Exercise physiologists and coaches will say to get better at running, one must run. This is called the specificity of training. To see improvements in run performance, runners must train according to the task by increasing weekly mileage (Loy et al., 1993). Traditional marathon training plans for recreational runners last approximately 18-25 weeks and consist of 4 to 6 days of running up to 25-50 miles or 40-80 km per week (Chorley et al., 2002). Consistent endurance training in higher mileage running facilitates physiological adaptions that allow for a sustained submaximal work effort for a longer period of time (Gibala et al., 2006). Unfortunately, higher weekly mileage places a runner at risk for injury. According to Van Middelkoop and associates (2008), running injury rates increase with weekly running distances beyond 32 km/week. This is only 19 miles a week of running! Okay, who has trained for a marathon and ran much more than 19 miles a week in training? I am going to assume most people, especially as the long run distance ramps up, not to mention many (not all) training programs run up to 20-22 miles as a long run. Never mind the weekly mileage to support that long run. The problem is that some people are injury prone to begin with, regardless if their body has been loaded with the appropriate training distances at appropriates time by a knowledgeable coach. The bottom line is that some people cannot take the ground reaction force, the pounding of the pavement sustained in endurance running. With that being said, alternative training may be the way to go for some.
If you are recovering from an injury or want to substitute some run miles with cross training that can actually benefit your run performance, this is the blog post for you! Runners tend to go to swimming and cycling to substitute their run training, but if it is not done at a great enough intensity, it cannot work as a substitute for run mileage but a supplement. Substitute meaning instead of running and supplement meaning in addition to running to maintain current fitness. When injured, some runners go to water running, which has been shown time and time again to allow runners to maintain their cardiorespiratory fitness achieved through their run training. This allows you to continue training with 85% less force to the body, but the viscosity of the water creates resistance, to make you still “work”. But come on, it is super boring!
So let’s take a moment to look at some research to see what else you can do to substitute running miles to improve run performance variables while decreasing run mileage volume. I personally love the StairMaster Gauntlet machine most gyms have. I’m not going to lie, the number one reason why I love it is because it gives you a bird’s eye view of the gym room floor and produces optimal people watching. In a 9-week study conducted by Loy et al. (1993), study participants endurance trained on the StairMaster Gauntlet, four times per week for 30-45 minutes at 70-80% maximal heart rate. At the end of the 9-week training, the participants ran a 1.5 mile time trial and researchers observed a 12% increase in Vo2max and an 8% faster finishing time compared to a 1.5 mile time trial conducted at the beginning of the study. So let me crunch some numbers for demonstration purposes. If someone ran 1.5 mile time trial at a 7:00 min/mi pace, they would have good chances of improving their pace to a 6:27 min/mi pace after 9-weeks of climbing the StairMaster for 30-45 minutes, four times per week at 70-80% maximal heart rate. That is pretty good considering none of these subjects ran. Now this study was in fact conducted on non-runners, but I think it is a strong argument that, some run miles can be substituted for StairMaster Gauntlet climbing in injury prone runners to eliminate the ground reaction force, yet at least maintain cardiorespiratory fitness. Also, as a side note, I personally ran my fastest marathon without speed work, but did 40 minutes on the StairMaster Gauntlet, 2-3 times a week. This folks was long before I studied running, performance, or knew anything remotely close to what I know now. Just because it worked for me, doesn’t mean it will work for everyone. Consider that my disclaimer.
A lot of published research on “endurance athletes” is conducted in cycling, instead of running studies. Research by Silder and colleagues (2011) has demonstrated that lower extremity musculature in run/cycle are the same and strength gains in one discipline will transfer to the other. As previously mentioned, many runners substitute running for cycling, but intensity of the activity will determine gains in cardiorespiratory fitness, impacting performance variables. In a 2-week study by Gibala and associates (2006), researchers found that cycling for 30 seconds at maximal intensity for two days with four repetitions, two days with five repetitions, and two days with six repetitions, with four minutes of recovery between reps improved the subjects 30 km time trial by 10%, compared to a 7% improvement in a group of cyclists that cycled at 65% Vo2peak for 90, 105, and 120 minutes for two training days at each time interval. That may not seem like a huge difference, but the most astonishing take-away from this study is that the sprint cyclists total training time over the two week study was 18-27 minutes, including recovery time, whereas the total training time for the endurance cycling group was 630 minutes! I have employed this time saving tactic in some of my run training programs with great success. Again, just because it has worked for some, does not mean it will work for all. Consider that another disclaimer.
