How to Start Running and Stay Injury-Free

Dr. Busko: The act of running is the act of jumping from one foot to another, and you are requiring your whole body and your pelvis to stabilize on that one leg. So not just the leg strength, but upstream, deep core strength is really important to prevent injuries as we start running.

Courtney Allison: [upbeat music] Welcome to Health Matters, your dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.

[upbeat music] This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at the letter R for running. [birds chirping] Here in New York City, there is no place that captures that running spirit quite like Central Park, where you can find runners of every pace and experience level on the same paths. One of those runners is Dr. Morgan Busko, sports medicine physician at NewYork-Presbyterian and Columbia, and accomplished triathlete. Dr. Busko shares practical tips for building a running routine and preventing injuries, whether you're training for a race or lacing up for the first time. She explains why strength training, sleep, and nutrition are so important to a runner's health, and also reminds us of the joys and benefits of running.

[upbeat music] [footsteps] Dr. Busko, thank you so much for joining us today on Health Matters.

Dr. Busko: Hi, Courtney. I'm so happy to be here. Thank you for having me.

Courtney: So not only are you a sports medicine physician, you're also a triathlete. Is that correct?

Dr. Busko: That is, yes.

Courtney: So what do you personally love most about running?

Dr. Busko: With my triathlon background, I do love swimming, biking, and running. But to me, running is the most simple of all sports. It's just so wonderful that you can go out your back door, wherever you are, and find a trail, find a road, find a treadmill, whatever it is, and just get out there and have some time exercising and moving your body. So I really love the freedom that it brings and the simplicity of running.

Courtney: What are some other overall benefits of running for our physical health and our mental health? I know I find it's really good for stress, and there's a Haruki Murakami quote I love where he says, "If you can't solve a problem after an 8-mile run, you probably can't solve it."

Dr. Busko: [laughs] Yeah, so running has been proven to be beneficial not just for the cardiovascular system and the musculoskeletal system, but for the endocrine system. It helps reduce blood glucose levels, helps reduce the risk of diabetes. It's also been shown to be extremely helpful for mental well-being, so decreases rates of depression and anxiety. It's been shown to help reduce risk of cardiac disease and strokes. We know that it's, it's so good for the entire body. And, and mostly, like you said, I think just as much as all of the, the muscular gains, the most important are the mental benefits. So I think that's what brings a lot of runners back.

Courtney: So asking for a friend, how do you get back into running after a long, long break?

Dr. Busko: We've all been there, from professional runners to first-time runners. Everyone experiences that same feeling when we're trying to get back in shape, and I think it's so important to realize that it's going to get better, and you have to enjoy the process and enjoy the hurt a little bit in order to get to that point. But each day, it gets better, and you just generally find a little more joy in running if you give it some time. But the first few weeks can be a little tough.

Courtney: Can we break it down into the very first step? Because I've been saying for the past few weeks now, "I'm gonna get out for a run."

Dr. Busko: Mm-hmm.

Courtney: And Dr. Busko, it just hasn't happened. [laughs] What do I do? [laughs]

Dr. Busko: You're not alone. I think before we even start running or start planning a run routine for the coming months, whether it's just to get in shape or if you have a race that you've signed up for, it's important to get back to the basics. So, make sure that you have some sort of functional strength-training routine underway before you start running, because the act of running is the act of jumping from one foot to another, and you are requiring your whole body and your pelvis to stabilize on that one leg. So not just the leg strength, but upstream, deep core, gluteal strength is really important to not only feel good running, but prevent injuries as we start running. So, I always recommend starting a strength-training routine, and it doesn't have to be complex. It can be some band resistance and body weight exercise.

Courtney: So can you say more about why strength training is so important for runners?

Dr. Busko: Running is a high-impact sport, and that's great for a lot of reasons. It stimulates healthy bone density. It can definitely provide one of the most intensive cardiovascular workouts that you might look for. But it also does take its toll on the body if the muscles and tendons and bones aren't ready for it, and that can provide micro tears to the muscles and the tendons if we're not ready from a strength perspective.

Courtney: So if listeners only have a few minutes each week, what kind of strength training exercises should they do to prepare for running?

