Bonus Q&A: The grind of going the distance

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Enjoy a bonus portion of our Q&A on the risks of long-distance running with John Vasudevan, assistant professor of clinical physical medicine and rehabilitation at the Perelman School of Medicine.

DP: What are some of the injuries that can pop up the day after the race and beyond?

JV: So after the day of the race, of course a lot of times what happens is number one, you can do a lot of muscle damage going that distance and the proper nutrition, not just hydration but nutrition, to kind of replenish that damage is important because if you’re not caring for yourself very well afterwards, you run the risk of additional dehydration.

Marathons in themselves are obviously like any difficult workout — you’re going to feel really sore the next day. A lot of times people will kind of pick up conditions that weren’t serious enough to keep them from finishing the race, [like] knee injuries or ankle injuries.

People come to me with a sort of stress fracture after [marathons], because the adrenaline rush pushed them through to complete it, and then by the next day their body is reacting so strongly to the damage that has been done. It can be quite painful. DP: Is there a greater risk for either gender?

JV: As far as individual genders, overall there’s a trend toward females having more injuries than males, but I wouldn’t hang your head too much on gender.

A lot of times in long-term training with female athletes, the big concern is bone health, and kind of their ability to accelerate their training well, because there’s a relationship between body-mass index, the ability to have your period and the ability to maintain your bone density very well. So a lot of times an athlete who is female, and even [sometimes] a male, comes to me with current stress reactions or stress fractures, and I have to think more not just of the training errors but also [whether or not] there’s an underlying metabolic or endocrine issue, like a hormonal issue.

DP: Should most runners run on their forefoot?

JV: You’re touching on a very interesting subject, which is that of barefoot running or that of minimalist shoes, or forefoot or midfoot running as opposed to hindfoot striking. There’s increasing evidence that’s pointing towards decreasing types of injuries by switching the way you run, so if you run on the midfoot or the forefoot it appears that you’re less likely to get knee injuries or shin injuries. But it doesn’t mean you won’t get injuries — it just changes the kind of injuries you get. It can increase the [number] of foot injuries.

What I tell people is that number one, there is no magic in what kind of stride you pick as long as it’s not giving you recurring injuries. People who want to switch are people who keep running into trouble one way, and if you manage to get them to switch their pattern, they may avoid some injuries. If it ain’t broke, don’t fix it.

Don’t think that everyone has to run on their footfoot or their midfoot, and there’s no magic in the shoe type, either. The big mistake people make is [thinking] the shoe looks cool and it’s a good running shoe, but they don’t match it to the way they run. If you tend to run on your heel when you run, you shouldn’t be running a minimalist shoe, because you’re just going to increase the injury rate that you get.

DP: Two young girls ages 10 and 12 are running marathons in under 4 hours. Is that something you would advise against?

JV: A marathon is a very physically demanding sport to participate in and some people may argue that it’s an ethical concern to have children running such distances. My main concern is the one thing it [whether or not] the child had been through puberty. So a lot of times what the danger of this thing is [that] if you do that kind of distance, my presumption is that you’re not doing much other activity.

The more we learn about creating healthy bones that are going to last you for a lifetime, the more rotational stresses you place on the bone — doing things like tennis or soccer or basketball, and things that aren’t just going in a straight line like running — the more you can do that, the more you’re going to be able to fortify your bones to last you a long time.

A lot of times when there’s a runner in middle school who is a really good runner and wants to be a professional runner, the advice [they] should be receiving is play soccer, play basketball. Run when it’s the time to run, but you shouldn’t be doing that exclusively all year round because it’s those people who by the time they get to college, their bone structure isn’t enough to accommodate the demands that an elite level runners is going to need.

The takeaway points that I really want to stress are, it’s really important to know early on what your style of running is, what your deficiencies are in terms of strength or the way your foot hits and to try to prevent rather than wait for injury.

For people who are just starting to get into running, if they start running into trouble, it’s so much more important to come in early and identify what’s going on because a lot of the injuries that can plague runners can plague them for a long time unless you kind of get on to it on the early side ... You may have to miss one race in order to make the next 50, and that’s a hard thing to do.