Run F.A.R.: 13 Million People Can't Be Wrong

Dr. Vonda Wright

I just finished the Pittsburgh Half Marathon with 11,000 of my closest friends, along with my 72-year-old father. Apparently we are not alone—running is riding a new wave of popularity with more than 13 million people finishing a race in 2010.

The masses have discovered the joy of accomplishment, the runner’s high, and seeing how F.A.R. (Fortify, Achieve and Revive) they can go. It is no longer just the work of elite athletes, but the play of people of all ages and skill levels who are taking fitness into their own hands (and feet) to maintain mobility and health.

F.A.R. stands for the way I care for runners:
F: Fortify our bodies for running and for great health in general.
Through this pillar we identify health risks, physical muscle imbalances, and weaknesses, measure baseline fitness, and build a foundation for solid running and evaluate and plan smart everyday nutrition.
A: Achieve to maximize performance and minimize injury.
We strategically plan a vision for our running and health by determining what we really want from our training while taking action to get there.
R: Revive your body, brains, and bliss after a workout, race, or injury.
This pillar is the true sports medicine in this program. Runners want the best and correct information about how to treat themselves and when to seek medical care.

I love running—feeling strong at the end of a run, the countless miles alone on the road where my mind clicks in and manages to solve the day’s problems, being one of those crazy runners who continues through the minor aches (or outright pain) that comes with pushing past the comfort zone. It is knowing my body and listening to what every joint and muscle is saying, the rush of standing in the chutes in the cold morning air with thousands of other runners all nervous with kinetic energy, and racing (or hobbling) across the finish line.

Being a runner from a family of runners, I know the motivation that drives people towards the finish line. I also know that running and walking are for everyone.  For this year’s Pittsburgh Marathon weekend, we trained hundreds of runners in my Total Body Cross Training Program for Runners. The first timers literally changed their lives, dropped pounds, and experienced the satisfaction that only comes from an accomplishment well earned.

As an orthopaedic surgeon who has cared for thousands of runners of all ages and skill levels over the last decade, I am sure of two things.

  1. Real runners are going to find a way to run no matter what their doctor says.
  2. Runners who only run get hurt.

Running is good for your body, brains, and bliss. You need to be on the road. It is my job to keep you there.

The New Running Wave

It’s simple, requires minimal equipment, and everyone is doing it. According to Running USA, the number of runners on the road has doubled in the last 10 years. This new wave is more than 3 times larger than the wave of the 1980s!

The question is WHO are the masses? Simply put, today’s runners are: Educated, Affluent, Committed, Masters Athletes, and Women!

Runner stats from Running

Educated: 77.2 % college educated
Affluent: 72.9% report household income > $75,000
Committed: Average training days 213/year logging greater than 1,269 miles/yr
Masters: Women’s average age 38.5 years
  Men’s average age 43.6 years
Women: 53% of all race finishers in 2010 were female.

Don’t worry men, 6 million of your buddies are still on the road but the face of today’s wave is vastly different from the Jim Fixx or Bill Rodgers era where men ruled the road.

I see this demographic change reflected in my orthopaedic surgery clinics. Runners have always been committed but the fact that today’s runners’ median age is firmly in the masters range (35-55), means we have to train smarter to stay on the road. I developed the THRIVE total body cross training program (TBCxT) to give you the smarter edge. I want you ON the road and OUT of the doctor’s office!

How F.A.R. Can You Go?

The TBCxT Program is a 5-part, research-based program created around the concept of keeping the runner out of the doctor’s office and on the road using my 3 pillar philosophy of Fortify, Achieve and Revive.

