How to Help Prevent Injuries in Running

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we'll be talking about how to help prevent injuries in running. Our guest is Dr. Jeffrey Lai, who is board certified in both family and sports medicine and practices as a primary care sports medicine specialist in Long Beach. He is a full-time faculty physician with MemorialCare Medical Group and Head Team Physician for California State University, Long Beach. Welcome, Dr. Lai.

Jeffrey Lai, MD: Hi, good morning.

Deborah Howell (Host): Well, over 64 million Americans jogged or ran for exercise in 2016, including myself and probably you. So it's inevitable that many of them sustained injuries as well. So first of all, why should we run? What are the benefits of running that outweigh any risks of injury?

Jeffrey Lai, MD: Yeah, there's numerous, numerous studies that show that running, even just recreationally, will have numerous specific health benefits, mostly for the cardiovascular. There's a lot of great research and messages coming from the American Cardiology Association and the American Heart Association that has a magic number of recommending over 150 minutes every week of light to moderate cardiovascular activity. And running is just one of the most simple ways to get out and get that exercise. Besides the cardiovascular benefits, there's so many social benefits, there's so many emotional benefits, reducing stress. There's so many other benefits in terms of building strength, building endurance, that just makes running the number one choice for me when I want to go out and do some exercise.

Deborah Howell (Host): It's just that runner's high.

Jeffrey Lai, MD: [Laughs]

Deborah Howell (Host): Most of us think we naturally know how to run. You know, we probably started running shortly after we first learned how to stand on our own two feet. But would you say this still holds true when we take up running as a regular exercise? Or do we need to begin a running program by first unlearning sort of our old patterns and replacing them with new ones in order to help prevent future injuries?

Jeffrey Lai, MD: Yeah, that's a great point. You know, running we think is as natural as walking, and we've all been doing walking since we were little kids. I think what I discover a lot in my clinic is runners get injured. Over 90% of runners will complain of an injury or have complained of an injury in the last 12 months. And so we know that there can be some injuries associated with running. There are some tips and techniques that I like to recommend when someone wants to start running or if someone wants to get back into running, or if someone's looking forward to improving their running technique. And there's a lot of different schools of thought in terms of how to run. But what I like to focus on and what I promote is running tempo. So how quickly your feet are hitting the ground. And then I also like to talk about the posture, because I like to emphasize that you want to be standing straight up, you want to have a slight lean forward, and you really want to have a faster tempo when you're putting one foot in front of the other. There's a lot of good data that shows that the faster your feet move, so not necessarily how long you take a step, but the faster every stride is, the lower injury rates you have. One great visualization that I like to talk about is you want to try to focus on your feet kind of kissing the ground gently with every step, as opposed to plopping your feet down on the ground.

Deborah Howell (Host): Yeah, easier said than done.

Jeffrey Lai, MD: Yeah, yeah. And some of these, it's not to be discouraging at all. Sometimes it takes a while to really come into that natural running technique. But it's definitely something that you strive for. And when you have it, you'll have a lot more what we call running economy, and you'll get a lot more enjoyment out of running.

Deborah Howell (Host): Absolutely. What are some of the most common running injuries?

Jeffrey Lai, MD: Oh my goodness. So the top three that I'll see in my office, we'll see shin splints. And that's a very common one. You might have remembered it from the high school days, but that's where you're really running so much and you get that pain on the inside, the center side of your shins, worse with every step. Now, when you start having pain in your shins, it's always a good idea to take a break, stop, and kind of re-examine how you're running. Sometimes those shin splints can be caused by the type of surface that you're running on, whether it's always on concrete. Trails are sometimes a lot more preferred. Wet sand can be preferred. Sometimes the shin splints are from the surfaces and the angle of the surfaces, if you're doing a lot of hills or if you're doing curved surfaces. Sometimes it could be the footwear that you have. Shoes that are a little bit worn out, maybe your favorite pair that you've been running in for hundreds and hundreds of miles. And then going back to the running technique and the running form, sometimes it's due to just how your running technique and how forcefully every foot is dropping down on the ground. So shin splints, it's always a good idea to take a break, rest it, put some ice on it. The dreaded complication of shin splints is what's called a stress fracture. And once you have that, you're really out for a much, much longer time.

Deborah Howell (Host): It's heartbreaking.

Jeffrey Lai, MD: Yeah, and so that's one of the more common ones that I'll see. The other two that I do want to mention is Achilles tendinitis and then runner's knee, appropriately named. I'll start with runner's knee. Runner's knee is also sometimes called patellofemoral pain syndrome. And what essentially it is, and it's not just exclusively to runners, a lot of non-runners and other athletes can get this condition, but it's pain that happens underneath the kneecap or around the kneecap. And the way that you can think about it is it's a tug of war between the muscles above the kneecap, which are probably a little bit weak and might be a little bit inflexible, and then the other side of that tug of war is your feet and your ankle, which might be rolling in a little bit too much or moving around too much. And what gets stuck in the middle is your kneecap, which kind of just moves around a little bit more than it wants to with every step as you're bending and straightening that leg as you're running. And that causes a lot of pain, inflammation, and irritation right underneath or around the kneecap. That's probably the most common condition that I see amongst my runners. And very easily treatable by looking at how you're running again, your running technique, strengthening some of those quadriceps, thigh muscles, sometimes putting in some orthotics for your feet, and really examining which direction your toes are pointing and how your feet are contacting the ground when you step.