This blog post does not imply that using the Stairmaster Gauntlet and sprint cycling is all you need to do train for a marathon. Instead it offers alternatives to substituting some run miles in the injury prone runner or cardiorespiratory maintenance in the off season. Nor does this blog post imply that there aren’t other cross-training activities to supplement and/or substitute run training. Lots of research exists to also support maximal strength training and plyometrics to improve run times. Both yoga and Pilates have a place in marathon training as well as a supplement. All possible subjects for future blog posts of course.
Runner Image: Ricky Roane, Ultra Runner
Chorley, J. N., Cianca, J. C., Divine, J. G., & Hew, T. D. (2002). Baseline injury risk factors for runners starting a marathon training program. Clinical Journal of Sport Medicine, 12, 18-23.
Gibala, M. J., Little, J. P., van Essen, M., Wilkin, G. P., Burgomaster, K. A., Safadar, A., … Tarnopolsky, M. A. (2006). Short-term sprint interval versus traditional endurance training: Similar initial adaptions in human skeletal muscle and exercise performance. Journal of Physiology, 575(Pt 3), 901-911.
Loy, S. F., Holland, G. J., Mutton, D. L., Snow, J., Vincent, W. J., Hoffman, J. J., & Shaw, S. (1993). Effects of stair-climbing vs run training on treadmill and track running performance. Medicine and Science in Sports and Exercise, 25(11), 1275-1278.
Slider, A., Gleason, K., & Thelen, D. G. (2011). Influence of bicycle seat tube angle and hand position on lower extremity kinematics and neuromuscular control: Implications for triathalon running performance. Journal of Applied Biomechanics, 27, 297-305.
Van Middelkoop, M., Kolkman, J., van Ochten, J., Bierma-Zeinstra, S. M. A., & Koes (2008).
Risk factors for lower extremity injuries among male marathon runners. Scandinavian Journal of Medicine & Science in Sports, 18, 69
As a recreational marathon runner I am frequently asked by non-runners, “How are your knees holding up? Aren’t you afraid you will get arthritis in your knee and need a knee replacement from running marathons?” It is undeniable that running related injuries are high, and any other disease or dysfunction at up to 79% within a community would be considered epidemic proportions. The injury rates are scary to me, but what is absolutely maddening to me, is people frequently throwing around the arthritis word as if every and only runners would be afflicted with it. In this blog post I will define “arthritis” and I will offer a glimpse of what the research says about what populations are at greatest risk.
More than 100 rheumatic diseases exist, but the two most common types are rheumatoid arthritis (RA) and osteoarthritis (OA), often times just referred to as arthritis. Although the etiology, risk factors, and prevalence of RA and OA are different, they are both characterized by pain in the joints and debilitating functional limitations (Stone & Baker, 2014). The largest difference in RA and OA is in their physiological mechanisms. The exact cause of RA is unknown and is considered an autoimmune disease which is possibly the result of an interaction between genetic disposition, environmental factors, and chance. RA is a systemic inflammatory disease linked to cardiovascular, pulmonary, and gastrointestinal diseases, in addiction to cancer and is sadly observed more in females (Gibofsky, 2014). The good news is, US studies have noted a progressive decline in RA prevalence since the early 1960s (Helmick et al., 2008).
