We are thrilled to bring you answers from experts at Hospital for Special Surgery to questions on injury prevention and treatment, nutrition, and recovery. Their guidance and advice are designed to help you run to your best potential and to give you the tools you need to recover quickly from injury.
Located in New York City, Hospital for Special Surgery (HSS) is ranked #1 in the nation for orthopedics by U.S.News & World Report. HSS serves as the official hospital of New York Road Runners for the TCS New York City Marathon, offering educational programming related to injury prevention. For more information, visit www.hss.edu.
When running long distances, like a marathon, the three main nutrients your body needs to keep going strong are fluids, electrolytes, and carbohydrates. Salt, particularly sodium, is the primary electrolyte lost when you sweat.
Your first appointment with your physical therapist is arguably the most important. Your therapist will ask you a detailed history of your injury. The subjective portion, or the question portion of the evaluation, is invaluable.
There are 20 different amino acids—some we can make on our own; others we must get from our diet. When it comes to sports performance, we tend to focus on the three branched-chain amino acids (BCAAs).
The fundamentals of any pre-race meal are: carbohydrates, moderate protein, fluids, and electrolytes (sodium is most common electrolyte). For those with sensitive stomachs, less fat and fiber would be beneficial, as well as having a liquid-based breakfast (i.e. smoothies), which is more easily digested.
The next generation of runners is beginning to find the love and joy in lacing up and going for a run. The research has shown that a regular running program in children will improve concentration, quality of sleep, endurance, and cardiovascular fitness. Running is a great tool to build strong minds and bodies in today’s youth.
It’s race day. You’re excited. You’re nervous. You’ve probably gone to the bathroom more times this morning than you usually do all day. This happens and is absolutely normal. Your body is revved up, and when the gun goes off, it can be tough to rein in all the excitement and nerves.
Energy gels are primarily a source of carbohydrates (carbs), one of the three main nutrients endurance athletes need during prolonged activity, in addition to fluid and electrolytes. Carbs are our muscles’ (and brain’s) primary source of fuel, much like gas in a car. And to continue to the car metaphor, our bodies can store a certain amount of gas in our tank (muscles and liver), called glycogen.
A tempo run should be “comfortably hard.” If you are unsure of just how hard “comfortably hard” is, I recommend using any of the following three methods to pace your tempo run.
When running is not in the cards, and you don’t have access to a treadmill, it is a perfect time to implement some cross-training and body-weight-resisted exercises. Just because you aren’t pounding pavement does not mean you can’t get a great, blood-pumping cardiovascular workout!
The answer to this is simple: Of course you should! You should protect your skin from the sun no matter what time of year it is. We tend to shy away from using sunscreen during colder months; however, the dangerous rays of the sun—UVA and UVB—are just as strong this time of year as they are during the summer.
Nothing can replicate running hills other than running on hills, but if you live in a flat area, you have a couple of options.
Yes, winter activities can benefit your running! Although we would like to hibernate like bears in the winter and spend all of our time by the fireplace roasting marshmallows and staying warm with hot chocolate and blankets, winter activities can be quite beneficial to your fall and spring race schedule!
Deciding when to take that first post-marathon run, or do any workout, really depends on how your body feels—and only you know that. Some runners may be fine a few days after the race, while others may continue to feel the effects a week out. In either case, the body needs time to rest and repair.
Low back pain after long runs can be caused by multiple factors. In order to treat and prevent it effectively, you need to determine the exact cause of your symptoms.
High-quality carbohydrates are easy to digest and should be your main source of fuel. Moderate protein helps you feel satisfied, but it won’t weigh you down. Low intake of fat and fiber is encouraged, as both take much longer to digest, and could potentially cause you to feel sluggish or, worse, cause some serious GI distress.
Both novice runners and seasoned marathoners alike have all struggled with nagging injuries such as runner's knee, iliotibial band syndrome (ITBS), hip bursitis, Achilles tendonitis and other kinds of tightness or aches. These injuries are commonly caused by restrictions of fascia, a layer of fibrous tissue that surrounds the muscle.
During running, the hip flexors raise the thigh and lift the foot off the ground, helping to spring the leg forward into the next step. As well, the hip flexors have an impact on the spine and may help us maintain a proper posture.