The program includes:

  1. 24 running training videos entitled 90 seconds to THRIVE
  2. LIVE TBCxT workouts (soon available online and in gyms across the country)
  3. POWERPLAY for Runners DVD workout taught by myself and demonstrated by real Pittsburgh marathon runners
  4. Run F.A.R. , A 26.2 chapter book- to help Fortify your run, Achieve in your race and Revive your body, brains, and bliss
  5. ESPN weekly radio show talking about everything running on 970 AM and podcast online

Cross Training for Runners

I see runners flood the doctor’s office in three waves: 

  1. Novice runners and those early in their training season come in with the terrible too’s—too much, too often, too soon! 
  2. The overuse and imbalance crowd show up as their long runs reach over 15 miles.
  3. On the big day, racers push past normal fatigue during the middle and end of the race, their tired muscles and joints more prone to acute injury.

No matter what the cause, no one wants push hard only to have take 2 weeks off and nurse an injury—talk about wreaking havoc on a training schedule.

Running is a Total Body Sport

Most runners tell me they don’t do any kind of resistance training or aerobic cross training because their legs are strong. I understand their thinking, “anyone who can churn out 13-26.2 miles at one time has to be strong, right?” Runners train to endure. In doing so by only running, they also develop terrible muscle imbalances, kinetic chain weaknesses, generally ignore their cores and arms, and rarely stretch their muscles back out to optimal working length to maximize efficiency.

Any minor imbalance, weak link, or injury is amplified by an average of 2,000 steps per mile—equaling more than 56,000 opportunities to aggravate an injury per marathon. Our legs are the center of our universe, but those only running, either for recreation or to prepare for competition, develop overuse injuries. Because running results in the athlete performing the same motions hundreds of thousands of times a month, it actually magnifies or reveals the body’s weak areas. Achilles tendonitis, plantar fasciitis, medial gastroc strain, and even knee pain, are due to minor muscle imbalances and over use magnified by 2,000 steps per mile after mile after mile. Every link in your kinetic chain, from your big toe to your low back, must be functioning efficiently to prevent injury. Even small limitations in joint motion and muscle length, can change your entire stride.
Running surveyed runners about their injuries and see table below for the detailed results.

Self-Reporting Running-Related Injuries in 1 year
Blisters   30.9%
Knees pain   22.7%
Iliotibial Band Syndrome (ITB)   15.6%
Plantar Fasciitis   14.0%
Shin Splints    12.7%
Hamstring strain   12.3%
Foot pain    12.0%
Hips pain    11.9%
Low Back pain   10.4%

My job is to keep you on the road and out of my office, better yet my operating room by helping you make corrections, while teaching you to recover from injury effectively to prevent them in the future.

Cross training for runners is all about maximizing performance and minimizing injury. It does not distract from your running, but fortifies your body.

F.A.C.E. Your Race

Today’s wave of running enthusiasts is at the masters level, reaping all the advantages of their age. I always tell my patients our bodies are unique, not merely bad sequels to what we were in our 20s—meaning they need more thoughtful, well rounded training. We can’t just run out the door and be reckless like we did when we were kids. Our play must be smart, intense, and fun. Focusing on the 4 components of fitness every adult body needs is the key to this.

F- Flexibility: Daily attention to optimizing muscle length and joint economy via foam rolling, dynamic stretching, and warm-up prior to running and long gentle 30 second static stretches after running.

A- Aerobic: Cardiovascular efficiency is a key component of running. Many total body aerobic activities can train your heart and lungs, strengthen your muscles, and give your legs a rest.

C- Carry a Load: Strong runners have strong balanced muscles. I specifically do not teach weight training using machines because that is not the way muscles function in daily or sporting life. The best muscle training includes functional resistance in 3 planes of motion, using gravity and ground reactive forces with body weight, or free weights to achieve total body strength in the way our bodies actually move.

E- Equilibrium: Running is a single leg sport— 2,000 times per mile and 56,000 times per marathon, you are balancing on one leg. Great balance and proprioception are keys for optimized running. Right now, in a safe place, put on your running shoes and stand on one leg. Swing your arms. Shut your eyes. If you feel unsteady or topple over in less than 22 seconds, we have work to do.

Why Do Runners Need to Cross Train?