Dr. Busko: I love band resistance exercise because it's simple. All you need is a resistance band. You can spend literally 5 to 10 minutes before each run activating the deep core muscles and the gluteal muscles. And by recruiting those muscle groups before the run, your body will then choose to engage them as you're running instead of overloading some other muscle groups that may not be prepared for the act of running. So hip extension is super important, and the gluteal muscles play a big role in helping to extend your hip. The deep core helps to stabilize. So really, a series of band exercises like clamshells and monster walks and glute bridges. If you're looking to add a little bit of strength, you can add something like single-leg squats or single-leg split squats.

Courtney: For warming up, what is the difference between static stretching and dynamic stretching, and which should we be doing?

Dr. Busko: A dynamic warm-up is the most important thing you can do before a run. I think that spending 5, 10, 15 minutes is all you need prior to a run. So, when we talk about mobility, we're talking about...stretching the muscles and the joints and the tendons, but not with a static stretch where you hold it for 20, 30 seconds, but more with the motion of moving back and forth. So for example, you could get some mobility for the hips and the hip flexors by doing some leg swings. You can do that in a few different directions. A lot of people don't realize how important it is to open up the rib cage and the shoulders and how important posture is for the running motion.

Courtney: I think one of the most important questions for runners, how can we train and avoid injury?

Dr. Busko: Preventing injury in runners is one of the biggest things we think about. Every runner fears being injured because that can mean days or weeks or months off of running, which can take a big toll mentally and physically. So, the first thing I recommend is making sure that you're consistent with a strength training routine because you can't just go out and run 50 or even 15 miles a week. You really do need to be activating and strengthening the muscles that are so critical in helping you bounce from one foot to another. The second thing is having a reasonable plan for how you set up your run weeks. If you don't know how to go about that, a coach for a period of time can be a helpful way to navigate that if you are someone who wants to increase your mileage or start adding more speed work or train for a race. I also recommend not focusing all the time on the numbers and the exact metrics of the workouts. A lot of times these days, everyone has a GPS watch, and it can make us hyper-focused on exactly how far did I run? What was the total weekly mileage? What was the pace? Is my heart rate too high for the perceived exertion right now? And it just takes away the fun of running and the joy. You don't actually need to track everything.

Courtney: So, for someone who hasn't run in years and maybe isn't hiring a coach right away [laughs] or doesn't consider themselves a runner, what does a realistic first month look like?

Dr. Busko: I recommend starting with a walk-run routine. If you've never been a runner or you're coming off of a period of months to years where you have not been running, it can be very helpful to jog a minute, walk a minute, jog a minute, walk a minute. And then every other day, you increase that where you jog 2 minutes and walk a minute. That way, you're slowly reloading the muscles, tendons, the bones. You're allowing the aerobic system to develop. And quickly within a few weeks, you're up to some progressive running. I think that is much more manageable and much less likely to lead to injury.

Courtney: When someone has a goal race on the calendar, what's the smartest way to build up their training?

Dr. Busko: I think if you give it a good 3 months off for the race where you're planning strategically and trying to slowly increase both the mileage and the intensity, you can have a lot of success. So you don't wanna be increasing your mileage at the same time that you're adding in intensity 'cause that's a setup for injury. As long as you can plan accordingly, usually you need a few months out from a race to say, "This is a week where I'm gonna increase mileage, and then the next week, maybe I add in a speed workout with steady mileage, and then the next week, I increase a little bit more." That's usually the safest way to go about it. But the time that it will take to build up will depend on the distance. It'll take much longer to train for a marathon than a 5K.

Courtney: So how important are sleep and nutrition when it comes to performance and injury prevention? I feel like training for a race, it's not just about running.

Dr. Busko: Absolutely. Sleep and nutrition are critical for running success. Sleep is really the time where the body does its repair, and it's that deep sleep when the muscles and the tendons and the bones are actually undergoing changes very rapidly each day that help all those little micro-tears that develop during the run to actually heal. And if we don't get enough adequate sleep over time, that builds on itself, and it decreases our chances of repairing those micro tears. We need to undergo those little tears to actually get stronger and get faster, but we also need to repair. And nutrition, we know so much more about nutrition now and what the demands are for a runner, particularly a long-distance runner. And we now know that the more you can take in during a workout, right after a session, during a race, the better off you'll be. It's really that 30-minute window after each run or workout that you wanna be getting about 200 calories of a carbohydrate-protein mix in order to replenish the muscle stores of glycogen. You don't wanna wait a few hours to have a meal or have a snack after the workout.

Courtney: Do you have a favorite post-recovery snack?

