Run for Your Life
Page 1
THIS IS A BORZOI BOOK
PUBLISHED BY ALFRED A. KNOPF
Copyright © 2018 by Mark Cucuzzella
All rights reserved. Published in the United States by Alfred A. Knopf, a division of Penguin Random House LLC, New York, and distributed in Canada by Random House of Canada, a division of Penguin Random House Canada Limited, Toronto.
www.aaknopf.com
Knopf, Borzoi Books, and the colophon are registered trademarks of Penguin Random House LLC.
Library of Congress Cataloging-in-Publication Data
Names: Cucuzzella, Mark, author.
Title: Run for your life / Mark Cucuzzella, M.D.
Description: First edition. | New York : Alfred A. Knopf, 2018. | Includes bibliographical references and index.
Identifiers: LCCN 2017061533 (print) | LCCN 2017056684 (ebook) | ISBN 9781101946305 (hardback) | ISBN 9781101946312 (ebook) Subjects: LCSH: Running—Training. | Running—Physiological aspects. | Running injuries—Prevention. | BISAC: HEALTH & FITNESS / Exercise. | SELF-HELP / General. | SPORTS & RECREATION / Running & Jogging. Classification: LCC GV1061.5 (print) | LCC GV1061.5 .C83 2018 (ebook) | DDC 613.7/172—dc23
LC record available at https://lccn.loc.gov/2017061533
Ebook ISBN 9781101946312
Cover design by Carol Devine Carson
Cover photograph © the wolpertinger
v5.3_r3.2
a
Contents
Cover
Title Page
Copyright
Introduction
PART I Before the Starting Line
CHAPTER 1Our Bodies Are Older Than We Think
CHAPTER 2Stand Up and Breathe
CHAPTER 3Walk Before You Run
CHAPTER 4The World Is Flat If You’re a Foot
CHAPTER 5The Springs That Move Us
PART II The Body in Motion
CHAPTER 6The Elements of Style
CHAPTER 7The Engine That Runs Us: Building Endurance
CHAPTER 8Move More and “Exercise” Less
CHAPTER 9Eating to Go the Distance: Nutrition and Health
CHAPTER 10What’s for Dinner: Setting Your Meal Course
CHAPTER 11 Recovery Is the Training
CHAPTER 12Running a Marathon
CHAPTER 13The Runner’s High: The Mind of a Winner
CHAPTER 14Outsmart Injuries with Prevention
PART III Running Is for Everyone
CHAPTER 15Women Are Pulling Away from the Pack
CHAPTER 16Young at Heart
CHAPTER 17Healthy at Any Age
CHAPTER 18The Nature Cure
CHAPTER 19Running in Place: The Health of Our Communities
APPENDICES
I Web Resources
II Drills for a Lifetime
III Training Plans for a 5K, a Half Marathon, and a Marathon
IV A Selection of Books on Running and Healthy Living
V The Ten Essential Elements of Healthy Running
Acknowledgments
Notes
Illustration Credits
Introduction
If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.
—HIPPOCRATES
In college, a persistent dream captured many of my waking hours: to run with effortless, efficient grace.
But first, I had to figure out how to run without pain.
Getting to that point wasn’t easy, nor did it happen quickly. I had to scrap my preconceptions and retool the way I stood, walked, and eventually ran. My roundabout path took me to medical school, to active-duty Air Force, to the University of Colorado, and to a rural West Virginia family medicine practice—via twenty-four Boston Marathons. Along the route, I picked up more tasks—as the U.S. Air Force’s running coach, as a prof at the West Virginia University School of Medicine, as a race director, and as the owner-operator of an award-winning shoe store.
Eventually—and as something of a surprise—I reached a sustained high level of pain-free physical performance, accompanied by a remarkable sense of well-being. This sense of wellness is there for the learning and the taking. It requires little more than getting outside—moving, exercising, running, walking, and enjoying physical activity together.
