Simply put, athletes and patients with running injuries receive too much treatment and not enough attention and thought. Medical schools and hospital residencies offer little guidance in the evaluation, prevention, and rehabilitation of overuse injuries. In med school, we learned how to treat parts of bodies (as if the body were a department store), not whole bodies. We were taught to treat the symptoms, not to address the underlying imbalances and weaknesses. True prevention means not allowing the condition to arise and develop in the first place. Take diabetes and heart disease. The best prevention is to eat a healthful diet, to avoid stress, and to go on a daily walk or run. And of course not to smoke.
The medical profession can begin by drawing nonphysicians—physiotherapists, podiatrists, coaches, media people, tech and engineering innovators, and runners themselves—into the discussion about why running injuries recur and persist. Their ideas, experience, and observations can help short-circuit the endless diagnostic duet that doctors and patients have been playing. This may not happen overnight. It normally takes ten years for an important medical discovery to become routine in a clinician’s practice. Indeed, it was a decade before the modern protocol for the treatment of heart attacks was widely adopted by emergency departments.
What’s needed is a new approach to running. Paradoxically, that approach involves less medical intervention for runners, not more.
As a family doc, I generally ask patients what physical activities they like do.
“Well, I can’t run…” is a common response.
“Tell me a little more about that,” I’ll say.
Typically, they complain of suffering from a bad back, a bum knee, or pain in an ankle, then add, “My last doctor told me to do something safer.” Or they simply say that running is too difficult and painful for them.
“Tell me some more about that,” I’ll press.
Inevitably, I discover that their lack of physical activity, unhealthy lifestyle, questionable diet, and prior physician’s discouragement are largely to blame for their symptoms and the illness they are suffering.
This recurring clinical experience indicated to me that our community had the makings for a public health crisis, so I tried out some simple ways to address it. I taught courses in low-carb living, developed a series of community running events aimed at beginners, and hosted training clinics to prepare them for running safely. Then I opened a small retail run and walk center.
The more I examine patients and learn about how their bodies function and respond to stress, the more I realize that it’s almost always possible to get into good running shape—safely. Humans were designed to run. Many more of us can run than believe we can.
Indeed, as a society, we need to run. The incidence of obesity has skyrocketed globally, and continues to climb. The Centers for Disease Control and Prevention estimate that more than one-third of U.S. adults and 20 percent of children and adolescents aged two to nineteen years are obese. That’s 12.5 million kids. The American Heart Association recently reported that children today are ninety seconds slower on a one-mile run than their parents were at their age.
In our local running races and running clubs, I’ve observed that children don’t choose to be obese and inactive. And they love to run. So I sparked a local initiative to build running trails at a dozen elementary schools, with daily activities scheduled on them. West Virginia recently mandated thirty minutes of activity per day for schoolchildren, and the trails facilitate this—without adding a burden on PE teachers or school resources. Cross-country running is now a sport at our area’s middle schools, and has been wildly successful since the inaugural year, 2016, in Berkeley County.
These may be small, localized efforts, but our experience underscores that our community’s public health challenge is shared nationwide. The obese and unfit are more likely to develop chronic diseases such as type 2 diabetes, heart disease, dementia, and certain types of cancer. Medical science has no pill or intervention that can reliably reverse the course of these chronic illnesses, but we can reverse much of them on our own: studies increasingly show that physical activity and improved nutrition yield the best results in terms of improving health, well-being, and longevity. As a physician, I can’t help but prescribe health to my patients. In my mind, to not do so would violate the Hippocratic Oath.
Good nutrition is key. At the WVU School of Medicine, I’m co-directing a project, now in its fourth year, to not only teach students nutritional science, but to instruct them in cooking. In this book we’ll show you how easy it is to eat healthfully: simply eat real food. Avoid sugar and processed ingredients, and load up on the natural nutrients available in plants, nuts, full-fat dairy, eggs, animals, and fish, if you choose. Modify a true Mediterranean- or Paleo-style or low-carb diet to your culture and tastes. We’ll discuss this more in the chapters on diet and nutrition.
Humans can adapt. Almost twenty years ago, doctors advised me to quit running. Now I am running with a near-magical sense of well-being. It may sound like an extravagant claim, but running can be a comfortable, energizing, and fun activity for nearly anyone, at any age. In running, as in play, there doesn’t need to be a measurable outcome. Simply put your foot down, maintain correct body position, and push and extend from the hips and glutes. Feel the spring. No stress, bending, or pain.
The adage No pain, no gain should be a thing of the past. No pain, thank you—this is the natural, healthy way. The goal doesn’t have to do with running times. It’s about health and well-being of the body and mind. Running, the activity that we humans are perhaps best adapted for, is a marvelous vehicle for this. It’s a great place to start. And it’s a great place to circle back to, again and again.