Osteoarthritis (OA) is distinguished by degeneration of the articular cartilage, progressing to eventual cartilage loss, creating a bone on bone scenario of weight bearing joints, most commonly the knee and hip. OA is the leading cause of knee and hip joint replacement (Rooney, 2004). The cause of OA is multifactorial with the largest contributing factors including, higher body mass index (BMI), previous traumatic knee injury, occupational activity, and increased age (Richmond et al., 2013). I don’t know about you, but I did not see being a runner as one of the largest risk factors associated with OA or joint replacement. Unlike the prevalence of RA decreasing, previous research showed OA increased 22% from 1995-2008 (Lawrence et al., 2008) and continues to rise.
If you have read the “about” section on my website, you know that I work as a registered dental hygienist and I have done so for 19 years. One of the first things I do at the beginning of my patients appointment is to go over their medical history. I treat several patients a week that have had a joint replacement. I can say with certainty that I have never had a patient acquire arthritis or need a joint replacement from marathon running. I think we all are aware of the prevalence of overweight and obesity in our society. Does anyone think that the increase in osteoarthritis may be parallel with the overweight and obesity epidemic? Does anyone think that the increase in osteoarthritis may be parallel with the longer life expectancy due to medical interventions? Does anyone think that there are more traumatic youth knee injuries from early sports specialization more common in the last couple of decades? OA is actually highest in former female soccer players with a previous anterior cruciate ligament (ACL) injury and football players that take traumatic hits and are often times obese. You see large football players and although they may be athletes, I see a Ford 250 Extended Cab truck, rolling around on Honda Civic tires. Imagine it, those tires are going to breakdown sooner than later.
Runners can be at risk for OA if they constantly run through injury without proper treatment and time off, which cumulatively can lend itself to the previous injury risk factor. A runner and their coach if they have one, need to be mindful of the laws of biomechanics I wrote about in my injury epidemic blog post. If you haven't read that blog post, please do. A runner can also be at risk if they have poor mechanics with muscular imbalances. This would be similar to a car having it’s alignment off and the tires wear unevenly. The same thing can happen with the meniscus of the knee. However, these risk factors are extremely low for developing arthritis in the knee if not coupled with higher BMI, previous knee injury, occupational activity, and/or increased age. To say that runners will ruin their knees, get arthritis, or need a joint replacement because of running is a fallacy.
Runner Image: Ara Miralles
Gibofsky, A. (2014). Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: synopsis. American Journal of Managed Care, S128-S135.
Helmick, C. G., Felson, D. T., Lawrence, R. C., Gabriel, S., Hirsch, R., Kwoh, C. K….Stone, J. H. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis & Rheumatism, 58(1), 15-25.
Richmond, S. A., Fukuchi, R. K., Ezzat, A., Schneider, K., Schneider, G., & Emery, C. A. (2013). Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 43(8), 515-524.
Rooney, J. (2004). Don’t get out: Understanding the difference between osteoarthritis andrheumatoid arthritis. Nursing Made Incredibly Easy, 2(2), 26-35.
Stone, R. C., & Baker, J. (2014). ) Physical activity, age, and arthritis: Exploring the relationships of major risk factors on biopsychosocial symptomology and disease status. Journal of Aging and Physical Activity, 22, 314-323.
Yesterday I spent the morning cheering on runners at the inaugural San Diego Beach and Bay Half Marathon. It was a great time and I reached a personal record! That’s right, I reached a personal record in receiving the most sweaty hugs in one day. I could have wrung some of those runners out and had buckets of sweat. Sweating is good though, it helps thermal regulate the body. What is your body losing in that sweat and how should you replace it to help regulate body temperature and metabolic processes? All those sweaty hugs inspired this blog!
Over the years, the recommendations for hydrating during endurance exercise have changed. The first recommendation was to drink, “as much as tolerable”. Dr. Timothy Noakes stated in 2003 that there were 250 documented cases of hyponatremia (low blood sodium) from 1985-2001, with the runners reporting that they had followed the standard recommendation of “drink as much as tolerable”. One is at risk for hyponatremia not only when they sweat and don’t replace it with fluids, but when they sweat and they rehydrate with lots of water only, basically diluting the sodium in their blood. Our bodies are actually made up of 60% water and rehydrating with water is fine if you are running for less than an hour, but when running for more than an hour your fluids should also be supplemented with a sports drink containing electrolytes.
