By: Jonathan Zimmerman PT DPT | Contributing Author | Paulseth & Associates Physical Therapy Staff Member
If you venture down to the Santa Monica boardwalk just after sunrise on a random weekend morning, you will see something that really impressed me the first time I came upon it. People from all walks of life, all shapes and sizes, and all levels of fitness are out there running, jogging, and walking up and down the coastline in giant packs. These people are smiling, socializing, and believe it or not, they’re simultaneously working out! They’re enjoying every minute of the beautiful scenery, the wonderful fresh air, and the chance to do something healthy for their bodies in a social setting. This is the joy of running. If you haven’t tried it, or you think this type of exercise is impossible for you due to previous injuries, your current health status, or because you simply don’t think you like aerobic workouts, think again after reading this article. CHALLENGE?
“As beautiful as it is to see persons of all different levels of fitness beginning walking, jogging, and running programs, there is inevitably a certain amount of risk involved from an orthopedic perspective, and that’s what I would like to address in this issue of the Paulseth & Associates Newsletter.”
First of all, I see it very often where persons become scared off too quickly from beginning a running program. Whenever we start a new form of exercise, no matter what type of shape you may be in, there will likely be underdeveloped muscles that are important for that specific exercise that you may not have used in this manner with any other types of exercise. In running specifically, the Gluteals (the rear-end), quadriceps (thighs), and the calf muscle groups are perfect examples of muscle that may become sore when beginning a jogging/running program. For example, think about the first day of skiing of every winter season. It does not matter that you had been hitting the gym on a daily basis and that you rock climb every weekend, nor does it matter that you walk up 6 flights of stairs every day to work without breaking a sweat…after that first day of skiing you come home and you are sore for at least 24 hours. Why is that? Skiing is a completely different challenge to your body, and with these new challenges to your joints and muscles, come completely different locations of joint stress and muscle loading. Running is exactly the same way. When one begins a running program, one can expect a learning curve for their body. This is why exercise physiologists recommend new runners abide by the “10% rule.” This rule says that joggers/runners advance their total weekly running amount by no more than 10%. Large studies have shown that 80% of running injuries are caused by too much of an increase in mileage. Follow the 10% rule and you can likely avoid becoming part of that statistic.
The age old question in exercise physiology also happens to be one that nearly every one of my runner patients ask me, “Jonathan, should I stretch before running?” It’s a valid question, and one that physiologists have been studying and struggling with for generations. The answer to this question may shock you. The current state of exercise physiology literature continues to contain almost zero evidence that stretching before exercise can prevent injuries. It’s true. So am I saying that the next time you run, you should simply tie up the shoelaces and hit the pavement without any preparation? Definitely not! The most recent studies done by experts in the running physiology world have all suggested that a 3-5 minute warm-up seems to be the best way to prevent a soft-tissue injury. Warm-up exercise should be similar or identical to the activity you are about to perform, so in our case of running, a short jog at a slower pace will be most effective. For a running athlete who usually runs at a 10 minute mile pace, he or she will want to warm-up at a 13-14 minute mile pace. And of course, do not forget to perform a walking cool-down at the end of your run for another 3-5 minutes. This will take advantage of the skeletal muscle pump (using your own muscles to push blood through your veins back up to your heart) to prevent pooling of blood in the lower extremities. This brings us to the other inevitable question my runners ask me, “So Jonathan, are you telling me that I don’t need to stretch?” No. While running, the muscles in your body literally become warmer, effectively increasing the extensibility, or in other words the elasticity, of your muscles. Stretching should take place at the conclusion of the run or on a non-running day, when it will be more effective, and it should be done statically (zero bouncing) and held for at least 30 seconds for each tight muscle group. If there is a particular muscle group that is tight, stretch it with higher frequency and don’t be afraid to stop during your run and perform a 30 second stretch or two. I know that 30 seconds seems like a long time to hold a stretch, but large scale studies done in the past several years have consistently shown that if you are not stretching for 30 seconds, you are simply not going to be effective. In fact, some studies have shown that 60 second stretching seems to be even more effective, but don’t worry, I’ll be satisfied if you can give me a good 30 seconds.