When to replace your running sneakers with a new set of wheels can be a difficult decision to make, and at times, confusing. The general rule is to replace them typically between 300 and 500 miles.
Most first-time marathon runners go into the race with the mindset that they will only run one marathon in their lifetime. They think of it as something to cross off of their bucket list. However, for a lot of runners, that first marathon can be such a positive and rewarding experience that they wind up wanting to run another one (or ten).
While the term “clean” can have different meanings, eating a nutrient-dense, varied diet—veggies, fruit, lean protein, whole grains, and healthy fats—is a cornerstone to fueling your body on a daily basis. The issue with consuming large quantities of processed foods is that they may not contain the nutrients your body needs to train and recover optimally.
There are many different types of running drills, all of which are geared at trying to improve foot turnover, increase efficiency, and improve running economy. Long, slow runs are really the bread and butter of marathon training, but those slow miles can make you feel sluggish. Leg drills can help to build strength, increase neuromuscular timing, and make you more aware of your running form.
Cross training can be a vital tool for runners to improve their performance, reduce the risk of injury, or burst out of a boredom bubble. It provides an opportunity to use muscles in different motor patterns and improve your strength and flexibility.
A hamstring strain is an extremely common injury many runners have experienced at one point or another in their course of running. I tend to refer to this injury as the "sleeping giant" and here is why: After the initial injury, most runners take time off to rest the muscle.
For runners in particular, the benefits of stretching have been a hotly debated topic. There is recent evidence suggesting that stretching before a race does not decrease your risk of injury. With that being said, the body does need to warm up before racing help to prepare the muscles that are being used for the run. There are two types of stretches you can use to warm up muscles: static stretches and dynamic stretches.
Many people may be intimated by hearing 10,000-step goals when first using a fitness tracker. Let’s be honest, 10,000 is a BIG number! If your goal is to complete a 10K race, you will take around 10,000 steps in the race alone.
First and foremost, when training for any sport or competition, it’s important to make sure you eat enough. This goes for all runners—athletes and weekend warriors alike. But when dealing with low bone density, there are a few things to keep in mind.
There are benefits in taking walking breaks while running. Periodic walking breaks can help to make you a better runner and improve your time as well as your endurance. Walking breaks give your legs a chance to actively rest, which can then allow you to run further with better form.
There are many potential hazards runners face daily, such as hydration, blisters, or any number of overuse injuries; one huge factor that is often overlooked is the sun! As the summer comes around, more and more people run outside but are unprepared for the dangerous rays of the sun.
Biking or swimming as cross-training is meant to give your body a break from running while still stressing the cardiovascular system. Therefore, it shouldn’t equate to running. When cross-training for the cardiovascular system, consider going for time, but don’t stop there.
As you're training for a race, you may be increasing your weekly mileage. With an increase in activity comes an increase in risk for activity-related injury, and many factors can increase or decrease your risk of running-related injury. Running on harder surfaces is one factor that can increase joint loading, particularly at the ankle and hip joints. When finding a softer running surface is not an option, it is important to reduce your risk of injury in other ways.
Recovering from any race is an important part of the entire training program and should never be discounted. However, there is no strict recovery protocol to follow after a race; this is because the amount and type of recovery you may need changes depending on how you feel after you cross the finish line, and on how well (or not) you trained for that particular race.
Standing all day is not the answer. The focus is on movement. Changing positions regularly is a good idea for office workers. Our body is not designed to be in one position all day, so a combination of sitting and standing is best. The posture you sit or stand in all day will influence the posture in which you run.
Ice and cool whirlpools have been staples in athletic training rooms for high school, college, and professional athletes worldwide for years. Ice, ice baths, and more popularly-termed “cryotherapy” have shown a recent focus on using such methods for recovery and injury prevention. But are ice baths truly helpful?
We know we need to hydrate and fuel up before a race to perform well. But what about during a race? With all the options, information, and recommendations out there, it’s difficult to determine the right method.
The cold weather can make for some difficult runs if not dressed appropriately for the conditions. Because the body generates heat when exercising, a general rule of thumb to consider when running in cold weather is to dress like it is 20 degrees warmer than it actually is.