Sweating isn’t just about losing fluid. It isn’t water out, water in, to maintain balance. Von Duvillard and colleagues (2008) refer to fluid balance as a complex process and exercise challenges the body to regulate fluid and electrolytes. The electrolytes, sodium and potassium are important micronutrients for maintaining optimal performance in half and full marathon running. Sodium and potassium replacement are important in endurance exercise not just for hydration maintenance, but for maintaining plasma volume. Sodium maintains or increases plasma volume by improving water and glucose (sugar) absorption in the small intestine, therefore aiding performance variables. Benardot (2012) refers to performance variables as the ability to maintain sweat rate, deliver nutrients to cells, and clear metabolic waste from cells. Yikes! The body is a machine and just like your car, you have to keep it fueled (or charged these days), lubricated, filters in check, tires pumped up, and alignment correct.
Later, Noakes suggested that runners should drink ad libitum, which is as needed, dictated by thirst. However, some will say that if you wait until you are thirsty, then dehydration has already set in. Drink too little, end up in the medical tent dehydrated! Drink too much water and end up in the medical tent with hyponatremia! Drink too much Gatorade on the course, along with salt tablets, and sodium containing nutrition, end up in the medical tent with hypernatremia (high blood sodium)!
So what is the recommended formula? According to the American College of Sports Medicine (ACSM) the current recommendation to best maintain fluid balance and optimal performance variables is drinking 3-8 ounces of water every 15-20 minutes for exercise less than 60 minutes and 3-8 ounces of sports drink every 15-20 minutes for exercise over 60 minutes. This is a pretty large spread and variables that should be considered are metabolic requirements, climate, altitude, duration, clothing, and individual sweat rates (Sawka et al., 2007).
I personally have high hydration needs. I ran eight miles at an aerobic pace and drank 20 ounces of fluids, which was close to 5 ounces for every 16 minutes. This was conservative for my needs, taking the length of the run into consideration. Had I run longer, I would have needed to drink more fluids earlier on to better maintain my hydration status. The key is to play around with your fluids during your long training runs. Keep a log of how much you drank and how you felt during the run and equally important, how you felt the remainder of the day.
Okay, so the next blog will be about arthritis!
Benardot, D. (2012). Advanced sports nutrition (2nd ed). Champaign, IL: Human Kinetics.
Noakes, T. (2003). Fluid replacement during marathon running. Clinical Journal of SPORT
MEDICINE, 13(5), 309-318.
Sawaka, M. N., Burke, L. M., Eichner, E. R., Maughan, R. J., Montain, S. J., & Stachenfeld, N. S. (2007). Exercise and fluid replacement. Medicine & Science in Sports & Exercise, 39(2), 377-390.
Von Duillard, S.P., Arciero, P. J., Tietjen-Smith, T., & Alford, K. (2008). Sports drinks, exercise training, and competition. Current Sports Medicine Reports, 7(4), 202-208.
Since the running boom began 40 + years ago, participation in marathon running events has risen from under 30,000 people per year to 507,000 participants per year (1). How often have you or somebody you know, signed up for a running event and became injured before race day? As marathon participation has risen, so has running related injuries. Sadly, the scientific literature on running injuries notes injury rates somewhere between 19-79% annually. The spread is huge, however much of the literature considers time off from running due to pain as an injury, even when nonspecific in origin. None the less, even at the minimum of 19%, this is far too great. Unfortunately, I have witnessed many times people running despite an injury. Quite honestly, I am not a fan of seeing runners wearing bracing devices. More than likely, if there isn’t an organic structural issue going on, whatever the runner is trying to band aid up could have been prevented or treated with proper run training, chiropractic, massage, gait training, and the assistance of corrective exercises. Bracing and taping often times helps symptoms in the short term, but doesn’t treat the dysfunction and will only initiate a cascade of training setbacks, creating barriers to improvement and goal achievement.