Prevention of injury in endurance running/jogging/walking goes beyond warm-up, stretching, and managing your mileage. There is an incredibly long list of factors that weigh into injury prevention, many are difficult to adhere to, but most are very simple things you can follow when going out on your run tonight.
Footwear: Peer-reviewed studies suggest that the single most important factor of a good running shoe is in the subjective report of comfort. In other words, are the shoes comfortable when you’re running? Remember that running shoes that are built with an increased lip in the toe and one on the heel are made for higher velocities, whereas the flatter lip and heel is going to be geared for walking or slower jogging. I also suggest changing your shoes every 300-400 miles, which is much less mileage than the typical runner will use a shoe for.
Running Surfaces: Whenever possible run on flat, soft surfaces. Yes, a treadmill is very soft. For those of you who must run through the neighborhood, if its safe, run on the asphalt pavement, it is MUCH softer than the concrete on the sidewalk!
Cross-Training: You really like to run, but you can’t take the impact of running on consecutive days or more than 2-3x/week? No problem, keep up your endurance and train your cardiovascular system by adding elliptical or bicycling exercise to your fitness program.
Resistance Training: It has been established that utilizing free weights, or some form of resistance training, can reduce the chance of injury from running. Just like starting a running or stretching program it is wise to commence a lower extremity and trunk resistance program simultaneously and build up as you do miles. The program should include calf, toe flexor, arch lifting, quad, hamstring, trunk at neutral, and of course, glut exercises. Check our website exercise area for suggestions on these.
Body Weight: While running or jogging the forces of impact on your joints can be up to 5-6x your body weight through the joints in your lower extremities! Eating a healthy diet and losing 5 pounds can take 20-30 lbs of force off your joints with every step. When you think about the fact that a mile run typically consists of 1500 foot contacts (750 per foot), there is something to be said for losing a few pounds to prevent an injury during running/jogging.
Sleep/rest: Keep in mind that the human body has an incredible ability to heal itself without any help from outside sources such as pharmaceuticals, natural remedies, or electrical stimulation. In fact, nearly all tissues in your body are constantly remodeling themselves as you’re reading this article. The majority of our tissue remodeling however, occurs while we are sleeping. Maintaining a healthy sleep schedule will allow your body to keep up with the regular breakdown of tissue that is occurring with endurance running programs.
If you try these simple steps and keep things in MODERATION, you should be able to enjoy your run and not view it as a tedious task that is too easy to skip each day. Remember, if you have questions about your running program or if you have a pain that has not gone away despite resting, icing, etc then please call our clinic to discuss a variation on your program.
About The Author | Jonathan Zimmerman PT DPT – received his Doctorate of Physical Therapy degree (DPT) from Mount Saint Mary’s College, Los Angeles in 2009. During his graduate work, Jonathan was selected to complete his clinical affiliations at multiple highly respected clinics in the outpatient sports orthopedics community, as well as receiving well-rounded experience at prestigious settings such as Huntington Memorial Hospital in Pasadena in an acute-care setting, and at Kaiser Permanente in the managed care patient population. As an undergraduate at Northern Arizona University in Flagstaff, AZ, Jonathan majored in Exercise Science and worked with multiple collegiate athletic teams. Jonathan was also involved with an adaptive recreational training program for youths and adults who were persevering through learning and movement disorders. When Jonathan’s not at work, you will either find him on the golf course, or spending time with his family in Orange County, CA. Jonathan’s treatments typically contain a blend of manual therapy, therapeutic exercise, and movement science principles to provide the most effective plan of care specifically tailored to each patient. Jonathan prides himself on emphasizing evidence-based practice using the latest Physical Therapy research as a basis for all evaluation and treatment techniques.