Run for Your Life is not a destination. It is a fun, relaxed journey. Try it and see where it takes you. Follow your body’s feelings, and if they are positive, keep going! I’m confident that you’ll discover that your legs and your body are a near-tireless vehicle—a parked hot rod that’s ready to rev up, roll out, and speed you to a whole new level of health and satisfaction.
DRILLS
How can we become healthier, more efficient runners? The exercises presented at the end of the chapters that follow are designed to make you—as my colleague Jay Dicharry (author of Anatomy for Runners) has deftly outlined—
Smarter—by using the illustrations to learn correct movement patterns;
Stronger—by building endurance, strength, balance, and stability in key postural muscles;
Springier—by gradually advancing and fine-tuning your workouts and daily movements, to leverage your body’s natural springs.
The drills are easy to perform, and they generate little impact and stress, if done correctly and progressively. Specifically, in the drills and accompanying text, you will learn to:
Breathe, sit, stand, and balance better throughout the day, and while running.
Rebuild and maintain the essential range of motion of all your limbs.
Bring strength and stability to your stance, and develop power in your hip extension.
Set and maintain a consistent cadence, while feeling a springy “pop” off the ground.
Run and move with comfort and joy, wanting more—even at the end of a workout.
Eat and enjoy food that is tasty, nutritious, and inexpensive—and help reduce excess body fat.
Learn ways to make your newly rediscovered health and vigor more accessible to others, and pay it forward to improve the health of your community.
The goal, during the running-oriented exercises, is to master the movements and maintain proper form—and then build more speed and power into that form. Less, done correctly, is better than more, done incorrectly. As your strength and neuromuscular sense grow, you’ll find that the natural “springs” in your legs and body become stronger and smart
er. Eventually, a properly performed drill becomes your running form.
The drills that you select can be performed as infrequently as twice a week, requiring no more than fifteen minutes each time. They are best done on days when you are not fatigued, and after you have warmed up. Begin by picking some exercises that look easy, and graduate to more challenging ones that play to your weaknesses—until they become your strengths.
Consider this book a user-friendly owner’s manual to the body, dedicated to the safe operation and maintenance of the gift we have been given. Thankfully, you don’t have to follow a tight regimen—but you do need to stick with it. If you suffer from a shortage of time, then take any opportunity to skip, jump, spring, and balance during your daily life. The drills and “exercise snacks” in the pages that follow can be surprisingly fun and energizing, if done with a little patience and good form. You are training, after all, for the rest of your hopefully long and healthy life.
PART I
Before the Starting Line
CHAPTER 1
Our Bodies Are Older Than We Think
Nothing in biology makes sense except in the light of evolution.
—THEODOSIUS DOBZHANSKY
MYTH: Life spans have increased compared with decades ago.
FACT: When chronic disease and declining public health are factored in, modern life spans aren’t much longer than they used to be. By some measures, average functional life spans in the United States have started to decline.
Whether your goal is athletic dominance or simply to arrive at a healthy old age, we all share the goal of making the best of our lives while on the planet, in the healthiest and most productive way that we can.
Let’s start by inspecting the miraculous equipment we inherited, to better understand what it is that our bodies were designed to do.
RUNNING IS ONLY HUMAN
Throughout human history—for almost 2 million years as hunter-gatherers, followed by 12,000 years as pastoralists and farmers—our ability to run, to walk, and to be physically active has been essential to life. By virtue of our existence—indeed, as evidenced by our domination of the planet—humans are succeeding. So far, at least.
Our prehuman, primate ancestors were slower and weaker than many of the large animals that they eventually would learn to prey upon. Masters of agility, their bodies and limbs were adapted mainly for living in trees, where they could find forage and fruit, and were safe from nonclimbing predators that lived on the forest floor.
So how did they come to dominate these other species, prey upon them, and even drive some of them to extinction? And later, what enabled modern humans, Homo sapiens, to win the evolution race with earlier species of our genus? Was it brains over brawn, or the other way around? Or did our brawn and brains coevolve?
By nearly every metric of human strength and performance, early hominids (and even one extinct line, the Neanderthals) were superior to Homo sapiens. We made an incremental yet critical adaptation by gradually becoming able to walk and run long distances.
Scientists generally believe that the ability to walk and run on two feet was a game changer. With the rudimentary tools available to early humans, it would have been difficult and dangerous to bring down an antelope. Yet there’s evidence that humans were killing and eating large prey for some time before spears and other weapons were developed.
The ability to walk and run long distances was a game changer for our ancestors.