In addition to improper run training loading, too great intensity of running, and too little rest/recovery, many injuries are due to poor biomechanics, such as hip internal rotation, hip adduction (the thigh bone moving towards the midline of the body), and contralateral pelvic drop (pelvic drop of the non-weight bearing leg). Although pain exists in one part of the body, the problem can actually be from a more distant site. I like to imagine muscle imbalances as muscles playing tug of war and the bone is actually the rope. The body will take the path of least resistance, which means that the tighter, overactive muscle will pull the bone in one direction and the weaker opposing muscle will allow for excessive, inefficient movements. This causes improper distribution of the ground reaction force up the kinetic chain or joint segments of the body.
Safe and efficient running requires an optimal orchestration of many muscles and joint movements and their movements are referred to as internal factors related to each individual runner. Part of understanding injury, is understanding how the body responds to forces placed on it. In the study of biomechanics I was introduced to Wolff’s and Davis’ law, which respectively state that bone and soft tissues remodel along the lines of stress. When we typically hear or read the word “remodel” we think of something nice or better. If stress or the load is undertaken in a biomechanically correct form, then the stress will be positive and it will strengthen tissues and bone. However, with poor movements, the lines of stress will be deviated from the intended path and can breakdown tissues and bone, which would in fact be a remodel from its former or intended state, leading to dysfunction. Running with a biomechanically correct stride has positive effects on bone. Bone mineral density (BMD), a measure of bone mass is greater in exercised limbs as a consequence of Wolff’s law, compared to sedentary individuals (2) and females have shown an increase of 0.9% BMD per year in exercised limbs at the loading site of impact (3).
I will admit, I am a bit of a nerd, but knowing this stuff is what helps me correct training errors of my runners and to help keep me out of fracture city like I experienced when I first took up distance running. As mentioned, running is actually good for bone, but not so much if your stabilizer muscles aren’t in good working order to do just that. There are three planes of motion that our bodies move in and running occurs in one, the sagittal plane. I think that an error many runners make is that they neglect some of the other muscles that help support running through stabilizing in the other two planes of motion. Only training the muscles that work in one plane is sort of like the shirtless guy you see running in a 5k with the well-defined chest muscles from his 100 push-ups a day, but as you see him from behind, his back is giggling, without definition. I have seen this friends and it is the oddest thing. Structurally this can create issues. Most people have heard of the piriformis and gluteus medius muscles. These are muscles that runners commonly have issues with and guess what? They primarily move in the other planes of motions, although the piriformis also aids in hip extension in the sagittal plane.
The reasons noted above for contributing to running injuries is not at all a complete list of potential internal and external factors that contribute to injury. However, knowing this information is a great aid in decreasing injury possibilities and building more efficient runners. My runners that are local in San Diego County, receive a screening before starting a marathon training program with me and have proven to be informative and valuable. I can also screen runners that train with other coaches and use other training plans. So don’t be shy to contact me to use my services.
In a blog next week, I am looking forward to giving you the appropriate answer to the question I’m sure every runner has been asked before, ”aren’t you afraid you will get arthritis from running?” Please feel free to message me with questions.
Runner Image: Christian Pratt
1. Fields, K. B., (2011). Running injuries: Changing trends and demographics. Current Sports Medicine Reports, 10(5), 299-303. doi: 10.1249/JSR.0b013e31822d403f.
2. Harrast, M. A., & Colonno, D. (2010). Stress fractures in runners. Clinics in Sports Medicine, 29(3): 399-416. doi: 10.1016/j.csm.2010.03.001.
3. Nevill, A. M., Burrows, M., Holder, R. L., Bird, S., & Simpson, D. Does lower-body BMD develop at the expense of upper-body BMD in female runners? Medicine and Science in Sports and Exercise, 35(10), 1733-1739.
I received an email from a runner today and upon reading it, I thought, “well this is something that is blog-worthy”. Here is a message to me from an anonymous runner:
“I have to confess coach: I have not been following the schedule. We have had long days with early starts, rain, too much beer and not much sleep. I've managed to put in a few miles.”