The emphasis is on the together part. More important than any running achievements, I’m most proud of having initiated several community school and health programs, and founding one of the eastern seaboard’s most popular fun runs. Throughout, my goal has been to help boost fitness and health for people of every age, and I’ve been encouraged by the testimonials from near-countless injured and sedentary folks who are now running, playing, and exerting with joy.
Distressingly, I’ve seen too many dedicated runners become former runners. And I’ve seen many nonrunners never begin. Too often in my medical practice I hear the phrase “I hate to run” or “I can’t.”
It doesn’t need to be this way.
However odd it sounds, health care professionals are often complicit in unhealthy behavior and outcomes, by providing treatments that don’t offer lasting solutions. When treating runners, we tend to ignore “prehab,” the preventive solution: learn proper posture, strengthen the core muscles, settle into a good running pace, build endurance, understand mobility and efficiency of movement, and indulge a sense of contentment. Add to that restful sleep, good nutrition, sufficient recovery time, and even a sense of community, and you are solidly on the path to becoming stronger, to preventing injury, and to appreciating the magical gift of the human form. Simplicity of style begets efficiency of function.
The chapters of this book, and the exercises that conclude each of them, are designed to fit into your busy life. Nowadays, I can’t imagine lining up for marathons and ultra distances without my secret weapon: the techniques that are summarized in this humble volume. By applying these principles, I now hold the world’s longest active streak (thirty years) for consecutive years of running marathons in under 3 hours. At ages forty and forty-four, I won the Air Force Marathon outright in 2:31 and 2:38, and at age forty-four I ran the Boston Marathon in 2:34. I’ve also dabbled in ultra-marathons, including a first-place Masters finish in the competitive JFK 50 Mile run. My times are slowing a tad now that I’ve reached fifty (and my life becomes overfilled), but I anticipate many more years of running enjoyment. You can, too—whatever your performance goals.
You’re invited to be my companion on this exhilarating path of self-discovery. For me, the discovery and learning continue—daily, at full throttle—as I devour emerging information on diet and diabetes, on our microbiome, on stress and stress relief, on the benefits of nature, and on much more. Simply put, we need to grab our kids and our old folks, get outside, and build movement, healthful food, and joy into our communities. It’s not just about running. If you prefer to walk—or garden, or hike, or play golf—most of what you’ll find here applies to you, too. My own path to these discoveries entailed endless trial and error. By reading this book, you’ll leapfrog my struggle and experimentation to find an easier and faster way to a fit, healthy life. I’m grateful for the chance to share with you the secrets that I have learned.
AN ULTRA-MARATHON-LONG STORY
For me, running didn’t happen in a straight line. I began to run at the age of thirteen, and often was the fastest in my age group. Modest successes generated enough positive reinforcement to keep me going, harder and faster. I competed through high school, and in the mid-1980s I raced for the Universit
y of Virginia.
But triumphs were well seasoned with pain, injuries, setbacks, surgeries, and lengthy rehab. I underwent my first knee surgery at age fifteen, and spent most of my high school years swimming laps at the YMCA instead of running. At one point, as a side effect of prescribed anti-inflammatories, I lost half my blood from an intestinal ulcer.
In 2000, arthritis in my big toes nearly ended my running career. That’s when I attempted to qualify for the 2000 Olympic Trials. I had run the Military World Championship Marathon in 2:24, on a steamy hot day in Rome and with marginal training. Surely I could finish the racetrack-like Chicago Marathon in 2:22, the time needed to qualify. For six months I devoted all my spare time to training for the 1999 Chicago race.
Pain dictates your level of effort, and your joy. And in the six months preceding the Chicago Marathon, I hadn’t strung together a single week of pain-free training. Plantar fasciitis nagged me with every step, even when walking.
I lined up, anyway, with the other competitors. I forced myself to maintain a pace of 5:20 for each of the first twenty miles, then began to slow. My final time of 2 hours and 24 minutes was respectable, but a couple of minutes shy of the qualifying time.