One compelling theory proposes that early humans’ ability to walk (and occasionally run) long distances in hot climates allowed them to track large, fast prey until the animals dropped of heat exhaustion and dehydration, unable to run or to fight. Doing so at a walking pace wouldn’t have been sufficient. Early humans sprinted when escaping a predator or other imminent dangers. But when tracking game, according to the “persistence hunting” theory, they would have needed to travel only fast enough to keep their prey moving and not resting. (Most large animals shed heat by panting, yet they are unable to pant while running.)
Our ability to travel long distances in an energy-efficient manner helped us with more than hunting. It also allowed us to relocate more readily to a new water source, for instance, or travel to a more bountiful area. Essentially, we could walk away from perils such as famine and drought, sometimes to distant locations, aided by an ability to efficiently store and utilize the calories we consumed.
WE GOT THE RIGHT GEAR
Dr. Dan Lieberman and colleagues have identified evolutionary adaptations in our anatomy and physiology that enhance our ability to walk and run long distances. Mainly, we benefited from the following features, which you may even begin to notice as you pay attention to your running:
Springy tendons and muscles in the legs that work in efficient harmony. As the springlike, fibrous tendons stretch, they load up with potential energy. The muscles contribute to stability at the same time that the tendons spring us forward.
Extra-large gluteus maximus, or butt muscles, that make for strong and stable hips and trunk.
An upright posture, exceptional balance, and a stable head and neck. Notice that these features enable us, while running on two feet, to remain simultaneously aware of our surroundings and focused on a distant object. Some believe that our well-developed vestibular system (the region of the inner ear that controls balance) may have contributed substantially to our survival success.
Sweat glands, which humans have an abundance of. Sweating provides effective evaporative cooling, or thermoregulation. We adapt to heat by perspiring more as the temperature and our activity levels rise. Our absence of fur, minimal body hair, and high surface-area-to-body-weight ratio mean that more skin is exposed to the air’s cooling effect. Also, uniquely, our breathing pattern is uncoupled from our stride, so we can unload body heat through our lungs during respiration, which four-legged mammals cannot.
The capacity to digest, store, and utilize fat as an efficient source of fuel. Fat contains twice the calories per gram as sugar. That fat is metabolized with seven to ten times greater efficiency than sugar, too. (We’ll explore this valuable fuel source in the chapters on endurance and nutrition.)
Feet that are uniquely adapted to walking and running, with their springlike arches and short toes. Each foot is an orchestra of 26 bones, 33 joints, 107 ligaments, and 19 muscles and tendons, providing cushioning, spring, and control in three planes simultaneously. Chapter 4 is devoted to this remarkable appendage.
SLOW, BUT SMART
Despite all of our evolutionary adaptations, humans would appear to be physiologically flawed. Raising our young to adulthood requires (nonproductive) years of nurturing and training, and our top speed is slow when compared to similar-sized wild animals.
Natural selection entails trade-offs and compromise. Humans have developed great endurance, but we aren’t very fast. (The fastest land animal, the cheetah, is specialized for catching prey with speed but has little endurance.) And the human ability to efficiently store fat is useful for surviving famines, yet comes with a high risk of obesity. Even brain size offers a trade-off: the large human brain is a hungry organ, consuming about a quarter of the body’s resting energy demand—diverting calories that might be more productively dedicated to strength and speed.
Testing the body’s design features: the 2015 JFK 50 Mile race.
It requires good posture, springy legs, stability from the glutes, efficient energy use, and a mix of walking and running.
Nonetheless, our brains have served us well. Our evolving brains led to the harnessing of fire, and the cooking, grinding, and mashing of foods with tools. Softening tough plant and animal fibers sped up the process of chewing and digestion, so greater quantities of protein and fat can be metabolized by the body. (Cooked foods yield more than twice the usable nutrition of raw foods: cellulose and the prot
eins of muscle fiber denature at high temperatures, making them softer and easier for the body to digest.)
The nutritional boost from consuming higher-quality food supported the development of more brain power. As humans grew smarter, their socialization, hunting skills, and tool-making abilities improved. Meanwhile, the control of fire helped with more than cooking: the deterrent effect of fire on wild animals allowed humans to sleep longer without fear of predators. Deeper REM sleep further aided brain function and growth.
Along the way, humans became fat-storing and fat-burning machines. Fats and proteins offer the critical building blocks for brain and muscle, and fat is more energy- and essential nutrient–dense than carbohydrates. The Inuit, for example, remained healthy without consuming any carbohydrates. Humans cannot survive without fat.
Early humans also developed an ability to store (energy-poor) carbohydrates by efficiently converting them to (energy-rich) fat, with the help of insulin. In times of plenty we could accumulate fat, then metabolize it in times of need—drawing upon it over periods without food, if necessary, before needing to “refuel.”
NURTURE OR NATURE?
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