Strength training is a great way to maximize performance and minimize injury for runners. Running involves repetitive movement and is done mostly in a straight line. Incorporating a strength training program that focuses on the lateral and rotational stabilizers of the core and hips is critical for efficiency and injury prevention.
The best time of day to run depends on many factors, and can vary from person to person. In general, it is difficult to find time to run between work, responsibilities, family, and friends. For this reason, many runners lace up either in the early morning to start their day, or in the later evening, as an end to it.
When the temperatures start to drop, many runners complain about discomfort and/or burning that they may experience when running in colder temperatures. Runners are often nervous or fearful about this cold air getting into their lungs.
Having gastrointestinal (GI) issues (i.e. gas, nausea, diarrhea, etc.) during or after endurance activities is common—studies suggest 30 to 50% of athletes may be affected, with greater prevalence in longer duration events. Current research has boiled down the cause of these stomach problems into three potential explanations: physiological, mechanical, and nutritional.
Running a marathon is a big accomplishment, and it also takes a big toll on your body. Even though the race is over, the strategic training is not. Just like you took care of your body for the months leading up to the big day, you need to take care of it now.
As a sports medicine physician, I often see patients in my office the days following the marathon with aches, pains, and fatigue. As a runner who has run more than 30 marathons, I have been one of the sickly "post-marathon hobblers" in the days after the race. Over time, I've learned some tricks to ease the post-race recovery period.
First, let’s understand the two most common types of stretches. Static stretching involves putting a muscle on stretch and sustaining that hold for a period of time. Research has documented a hold time from 15 seconds up to several minutes. Dynamic stretching occurs when you repeatedly move a muscle group through its range of motion while feeling a stretch at end range. Examples of dynamic stretches are walking lunges or straight leg kicks.
One of the great things about marathon training is the few weeks leading up to the race. You already put the time and mileage on your legs, and now it’s time to relax and get excited for race day! All of your training over the last few months has prepared you to run the 26.2 on November 1, so don’t worry—tapering is the time to refresh and prepare physically and mentally to run the streets of New York.
There are many ways to start preparing your body mentally for that extra marathon distance. You’ve spent months training your body, but those last few miles—when your body is fatigued and you begin to question yourself—is when the real work of the marathon begins. It truly is “mind over matter” at this point, and it’s the hardest part of your training. Here are a few tips to help with mentally preparing yourself for the best 26.2 of your life.
Achilles tendinitis is common in runners who have tightness in their calves. It’s likely that the pain in your Achilles has come on gradually over time, and you may also feel pain when climbing stairs or after sleeping or sitting for long periods. You may also notice a bump either within the tendon or right behind the heel bone, and you may find that certain shoes bother the tendon by rubbing against the bump.
You have probably heard by now that High-Intensity Interval Training (HIIT) is capable of providing participants with amazing results in losing body fat and improving fitness performance. Popular fitness programs like CrossFit, Boot Camps, Orangetheory, and Hard Exercise Works use high-intensity training as their basis for success. Many endurance athletes may wonder if this type of training will benefit their sport.
IT band syndrome is a very common injury that plagues runners, especially as they increase their training volume, and it can be quite painful. Training should be adjusted to tolerance. If it continues to hurt, decrease your intensity or volume, but even if it doesn’t, proceed with caution.
Core strength is CRUCIAL, not just for training for a marathon but really for any kind of running. Think of your deep core as a natural corset to support your spine, providing a strong foundation to support your body through high-impact activities like running and to help your body perform at a higher level. Having a strong core will make you a more efficient runner, help prevent injuries and pain, and reduce stress to other parts of your body as you run.
The TCS New York City Marathon is full of hills, mostly in the form of the bridges that connect the five boroughs. Performing hill workouts, specifically ones of longer distances (up to half a mile) is essential to prepare not only your body, but also your mind for the course.
CrossFit is a great form of cross-training for runners when done safely. CrossFit combines strength training, Olympic-style weight lifting, plyometrics, gymnastics, and aerobic endurance. It is important to research the credentials and experience of any coach or personal trainer you work with.
Refueling to support muscle recovery is important. The sooner you eat and drink after a race, the quicker you will recover.
It’s important to assess what kind of tired you are feeling. Are you feeling physically or mentally drained? “Feeling tired” is subjective, and it’s important to recognize your threshold and listen to your body.