My next event was surgery—to relieve (some) of the pain in my foot. But the arthritis left my big toe joints inflexible and crooked. Along the way, I acquired an array of arch supports, orthotics, and oddly designed shoes, which I offered (with prayers for deliverance) to my altar of pain-free running. Doctors consistently told me to quit running and take up another activity. But I could find nothing as convenient, relaxing, and enjoyable—nothing that delivered the same feeling of overall freedom.
As a chronically injured runner, I realized that if I wanted to continue to run, something would have to change. While studying at UVA, I became the patient and guinea pig of Dr. Daniel Kulund, the track team’s physician, and grew curious about his unorthodox methods for treating running injuries. He had me run in the college swimming pool—as is prescribed for horses in rehab—and his office featured a deep, hot tub–sized pool in which his athletes ran in place while tethered to the pool’s side wall. Instead of the stiff orthotics often prescribed by trainers and doctors, he molded soft shoe inserts in a toaster oven. These tools and techniques, it turns out—and others that are outlined in this book—are now routinely used by competitive runners for training, and they have shown remarkable results in injury prevention.
My perpetual cycle of running, injury, treatment, and recovery inspired me to study medicine. And in my free time, I set out to retool how I ran. I dove into the rabbit hole of physiology and running science, and sought advice from the leading experts. A book called Running and Being, by the late Dr. George Sheehan, caught my attention. Sheehan stressed that understanding the mechanics of movement (and the root causes of running injuries, and their prevention) is the foundation for running pain-free, for life. Experts such as Michael Yessis, Arthur Lydiard, Dr. Ray McClanahan, Phil Maffetone, and Danny Dreyer stressed that runners could improve their performance and reduce injuries by focusing carefully and mindfully on their technique. Clinicians and researchers Dr. Casey Kerrigan, Dr. Daniel Lieberman, Dr. Irene Davis, and Jay Dicharry confirmed this.
Gradually, I began to see that a mere handful of easy and commonsense changes to my running form—summarized at the end of each chapter—might allow me to return to running, by softening the impact with the ground, and by utilizing spring and momentum to move more efficiently over the surface of the earth. Just like the greatest runners of the world.
Kenyan runners and Mexico’s Tarahumara people were already long-distance-running legends. What made them such consistently good performers? The answer is that they had developed these techniques naturally and unconsciously—out of necessity, as part of daily life, and as a form of play. Aesthetically, too, their form was smooth, efficient, and beautiful, characterized by a springy stride, a quicker cadence, perfect body posture, and a relaxed smile. They landed with their weight near the middle of the foot, and closer to the point below the body’s center of mass. They often ran barefoot or in sandals.
Modern shoes for these runners would be nothing more than awkward and bulky prosthetic devices interfering with their pureness of form. Yet many of these design features have been incorporated into modern running shoes—a subject we will return to in the chapter on feet.
This book, and my mission, is directed at making running safer and more fun, regardless of what shoes you wear. I may be the only physician in the country who also owns a shoe store! The American College of Sports Medicine recently published a position paper on footwear that confirms and underscores what our small store, Two Rivers Treads, has been doing for years.
I had to homeschool myself on all aspects of foot health, especially in terms of stance and gait and how the foot interacts with the ground. While I was studying the natural human running form, what amazed me most was that the traditional runners of Mexico and Kenya appeared to be completely relaxed and happy, in contrast to having the pained expressions of so many of my running friends. I believe that this is because they were engaged in doing precisely what humans were designed to do: run. In a traditional nomadic hunter-gatherer society, the stakes were high: an injury that curtailed the ability to run or walk long distances meant being left behind. To run was to live.
It wasn’t only our premodern ancestors who ran in this natural manner. Kids still do, at least until encumbered by footwear. There is something here that we can learn—or relearn, rather—from our own children. In fact, everything I have to offer here will bring you closer to your experience of running as a child.