Deborah Howell (Host): Absolutely. Orthotics are a big deal to runners.

Jeffrey Lai, MD: Yes, absolutely. The third condition that I see a lot is Achilles tendinitis. And the Achilles tendon is your largest tendon in your body, and that's what connects your calf to your feet. And you'll always feel it kind of right behind that ankle. And you'll know, because with every step, if you have the Achilles tendinitis, you'll have pain with every step back there. And for that, one of the key contributors to that is just having really tight calves, really tight hamstring muscles, what I call the posterior muscle groups of your legs. And a lot of times for milder cases, simple stretching of those structures will really, really benefit. You can also rest, put some ice on there, take some anti-inflammatories. Proper footwear is also really important to help with the Achilles tendon problem.

Deborah Howell (Host): It brings me to the next question. You mentioned stretching. You know, there's so much information out there. Should we do it before? Should we do it after? Is it important? And if so, what kinds of stretches do you recommend and for how long?

Jeffrey Lai, MD: Yeah, great question. I think the stretching is always one thing that we probably should do more of, but we don't have time to do, if you're a runner like me. I really promote an initial stretch, but it's a certain type. It's a dynamic stretch, as opposed to what's called a static stretch. And one of the things you might remember, again, back in middle school or high school is kind of sitting around a field and being led by your PE coach, being told to touch your toes, and you're sitting down and touch the ground. And those are all very static stretches, and you might just be told to hold that position for 30 seconds, 45 seconds, 60 seconds. There's a lot of good data that shows that when you do that and you're acting on cold muscles and joints, you may actually be doing more harm and you may not be doing any good. So one of the concepts is to do dynamic stretches. And those are stretches that you do while you're still moving. And the most common movement to be doing is while you're still walking, you'll do a stretch on a specific body part. So whether it's a hamstring as you're walking, if you want to stretch the hamstring, you would just kick your foot straight up as if you were in a marching band with a straight leg kick in front. If you want to stretch your quadricep muscles, the front thigh muscles, you would just, as you're walking, try to kick your gluteus, your buttocks area, with your heel with every step. And so that incorporates a little stretching with some movement. And the thought is that that movement kind of warms up those muscles and joints before you put them into a nice stretch. So that's what I recommend before you run. And then after you run, I always promote a cool down period. And that cool down period also just incorporates some stretching. And at that point, once your muscles and your joints are loose, if you want to do some static stretches where you're just holding a position for 30, 40 seconds, that seems to be okay. It doesn't seem to be doing as much damage.

Deborah Howell (Host): Awesome. Is there such a thing as too much running?

Jeffrey Lai, MD: Yeah. In recent years, so I never like to tell my patients that they can do too much running, but there are some really interesting studies coming out where they're looking at ultra-marathoners and elite level marathoners. And if we just go back to the cardiovascular, your heart benefits for running, your overall health and your cardiovascular risk goes down the more you run, in general. And that's going to apply to 95, 99 percent of us, of the general population. Now, for that small population that are elite runners, the marathon runners, the ultra-marathoners who can go 100 miles, because this is kind of a newer trend and a newer type of activity, there is some newer research that shows that maybe if you're doing it too much, there are some changes to your heart that puts you at an actual increased risk of heart disease than if you hadn't exercised at all. So that's kind of a newer concept and we seem to have hit a limit on some of those benefits of running. And so there is a notion that you do it too much. Now that being said, if you're doing 100-mile runs as your typical race, you are definitely putting in a lot more mileage than the majority of the population. So that's kind of an elite level.

Deborah Howell (Host): That is exactly for sure.

Jeffrey Lai, MD: Yeah, yeah, absolutely.

Deborah Howell (Host): Okay doctor, I have one final question for you. What are some of the best ways to prevent injuries?

Jeffrey Lai, MD: Yes. So what I always advise, and this goes for novice runners or folks who are just getting back into running, is to go slow. Nowadays it's really popular, really fun to get involved in marathon races, half marathons, 10Ks. And I love promoting those and telling people to set those as a target. But you have to have a sensible training program that gets you up to the distance that you want to do. So you need to go slow, you need to stay in yourself. There's a very tried and true rule that we like to talk about in running, which is called the 10% rule, which is every week you don't want to do more than 10% of the mileage that you did before. And that can be a very slow, slow progression for a lot of us. But taking it slow is one surefire way to reduce your risk of injury.

Deborah Howell (Host): And we all have our devices now, so we know what 10% is, because we can just check our phones or our device. So no excuses.

Jeffrey Lai, MD: That's right. Whether it's your Fitbit or your GPS on your phone. That's right. There's a lot of technology and gadgets now that accompany running. We used to say running is one of the easiest and most economical ways of exercise because all you needed was a pair of shoes. But I think the last time I was at a race, just seeing how much equipment the other runners had, yeah, that might have changed a little bit.

Deborah Howell (Host): Well, we thank you so much, Dr. Lai, for your time and expertise today. But you know, gotta run. So we really enjoyed having you on the show. And for more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell, have yourself a terrific day.