It can be difficult to distinguish between muscle soreness and a more serious injury, such as a stress fracture, since they may initially present in a similar fashion. Both commonly occur after a change in activity. Examples of this are an increase of frequency or intensity of an activity, initiation of a new activity, change in terrain or external conditions, or alterations in equipment.
Ever go for a run, or worse, you’re in the middle of a race, and all of a sudden you feel a sharp pulling sensation in your side that stops you in your tracks? Commonly known as a side stitch, this pulling is thought to have a variety of causes, including contraction of the diaphragm or the visceral ligaments, drinking energy drinks with high sugar content, and eating meals high in fat right before you run. However, none of these causes is proven.
With so many different diets these days, people often wonder which to follow. I recommend that runners who are training for a 10K (or any distance) focus not on one specific diet, but on consuming a balance of carbohydrates and lean protein. This type of diet will give you the energy to train and will help you recover after runs and on race day.
Up to 72 hours after running, you can experience Delayed Onset Muscle Soreness (DOMS). DOMS manifests as pain and stiffness felt in the muscles several hours to days after strenuous exercise.
Finding yourself slowing down in the last few miles of your half-marathon can be disappointing after all the training time. I have some tips for you to make sure that doesn’t happen again.
Achilles tendinitis is common in runners who have tightness in their calves.
The key is balance. Smart organization of strength training, cross-training, and rest into your week will allow you to increase weekly mileage and successfully and healthily complete 13.1 miles.
While it may take a little extra thought and planning, a vegetarian diet is more than adequate to meet a runner’s calorie and nutrient needs.
Caffeine is one of the few substances with good research showing its effectiveness in improving endurance performance, mostly through its effects on the central nervous system and decrease in perceived fatigue.
Incorporating core exercises is a great way to help prevent injury while maximizing performance as you train for the United Airlines NYC Half.
When it comes to running shoes, the general recommendation is to replace shoes every 300-500 miles. Keeping within this timeframe prevents excessive wear, which can lead to injury.
You spend months training for a marathon, obsessing over the run, changing your diet and sleep patterns. But how much time do you spend recovering, or even thinking about the recovery process?
The “five fingers” shoes are minimalist footwear that more closely resembles barefoot running when compared to regular shoes. These shoes may allow for higher performance, as they weigh less; thus you expend less energy every time you lift a foot. However, this lightweight design also exposes the foot to more stress, and you may put yourself at a higher risk of stress fractures.
The soreness that you feel after a marathon is known as Delayed Onset Muscle Soreness (DOMS). DOMS is commonly thought to be caused by the body’s inflammatory response to micro-tears in muscle fibers resulting from activities like running,
Leg cramps—involuntary muscle spasms (contractions)—during a marathon can be very debilitating and painful. Runners commonly get them in the calves, hamstrings, and quadriceps muscles, and they often occur in the last few miles of a marathon or a long training run.
The challenge of treating tendinitis is that there’s not always the inflammatory component that the name suggests. As a result, the injury does not always respond to traditional anti-inflammatory treatments. Fortunately, there are many treatment options available.
Use your training runs as practice for the marathon. Simulate how you plan to manage your electrolyte intake, water stations, clothing, and even your meals the night before and the day of the race. This is valuable time to make your race-day plan.
Training for a marathon is a lot of work, so it can be surprising to some people to find they actually gain weight during the process. While you may find yourself eating more than normal during training, this is not necessarily the reason for your weight gain. There are a number of other factors that can lead to weight gain, some of which are beneficial
Iron deficiency, or low iron stores, is the most common type of anemia. Studies have found that iron deficiency is prevalent among endurance athletes, particularly runners. Iron is a trace mineral that is a major component of red blood cells and carries oxygen to muscles and tissue.
Heart rate monitors are popular among runners and other endurance athletes. Before spending money on the equipment and time learning how to use it, you should first understand what a heart monitor is capable of doing and how it can be used as a training tool.
It’s normal to feel fatigued during marathon training, especially when your mileage at its highest. But if you feel tired all the time or experience other overtraining symptoms, take a few days off and see if that helps rejuvenate your body.
Running a marathon takes a lot of preparation, discipline, and hard work. It can be very easy to lose sight of the fact that running is supposed to be fun! To stay mentally strong during a marathon, you have to enjoy what you’re doing.
