and pains.

Massage Chair Relief

逐日 said...
This comment has been removed by the author.
逐日 said...

People have a range as well, so there is some limits to how much flexibility someone can gain. (autooo)

Anonymous said...

After weeks of strength training and core training, and intermittent jog/walking, I tried running 2 miles without stopping at a 12 min. mile avg. The first two times I did it, I was tired but fine. The third time I did it, my right knee hurt a little for two days. Three days after that, I ran a 5k - both of my knees hurt for two weeks. I'd like to get back into the running without hurting myself, but don't know where to start. Do I have to start over? - AJ

Private First Class Hudak said...

When I first joined the Army I was sent to a training facility where I broke my knee. I hyperextended it and broke it. With a lot of time and slow retraining of the knee it finally got somewhat better, but I had sever pains due to weak patellar legiments in both knees. I do not know if this is the same issue you have but I fixed it with lots of squats and lunges. The Drill Sergeant loved me.....LOL. Now I am able to run what seems to be infinatly, but I am sure there is a limit.

PFC Hudak

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