Programs: How to Safely Start an
Guest: Dr. David Geier – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Austin: I’m Dr. Linda Austin. I’m interviewing Dr. David Geier who is
of the MUSC Sports Medicine Clinic. Dr.
Geier, a lot of people want to start, let’s say, a running program, some even
something more ambitious like a boot camp program. Let’s start, though, with just a simple
running program. Let’s imagine that you
are moderately overweight, 10 to 30 pounds overweight, and really want to get
into shape and want running to be part of that.
First of all, can a person like that safely start running if they’ve
never run before?
Geier: I think they can. I’m a big believer that anybody can get into
shape in a variety of ways. It may not
be running. Running may not be for everybody,
especially in the really obese or if someone has had injuries to, say, their
feet or ankles or their knees in the past.
That may not be their sport.
Assuming that they don’t have one of those problems, I think pretty much
anybody can start. I think the key to
remember is you’ve got to know where you are in terms of cardiovascular
endurance and start very slowly. Start
with very short distances at a very slow pace with an adequate number of days
to rest between runs and then work your way up.
I think that’s one of the biggest things I can recommend.
Austin: Now, you always hear it said
that people should first consult their physician and, obviously, that’s never a
bad idea. But I think it’s also pretty
obvious that a 20-year-old person is not going to run out and do that. Could you sort of draw a line, roughly, about
who really needs to get a physician’s evaluation before they start a running
Geier: Absolutely. I think if you know that you have a chronic
medical condition of any kind, either congenital or it has developed over time,
any heart or lung issues, that needs to be evaluated, if you’re pregnant, I
think that’s something you just want to make sure that is safe, that the
obstetrician feels that that’s an acceptable form of exercise. I think as you get past, maybe, say, age 35
or 40, when you’re recommended to get yearly checks by your physician, anyway,
for evaluation for a variety of problems, it’s probably a good time to get
approved to do an exercise program.
is not to hold people from the exercise.
It’s just to avoid something unforeseen happening. There’s been a lot of media attention
recently about the elite marathon runner that died at the U.S. marathon trials for the
Olympics. It can happen to anybody. So, if there’s any doubt, a quick visit to
the physician just to rule out any potential problems, is a great idea.
Austin: In starting a running program,
you mentioned starting with a very short distance. How short?
Geier: I think it really depends on what
their level of endurance is. I mean, we
may be talking about quarter miles or one lap around a track, or even running
half the lap and then walking half a lap, and then running another half lap,
really, starting very slowly. Now, if
they find they can do it quickly, they can increase to, maybe, a half mile or a
mile, so, maybe not so much starting with short distances but maybe an
infrequent number of times per week. You
may get to the point where you run six or seven days a week, but you might want
to start just trying to run one or two days a week and then doing other
activities, like walking, exercise bikes, or ellipticals, the other days so
that you don’t overuse your knees and ankles and create some overuse problems
by starting out with too much.
the things I would recommend when you’re thinking about how to build up your
endurance, say, in a running program, to do it safely, is to increase
slowly. So, one of the recommendations
we make is the 10 Percent Rule,
increase your mileage only by 10 percent.
Let’s say you run 10 miles a week, the next week you would increase that
by ten percent, so, your next week, you would run 11. That’s to prevent increasing too fast and
putting your body at risk for overuse injuries, like shin splints or pain under
the kneecap, or even potentially more serious things, like stress fractures.
Austin: Do you have recommendations
Geier: I think there are some general
rules of thumb. I think, one, and
probably most importantly, is check them, actually pick them up and look at
them. Look at the soles, make sure
they’re not wearing out and, specifically, make sure there not wearing in
certain areas, like, all to the outside of the shoe, or all to the inside. That could signify that you have a different
type of stride that puts more pressure on one part your foot and one part of
your knee than it might on somebody else.
In general, you want to replace them every 300 to 500 miles that you run
or about every six months, because a worn out shoe puts all of that extra
stress, which is, now, not being absorbed by the sole of your shoe, on your
foot and your ankle, and your leg and knee.
Shoes are critical. For runners,
that’s their only piece of equipment and they’re very important.
Austin: How about some of the more
extreme programs that people get into, for example, young people going into the
military who have to go into boot camp, or even at fitness centers, sometimes,
there are boot camps? Do you see many
injuries coming out of those types of programs?
Geier: I do. And, usually, especially in your recreational
boot camp, so to speak, or these really aggressive training programs, you’re
seeing injuries in people that, unfortunately, are out of shape, but,
fortunately, they’re in the program to get into shape. They’re being subjected to exercise that is
probably more than they’re ready for.