Recovering from an injury is an exercise routine in and of itself. It takes discipline, patience, and an incredible amount of self-control. When you’re nursing a running injury, it’s important to partake in what physical therapists call “active rest” in order to come back strong.
To recover properly and treat post-race ailments to be sure that you’ll be ready for your next race, follow the usual steps of rest and a gradual return to running and training—with added emphasis on treating any specific areas that are bothering you.
There are few better experiences than feeling strong throughout a race and meeting a goal time. In one survey, 87% of respondents reported having wrecked their race goals by going out too fast at least once.
Summer’s coming, and so is the hot and humid weather. What should you wear when you run? How should you hydrate? Summer presents its own set of unique challenges for runners.
Whether you’re preparing for your first 10K or looking to achieve a new personal best, cross-training can be of benefit.
“Runner’s knee” is a catch-all term for anterior knee pain, which is common in runners, particularly those who are increasing their mileage.
Ten kilometers is a challenging distance, especially for those who are new to running it.
Post-race recovery is a process that begins as soon as the race is over and ends up to several weeks later.
Running is essentially jumping from one foot to the other over and over. This is a plyometric workout in itself. To help your running become more efficient, start by adding strength training, flexibility and mobility exercises into your routine.
Despite the absence of previous running injury and running as naturally as possible, inefficient running form could lead to injury down the road.
Ankle sprains are very common and usually take from two to six weeks to resolve, depending on the severity of the injury.
Deep-water running can be used as a form of cross training, and it’s easier on the body due to the absence of any weight-bearing while you’re suspended in water.
Training for a race is like studying for an exam: You get the best results when you’re able to practice in the same or a similar environment to that in which you will be tested.
No two runners' overuse injuries are exactly the same, but there are some generalizations that can be applied to prevent future overuse. Let me start with the most serious one in your situation first. The fact that you have had stress fractures (plural) is a bit worrisome.
DOMS—delayed onset muscle soreness—can last a few days after the race or even up to one or two weeks. A marathon is a huge stress to the body, and the damage can last up to a month or longer even when the pain goes away. It’s important to have a plan for recovery.
This time of year, as marathon season peaks, I see hundreds of runners each month in my office complaining of “shin splints.” When runners increase their workout intensity or change surfaces (dirt, treadmill or pavement) they can find themselves faced with this common overuse injury.
The running analysis and VO2 max tests are excellent ways to measure how you are currently training.
You are right to recognize that as your mileage increases so too should your food intake. A basic rule of thumb is that for each mile, caloric needs can increase by 100.
It is often a struggle to find a balance between training for a marathon and the rest of your life's demands. Work and/or weather constraints can often lead runners to train on treadmills.
Feeling the after-effects of a long training run for two or three days certainly doesn’t mean you’re doing anything “wrong.” Microscopic muscle damage occurs as a result of impact forces sustained in a long run, and the inflammatory response that leads to muscle repair peaks 24 to 72 hours after the run.
Cross-training means including a variety of activities in your training routine, and there are many potential benefits to training this way for a marathon.
Runner’s knee (also referred to as anterior knee pain or chondromalacia patella) causes symptoms in the front of the knee around the kneecap. A variety of causes may be implicated, including lower-extremity muscle imbalance, flat feet, and/or kneecap misalignment.
If you’re running out of energy during your long runs, a few things could be going wrong in your training—including overtraining, poor nutrition, and pacing issues. Don't worry, though; all of these things can be solved so race day feels great!
The best way to bounce back after twisting your ankle is to start with the classic RICE: rest, ice, compression, and elevation. If you can walk without significant pain, you should be back to normal within a week or two.
Acupuncture is frequently and effectively used to treat painful sports injuries, including tight or sore muscles that may result from exercise. There are many different acupuncture styles and techniques used to treat various conditions.
When approaching a race in the final weeks, it is most important to trust your training. The week before the race, you’ll want to taper down your mileage to rest your legs for the main event.
The keys to running a successful 10K are preparation and planning. Your individual strategy for the race depends on choosing an appropriate goal, and to do that, you need to have a good idea of your current ability level..
