Freedom’s Run – The Art and Science of Preparing for an Endurance Event

Mark Cucuzzella MD,FAAFP

Focus on Form

The next practice point is learning how to run correctly. Don’t we all know how to run by being human? Doesn’t improvement come from running more and harder? This may be fine advice if you have never been hurt, always feel perfect effortless motion, and have a rare insight on when to push and when to rest. If you were trying to improve your swimming and in the process were feeling shoulder pains, fighting the water with inefficient strokes, and frustrated to the point of giving up; would good advice be “ignore your form, keep working harder and maybe it will all work out?” Maybe this is why many runners quit the sport for good.

Runners suffer high injury rates (over 50% per year in most surveys) and there is no consensus or evidence on the best approach to the heterogeneous and multifactorial issues which lead to injury. In the most recent survey of Air Force injuries running was the #2 injury sport behind basketball, and many of the basketball injuries were running related. Traditional approaches have focused on (1) treating local injury with rest, ice, anti-inflammatory medications (which indeed may inhibit healing); (2) orthotics and footwear- often with rigid support and heel cushion technology; (3) stretching and strengthening exercises; and (4) modifying training and surfaces. Despite all this “care” we have not had affect on reducing injury rates. What is mostly ignored is prehab- learning proper posture, core strengthening, and movement- as a means to prevent injury

Is there proper running form and can one learn it? Observational and preliminary research data support yes and yes. Highly efficient runners, especially the East Africans, run with these common principles.

• Landing with bent knees with feet landing softly under the center of mass. No hard heel striking or reaching out in effort to lengthen stride. This is a high impact braking motion and momentum is lost. Run over the ground, not into it. Visualize riding a skateboard or Razor scooter. Ideal ground contact is with your foot under your center of mass, and ideally accelerating back a bit.
• Touch down quickly and pick up the foot or heel. This is tap,tap,tap…not thud, thud, thud. Keep the knees low and just pick up the heels. High forward knee drive is for the sprinters.
• Shorter strides with quicker cadence and less vertical movement. Running is a series of short efficient movements. Shorter strides have less vertical movement to get from one point to another, like throwing a ball between two points- the ball must go higher if the points are farther separated. The ideal cadence is about 90 steps a minute, but build up gradually to this.
• Focus on the core and prefect posture. If you can teach your core muscles to lift your legs as opposed to pushing off with the small muscles of the feet you have discovered new power. Think “run tall” and straighten your spine. Connect the dots between your ear, shoulder, hip, and bony prominence of ankle. (see picture)
• A slight forward lean from the ankles (not the waist). This harnesses some of the power of gravity. Are you a bit skeptical?….practice ChiRunning for a few weeks and feel the difference. Practice running down a very gentle hill. When you allow yourself to relax and lean gently while maintaining good posture, and let your feet land under you to avoid braking- you are harnessing the power of gravity. This can be applied on the flats as well. Just watch the body positions during any world class track meet or marathon and you’ll see.
• Elbows bent to 90 degrees to shorten the pendulum. No crossing the center line. Arm drive back, not forward.
• Relax your breathing and movements. Respiration occurs in the lower lung fields so learn belly breathing. I’ve heard comment that often Kenyan runners look like they have a “pot belly”. They do for the moment their diaphragms are dropping on inspiration. Visualize filling a beach ball below your belly button as you breathe in…then you’ve got it.

How you visualize or cue these movements is not complex and fortunately programs exist to teach it. All use slightly different focuses. I encourage you to explore any or all of them.

1. ChiRunning
2. Newton Running
3. Cady Stride Mechanics
4. Evolution Running
5. Radiant Running
6. Pose

Can this be learned and does it decrease injury and effort? The author of ChiRunning and I did a survey of folks who have tried ChiRunning. We got over 2500 responses with enlightening results. Over 40% missed more than 10 days over six months before the technique. That number was reduced to 11% in the 6 months after the technique. 45% reported perceived exertion before ChiRunning to be very hard or hard. Less than 5% reported perceived exertion as hard or very hard after practicing ChiRunning. Almost all felt it easy to learn and had recommended the method to others. We cannot draw conclusions from this but is opens us up to new ideas. We are following this with further study now, as are the innovators at Newton Running. Newton Running has some great teaching videos at www.newtonrunning.com

The study can be accessed with all the comments at www.fmdrl.org (search Cucuzzella or ChiRunning). March 2009 Running Times highlighted our WVU research and the work of several coaches and shoe designers all working together to help keep people running healthy for life. Family Practice News also featured the research in their March 1, 2009 issue

For some of you this is like taking the “red pill” in the Matrix. Your choices are taking the blue pill and continue what you are doing, or take the red pill and open your mind to what may be some new magical experience. If you are often sore, injured, or moving much slower than you think you should then go for the red.

What is my personal experience with what seems to be too simple to be true? I took the red pill. Trust me; I would never suggest anything without the personal road test of many years. In 2000 after 20 years of competitive running I needed surgery to correct severe osteoarthritis changes in my large toe joints (essentially big toes could not bend…not good for running) and advised to find a new sport. (See NPR story here) Not satisfied with that answer I needed to figure out how to continue the enjoyable lunchtime diversion. I studied and applied the aerobic heart rate techniques and form focuses. I needed to relearn how to run without hammering my feet and lower extremities. I ran slower than I ever had to keep my own HR below 155. When the beeper went on signaling too high a HR I’d relax, focus on easy efficient form, and usually without slowing the HR would lower. My time at the set HR went from 9 minutes a mile to 6 minutes a mile after a summer of doing this alone and no faster interval running. Surprisingly 6 months after the surgery I ran 2:28 for 3rd place at the 2000 Marine Corps Marathon. Never had running seemed so effortless and enjoyable. No pain…good. I’ve not missed a day due to injury or illness since the surgery and at age 40 won the Air Force Marathon in 2:31. As can be true with all of us, I continue to “practice” and learn every day. I’ve applied the principles to 2 successful JFK finishes- 16th and 2nd Master in 2007 and 11th and 1st Master in 2008.