Medical school didn’t provide many answers. Learning the names of the bones and muscles and tendons of the foot gave me little insight into how this remarkable biological machine actually works. Indeed, the foot—maybe the least understood of all moving body parts—is the orchestrator and foundation of all motion. What we do know is that it is superbly designed for its most important functions: absorbing shock, sending signals to the brain to maintain stability, and propelling the body forward.
Except in cases of structural deformities of the foot, modern shoes—inventions of the past thirty-plus years—haven’t been able to improve upon the natural function of the over one-million-year-old human foot. Take a look at the chain of events that happen when you place your foot in a modern shoe: the heel is elevated, the toes are compressed, the arch of the foot is braced. All of this alters forces on the knees, hips, pelvis, and spine.
The arch, when confined within a non-anatomically shaped shoe, doesn’t function in the manner it was designed for. And elevating the heel initiates a domino effect of compensations. Especially the great toe is dynamic and important. Overall, the resulting loss of foot stability is telegraphed up the kinetic chain of our bodies, tilting the pelvis, swaying the back, and shifting our center of mass forward—away from the critical area of the foot that is meant to bear weight. Our posture and gait are thrown out of whack. Picture an orderly stack of building blocks. Then elevate one edge of the bottom block. To restabilize the tottering stack, you’ll likely need to make several adjustments, misaligning each piece slightly, from bottom to top.
Introducing high heels causes the body to make adjustments to posture that misalign the entire kinetic chain.
Many runners have described the techniques outlined here as nothing less than life-changing. Admittedly, my wife, also a physician and researcher, remarked that “the plural of anecdote is not fact.” She’s right. So I launched studies of my own. In late 2007, Danny Dreyer, author of ChiRunning, and I surveyed twenty-five hundred runners who had adopted these techniques and presented the findings at scientific assemblies. We found that those who landed more on their midfoot while running ran more comfortably, suffered fewer injuries, and shared a feeling that they needed less effort to run. In 2012 I developed the Efficient Running Program for the U.S. Air Force—an int
eractive multimedia course designed to teach members of the military, as well as civilians, to be healthier and better runners.
There’s more to healthy running and walking than footwear and biomechanics. Sports science legend Dr. Tim Noakes, a friend and colleague, stresses that what we are really training for is the maintenance of optimal health, and to live long and productive lives. That means that the best type of training is the level of training that is sustainable.
We now appreciate that the healthiest and often the fastest runners—those with consistently high performance and the fewest injuries—focus their training not on maximum speed but on achieving maximum efficiency at the fully aerobic effort appropriate to each individual. These athletes don’t strive for maximum output. They tune their effort to their personal level of sustained output. This is the level of exertion at which our stores of fat are drawn upon as the primary, consistent fuel source—in preference to recently consumed and quickly metabolized sugars.
In the process of building the aerobic, fat-burning system to its highest potential, the runner becomes efficient in terms of both form and aerobic metabolism (conversion of sugars and fat, in the presence of oxygen, to energy). Over a long—but not exhausting—period of training, our bodies build millions of new capillary pathways for oxygen delivery. Paradoxically, in order to reliably increase performance, a runner actually needs to slow down and observe a modest speed limit, below the maximum level of effort.
As a physician, I have tried to ground my recommendations in science. Sports equipment design has been evolving for decades. Training regimens, and the level of play itself, have been changing and expanding. But sports medicine hasn’t kept pace with these changes, and medical professionals have been slow to learn. Medical science and technology have advanced greatly, but running injuries are still treated with old-school remedies: enforced rest, ice packs, heavily cushioned shoes, orthotics, and stretching. Despite all this care and intervention, more than half of all runners continue to be injured each year. Pain relief is almost always temporary, and some medications, such as ibuprofen, actually inhibit healing and can prolong the recovery period.