What I love most about this message is not that she is being honest with me, but that she is being honest with herself. As recreational half and full marathon runners, we typically have a lot on our plate; work, family, volunteer, and run training responsibilities. If we want to do it all, we need to learn to balance it all.
The runner quoted above doesn’t have a time goal for her race and she is happy with doing what she can do with the time that she can commit to training. I get runners that are aiming to run a personal best, qualify for the Boston Marathon, and runners like my example runner. Any type of runner is cool with me, as long as each individual is honest with him/herself, including understanding their inherent ability as a runner. You can train to your ceiling, your natural level of ability, but what that is for me and what that is for runner A, B, C….is different and more importantly, the process to find out what that is takes time and requires both patience and persistence.
In addition to run training, nutrition, health and fitness, future blogs will cover really important topics that help runners achieve their goals, such as realistic goal-setting, ways to foster self-efficacy, which is confidence in your ability to achieve intended results, and learning how to identify one’s barriers to success.
Lots of great information coming in the following weeks, months, and hopefully years, so keep checking the website regularly! Next up, we will be taking a look at injuries in our distant running community. Until then, happy running and feel free to email me if there are any topics you wish to be covered in the future or need some immediate questions answered.
Runner Image: Art Santos
Ouch, ouch, and then I dropped to my knees and crawled to answer the phone on a Sunday morning in December 2005. What is up with my feet and why can’t I bear weight on them first thing in the morning without deep, intense pain? I am one month out from my first marathon, the P.F. Changs Arizona Rock-n-Roll Marathon and don’t have time to deal with any setbacks. On January 15 2016, I completed the marathon. It was such an incredible experience. I swear I saw my entire life pass before me during the 26.2 miles. Although I was happy with the accomplishment, my performance on that day was not reflective of my training. I pretty much bonked at mile 15. I wasn’t experiencing cramping as many of my fellow recreational marathon runners have expressed to me when reflecting on their race experiences, but I was just physically and emotionally exhausted. I clearly remember running past a cemetery on the race route, somewhere between miles 20-23 and thinking in that moment, maybe it wouldn’t be such a bad thing to be on the other side of the grass.
Somehow, I pulled it out and wobbled my way to the finish line and qualified for the Boston Marathon on my first marathon by 44 seconds. Holy smokes, what an experience! The entire training program, the relationships I made, and the race day memories. I can’t forget the nagging experience of my feet hurting for a few more weeks after the marathon too. So what was up with my feet? I finally visited a podiatrist in my office building and he ordered x-rays of my feet. Lo and behold I had stress fractures in both feet, yikes! Yes folks, that is right, not one, but both feet. To be more precise, I had fractures in both navicular bones.
In the 2007 documentary, Spirit of the Marathon, Dick Beardsley makes this statement regarding running a marathon, “when you cross that finish line, no matter how slow, how fast, it will change your life forever”. It absolutely did change my life forever. Maybe not to the same extent as others, but I finished my first marathon training and race with questions and I wasn’t going to be satisfied until I received answers to my questions, including why the heck did I get stress fractures in my feet?! For that reason, my life was changed forever. A couple of years after my first marathon I obtained a personal training certification from the National Academy of Sports Medicine (NASM). A few years later, I pursued a Masters of Science Degree in Kinesiology, the study of movement. My entire focus while in the program was on intrinsic and extrinsic factors related to running related injuries and the fine line between training too little, too much, and just enough to enhance performance and decrease injury possibilities. I have been fortunate to work with a number of recreational marathon runners that have hit performance plateaus, recurrent injuries, or just have received poor training advice through friends, books, popular press, or even worse; uneducated “coaches”. In my experience with runners that seek to improve their run training and racing, there is a reoccurring comment about training books available. They are either too technical for the average person to understand or dry. With that in mind and the urging of others around me, I have decided to include a blog on my website to educate runners and help fuel the fire of those yearning to improve their marathon performance. This blog is my labor of love for helping others and will touch on physiology, anatomy, biomechanics, and nutrition to clearly understand how runners can enhance their run performance and reduce running injury incidence in an effort to meet each individuals inherent potential as a distance runner.