Consuming enough calcium is important for bone health and athletic performance. This mineral is essential for maintaining strong bones and teeth, and it also plays a key role in hormone action, blood clotting, muscle contraction, and nerve function.
ITB stands for iliotibial band. It’s a strong, thick strip of connective tissue that runs along the outside of your hip down your thigh to your knee. Muscles of the hip and pelvis attach to the ITB, which attaches into your kneecap and to your shinbone on the outside of your leg close to your knee.
If the farthest you’ve ever run is three miles, doubling that distance can seem daunting, but you’re halfway to your goal! Here are some tips to help you increase your mileage:
Consider the effects of strength training on running performance. Registered clinical exercise physiologist, exercise specialist, and exercise test technologist, Polly de Mille has your answer.
Seductive claims abound that promise superior athletic performance. Sports nutririonist Heidi Skolnik provides advice on sorting out health claims.
Dr. William Briner covers what kind of shoes to wear during half-marathon training and on race day.
Even on chilly days, you’re losing fluids out there. A Hospital for Special Surgery expert explains how to get it right.
The Kinesio Taping® Method was developed by Dr. Kenzo Kase in 1979. It has become increasingly popular among professional and recreational athletes in recent years.
A Hospital for Special Surgery expert weighs in on the benefits of “compression” clothing for runners.
Supplementary exercises can help prevent many running injuries. Running is a great way to build cardiovascular endurance, but it doesn't do much to build muscle strength. Strengthening your legs and core can decrease the likelihood of developing some of the common aches and pains that runners go through. Here are examples of such preventative exercises.
The type of running surface, quantity and intensity of training, and type of running shoes may all influence the incidence of injuries in runners. Recent research in this area shows that more compliant or flexible running surfaces, such as grass, may reduce the total stress on the muscles and joints when compared to more rigid surfaces like asphalt and concrete.
The link between massage and sports performance and recovery goes back to the time of ancient Greece. Sports massage has been used to treat pain, soreness, and stiffness associated with athletic injury and training, as well as for injury prevention. It is believed to potentially increase blood flow to the muscles, decrease swelling, reduce muscle tension, and increase a sense of well-being.
Foot, ankle, lower leg, knee, hip, and lower-back problems are often treated with orthopedic appliances called orthotics. Prescription orthotics are medical devices inserted into shoes to correct an abnormal or irregular walking or running pattern. Orthotics work like shock absorbers to remove pressure and stress from painful areas in the feet and ankle and promote the proper alignment of the feet.
Iliotibial band friction syndrome (ITBS) is a reactive inflammation under the iliotibial band, just above where the lower part of the thigh bone meets the knee. Managing the symptoms (pain, sometimes cracking or popping noises) can be as simple as rest but may extend to medicines and/or injections, and in extreme cases may require surgery.
We are thrilled to bring you answers from experts at Hospital for Special Surgery to questions on injury prevention and treatment, nutrition, and recovery.
Stress fractures are micro-cracks in bone that occur when a bone is faced with more load, or "stress,” than it can handle. The most common sites of stress fractures are the bones of the foot and lower leg, but they can occur in virtually any bone, including the femur (thigh bone), pelvis, and back.
This question is actually very common. One of the likely sources of the pain is the kneecap or patella. Every step you take walking or running, your patella “tracks” in a groove at the end of your thigh or femur and the movement of the patella can become altered. Other potential sources of the pain, besides the kneecap, would be related to a tendon.
Foot pain with the first few steps in the morning is commonly associated with plantar fasciitis, an irritation of the plantar fascia. The condition, which is very common in runners, causes heel pain that can also radiate into the arch. It is often associated with a tight Achilles tendon and calf muscle.
It is important to have a pre-run meal or snack to maintain energy sources and delay fatigue. This is especially true if you plan on going for a long run. The challenge is finding the right type of food that you can tolerate and won’t cause stomach discomfort while you run. Here are some tips for meal planning before a long run.
How much you drink while running should be determined by the duration of your run, the weather, and how much you sweat.
Shin splints” is a term for a spectrum of pain in the front of the shin. The condition—very common in runners—can result from a stress injury (irritation of the bone) or a stress fracture (actual crack inside the bone). You’ll know you have shin splints if your shin bone (tibia) hurts when you press on it firmly with your finger.