And a lot of what I see is, they start to fatigue after being really worked
for 30, 45 minutes and then they take a misstep because they’ve gotten really
tired. That’s where you run into acute
injuries, meniscus tears, ACL tears, that type of thing. And then some of these people just get
overuse injuries. They haven’t done a
lot of impact running, impact stair climbing, and that type of thing, for a
long time, and doing that for 30, 45 minutes a day, from day one, and doing it
everyday, sometimes really puts them at risk for some of these overuse
also happen, like you say, in your military recruits about to be subjected to a
physical fitness program. They’re not
immune to these injuries either. Stress
fractures are very common in the military, as well as acute injuries like
meniscus tears, ACL tears, and shoulder dislocations. So, it’s not just a problem of being out of
shape or overweight.
Austin: I recall when the Citadel first
admitted women, a couple of the women, early on, got, I believe, pelvic stress
fractures, if I’m remembering that correctly.
Is there anything you can do to protect from a stress fracture?
Geier: To a certain extent, it may
happen no matter what you do. But there
are, certainly, some good rules of thumb.
One is, and I think it seems straightforward yet not done enough, to
listen to your body and understand it.
If you’re having a lot of pain in a certain area, especially fairly
localized pain, you may want to think about taking a day or two off and see how
you respond and not just trying to run through every ache and pain, because
sometimes it can be harmful doing that.
Other simple things: make sure
you’re eating enough. I think, again, that
sounds very straightforward.
especially, in your Citadel example, for instance, some of these people are training
so much that they’re not getting enough calories, adequate protein, vitamins
and minerals. Their nutrition can’t keep
up with their activity and that puts them at risk for stress fractures. Certainly, in women, there are issues related
to hormones and not having regular periods due to overtraining, and that can
set you up for thinning bones, what we call osteopenia or, in severe
circumstances, osteoporosis. A lot of
these problems with stress fractures are not just a problem of postmenopausal
women. We see a lot in our 15, 20,
25-year-old athletes, especially female athletes.
Austin: And, do these come from one
sudden, let’s say, misstep, or do they come from sort of pounding on the bone
over a period of time?
Geier: Typically, it’s overuse. Like you described, they continue to pound on
a certain area. But it isn’t uncommon
for a patient, an athlete, to have kind of a dull achy pain that bothers them
when they run and then they take a misstep.
They do something that puts abnormally high stress on it and finishes it
off, so to speak. What they remember is
that one step, but the problem probably started a long time ago.
Austin: It sounds like you’re not
particularly a believer in no pain, no
Geier: That’s probably a good way to put
it. I think there are two types of pain
with sports and athletics. I think there
is the muscle soreness and fatigue that comes with training and really trying
to push to get stronger and faster. And
I think, for the most part, most of that is acceptable pain. I don’t know if I’d call it good pain, but
it’s certainly something that I think is reasonable to keep going. I think the more worrisome kind, and this is
somewhat difficult to figure out sometimes, is this pain that you shouldn’t
work through. And, while this is
somewhat generalized, I would say that any pain that is really a sharp
uncomfortable pain, rather than a soreness, or a very localized pain, it’s in
one specific area, and pain that really makes it difficult to run or to lift
weights or do some motion in a sport, if it’s really uncomfortable, I don’t
think it’s good to work through that kind of pain.
Austin: What are your recommendations
about pain relievers after a hard workout?
Geier: I think there are risks and
benefits with all treatments after training, and after injury. I think the one people always think of,
because you see it on TV, are the anti-inflammatories, Advil and Aleve. I think they’re fine for brief usage, you
know, two to three weeks of, say, knee soreness, or shoulder soreness. I think something like Advil or Aleve, or
some of these fancier anti-inflammatories, is acceptable. I don’t know that they should be taken on a
chronic basis, almost as a preventative measure, because those drugs have side
effects. Anti-inflammatories can cause
stomach discomfort and stomach ulcers.
They can affect the kidneys and exacerbate high blood pressure. They’ve been linked to heart attacks and
strokes. Now, the vast majority of
people can take them and do fine, but, certainly, you should be watch how much
you’re taking and for how long.
some of the non-medication alternatives are just as effective, like taking a
day off, or not necessarily resting completely, but switching to an activity
that’s less stressing. So, if you run
five days a week and you’ve been having leg pain, maybe switch to three days of
running and the other days you do something that doesn’t hurt your leg, like an
exercise bike, swimming, something along those lines. I think ice is a huge ally to the
athlete. If there’s a really painful or
sore area, either from overuse or an acute injury, get a bag of ice on it and
put on an ACE wrap. Do that for 15, 20
minutes to get the swelling down and decrease the inflammation. I think all of these have their role.
Austin: Is there a role for heat?
Geier: It really depends on what the
issue is. I think heat is good in the
setting, especially before exercise, of trying to warm up muscles. A good example are people with stiff and sore
lower backs needing to get kind of loosened up before they run or do their
exercise. Heat, after activity,
especially in the setting of pain, I think, is less effective and in some ways
can be detrimental, because heat actually stimulates blood flow to the area and
can increase inflammation. We typically
use ice, but there are some roles, especially in loosening up muscles before
activity, in which heat can be effective.
Austin: Dr. Geier, thank you so much.
Geier: Thank you.
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