So You Want to Run?

Posted December 22, 2021 by Nilesh Shah, MD

Running is great cardiovascular exercise and most of my patients start running to lose weight. It is a great exercise for weight loss, and running has amazing positive feedback. You feel better after a run, and as the pounds start coming off, you get hooked. This is when the problems start. As typical human nature takes over, we think: a little is good, so a lot is obviously better.

It starts as an ache — and you keep running. The ache becomes a pain — you keep running (the pounds are still coming off by the way). However, before you know it, the pain is now not going away, and now you miss a few workouts. This turns into a few more missed workouts, and the endorphins you used to experience from exercise are not circulating. Some of the weight is coming back on, and you start feeling down. This is such a familiar story in my office.

How can we prevent this?

There are a few simple rules to follow that will keep you out of trouble, out of my office, and at the gym. When starting a new activity, start slow, and increase the activity slowly. There are three variables you can change in any exercise activity: duration (how long you do the activity), frequency (how often a week you do the activity), and intensity (how strenuously you perform the activity). I have my runners only increase one of these variables per week. Increase in duration should be only 10 percent per week (either time or mileage).

I will also ask my runners to start a core strengthening program if they are not performing one currently. Core strength, simplistically, strengthens the abdominal muscles, lower back muscles, and the gluteal muscles while teaching them to work in concert.

Lastly, I will also have the runner add in leg strengthening exercises. Workout machines are not needed. Work on squats, lunges, and calf raises with just body weight. Using proper technique for the core and leg exercises is essential.

How much pain is too much?

All pain is not created equal. If I waited for every patient to have zero pain to be active, I would not have very many active patients. I feel you should seek a sports medicine provider:

• If your pain is more than a 3 on a scale of 1-10 during running
• If your pain is changing your running mechanics
• If your pain is significantly interfering with your daily life outside of your run
• Or if you have any joint swelling

Any pain less than this can be monitored, and you can continue to train with the pain.

What are the common running injuries in women?

Patellofemoral Pain Syndrome

This is commonly called "runner's knee." It is pain to the front of the knee that is typically worse with running, stairs and with sitting for long periods of time with the knee bent (long car rides, sitting at a desk). Prevent and treat it by strengthening your quads, hamstrings, and gluteals with squats and lunges to stabilize your kneecaps and help keep the pelvis level while you run. For more on knee pain, read Summa Flourish™ tomorrow for a blog by Physical Therapist Kim Koran, PT, DPT, of Summa Health Center at Western Reserve.

Iliotibial-Band Syndrome

Also known as IT band syndrome. It is an inflammation in the band of fibers that run along the outside of the knee to the top of the shin. This will cause pain to the outside part of the knee that is worse with running and with stairs. Prevent and treat it by strengthening the side gluteal muscles. Using a foam roller to perform deep tissue massage to loosen the band will also help.

Plantar Fasciitis

Pain in the heel and the bottom of the foot, especially with the first steps out of bed in the morning. The problem here comes from an inflammation of the tissue in the bottom of the foot. Prevent and treat it by stretching regularly and vigorously — the feet, calf muscles and Achilles tendons. Adding strengthening exercises for the feet will help build the muscles in the region to make them stronger to absorb the pounding that comes with running. Special splints worn at night may help with the flexibility.

Running is a very enjoyable activity that has many beneficial effects psychologically and physiologically. To run safely and pain free, follow the prevention strategies above and watch out for "bad" pain. If you do, your running will continue to be enjoyable. I've personally been running for more than 25 years and have competed in more than 15 marathons relatively injury free following the above advice.

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