Dr. Busko: I love smoothies, and my husband loves chocolate milk. I think those are both great for post-workout energy sources. A lot of the energy bars out there are really a mix of protein and carbohydrates, so that's a great easy option as well to always have in your gym bag or in your car for after a run.

Courtney: Yeah, chocolate milk is my favorite post-run drink. Are there any dos and don'ts for during the race fueling?

Dr. Busko: Number one rule is never try anything new on race day. All of this should be something that you are practicing on your weekly runs. Your weekly long run really should be your race-day prep. That's the day that you try to eat the same thing before your race and take the same number of gels you're gonna try taking during the race so that over time, your body actually adapts and is able to consume it, but also absorb it.

Courtney: Could you define a gel for anyone who might not be familiar with that term?

Dr. Busko: So a gel is a packet of energy, basically. And there's different sources of energy that we can get, glucose and fructose, and some of them have a combination of both. And it's a way for the body to rapidly absorb carbohydrates during a race. You should figure it out as your training goes on what works best for you. Some people take one every 4 miles of a race. Others take one every 25 or 30 minutes.

Courtney: In preparing for this interview, I crowdsourced with a lot of my running friends, and people had so many burning questions. One of them was, how much water should you be drinking through a race, and how do you know if you should be going for water or maybe something with electrolytes in it?

Dr. Busko: It's helpful to practice on your training runs and…get a gauge of how much your body is sweating and how thirsty you are on those runs, and are you replenishing with water? Are you replenishing with an electrolyte drink on those runs? 'Cause that's gonna give you a sense of what your body needs on race day. And some people just get their carbohydrates and their electrolytes in through the gels, and they only drink water. And others prefer to do a mix of water and electrolyte carbohydrate-heavy drink so that they can get some calories in from the drink as well.

Courtney: How do you address the mental component of running? How do you mentally stay focused and motivated during a run?

Dr. Busko: Running is part physical and mostly mental. I think every runner deals with the mental side of the sport, where you can be extremely motivated and feel great one day, you absolutely love it, and then the next day, it can be a challenge just to get through the run. It's constant mental battle. I think that's part of why we do it. We love the challenge physically, and we also love the mental challenge. And I think every runner will tell you that despite how hard it was to get out the door, they get home, and it's the best thing they did that day. And it's actually those harder days where you're not as motivated to get out there that actually are way more rewarding than the easy days because it, it shows us the mental fortitude that we have.

Courtney: I think a lot of runners pride themselves on pushing through discomfort, because I think running in general is not always comfortable. But how do you know the difference between discomfort and pain when there's a real problem you need to address?

Dr. Busko: I don't recommend ever pushing through pain. Pain is generally not something that we should have, and if you're feeling pain in a joint or a muscle or a tendon specifically, especially a pinpoint pain, that's usually when I think it's time to say, "Hey, I'm tough, but I think it's time to call it a day." Maybe take a few days of rest and see how it feels. And if it's resolved, great, but if it's a persistent pain, that's usually something that should be checked out by a doctor.

Courtney: Are there any running myths out there that you want to clear up?

Dr. Busko: A lot of my patients ask if running causes arthritis, and it does not. If done in a healthy way, meaning if you have the proper underlying muscle strength and you reload the body in a very gradual way, it does not cause arthritis. But if you already have arthritis, sometimes when the arthritis is flared up, it can certainly be painful to run.

Courtney: And finally, for someone listening who feels intimidated about getting back into running, what's the one thing you'd like them to remember from our conversation?

Dr. Busko: Find the joy in running. Find what makes you excited about it, and that is going to be different for everyone. Keep in mind why you do it. If it's stress relief, if it's competitive feelings that you really want to crush a race, if it's community and you're out there running with friends, if it's your solitary time, remember that even on the hard days because it's always worth it.

Courtney: Thank you so much, Dr. Busko. You sold me. I'm going out tomorrow [laughs] to go for a run through Central Park. Such a beautiful place to run.

Dr. Busko: Oh, we're so lucky. It really is the best in the world.

Courtney: [upbeat music] Our many thanks to Dr. Morgan Busko. I'm Courtney Allison.

Courtney:

Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Busko's work with patients, check out the show notes. NewYork-Presbyterian is here to help you stay amazing at every stage of your life. Join us next time when we talk about snoring and how to get a good night's sleep. That's in 2 weeks, right here on Health Matters. So you don't miss it, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.