Many runners come into my office with injuries or desire to maximize their performance and minimize injury. When exploring their workouts, I find that the only cross training is occasionally throwing in some legs on a weight machine. The fact is running is a total body sport.

Arm Yourself: Every time your legs take a step, your arms and upper body take a step. Your upper back has to stabilize each arm swing. The triceps, rhomboids, and trapezius fire for your back swing while the front of your trunk (pecs, deltoid, and rotator cuff) pulls your arm through the upswing. All the time, your biceps are held in a somewhat static contracted position. In this context, it is little wonder that you see some runners dangling their arms and stretching their backs as they run towards the finish line.

The CORE and More: The runner’s core is a hot topic right now and with good reason. Your core is the foundation of every stride both on and off the road. Many of us have sabotaged our foundation with a necessary evil, the desk job! For 8 to 12 hours a day, we are sitting on our strongest muscles, forward posture, with abdomen and shoulders forward and hips flexed. It not only sets us up for lower back pain but offers no opportunity to maintain core strength.

What is your core exactly? Is it the ripped 6 pack you commonly see in fitness magazines? Well, the abdominal rectus muscle (the 6 pack) is attractive but ultimately not as important as the 3 layers of oblique muscle that wrap around your body to package your trunk. Your internal obliques, external obliques, and transverse abdominals are the muscles you feel when placing your hands on your sides and bear down (like you are about to be punched in the stomach) and the ones that scream out during a side plank. This natural weight belt supports your upper body, holds your posture inline, and helps power your stride. If our cores are weak, it allows our pelvis to tilt and changes our stride kinetics.

A Weak Butt Kills the Runner: Perhaps even more important than a fabulous core is a strong butt. A weak butt kills the runner. I say this so many times a day in my clinic; it has become a joke among my resident doctors. Our butts were designed as the largest muscle group in our bodies, not to provide a cushy setting for 10 hour a day desk jobs, but to powerfully contract to produce the force that powers us down the road and provide shock absorption so we don’t batter our legs up. Unless you are running up hills, butt muscles are not significantly strengthened to endure the final miles or get up that big hill. This weak link leads to significant muscle imbalance and down-stream injuries as it fatigues and changes the whole biomechanics of your stride. When a runner comes into my office with iliotibial band syndrome or anterior knee pain, the first thing I do is examine their butts. The gluteus maximus, medius, and minimus, are responsible for power generation and deceleration of every step. You need butt power to get up hills and stabilize your pelvis. A weak one will not only make you look like your waddling across the finish line but results in IT Band syndrome, knee pain, low back pain, and aggravation.

It is not uncommon for seasoned runners to report to me that they spend up to half of their time injured during a running season. They usually have a list of injuries that predictably recur each season and are understandably frustrated at their loss of performance. Recently, a 45-year-old life-long runner brought her list of injuries in to me: left IT Band pain, lateral knee pain, and lateral foot pain. Nothing was hurting at that moment, but with an 8–week ramp up to a half marathon on the horizon, she was predicting her future.

I bet you’re are reading this and nodding your head. As always, I started examining her by testing her butt strength with a trendelenberg sign. Sure enough, her right butt muscles were much weaker than her left, thus contributing to her repetitive left sided injures as her left pelvis dropped with every step because the right butt was not supporting her.

Total Body Cross Training Benefits Go On and On

Total Body cross training for runners is not only important for injury prevention but it also pays off by increasing oxygen capacity, reducing body fat, strengthening and building muscle, and increasing bone density. It builds a strong upper body (usually neglected in running) and core for pelvic stability. Running specific cross training with a focus on total body fitness and plyometrics will improve running economy (the use of oxygen) and neuromuscular speed (spin bursts).

Runners can think of their bodies like a car. Going long distances builds a high endurance aerobic engine. Revving up a huge engine in a weak frame is a recipe for breakdown. That’s why runners need to build their body strength to match their cardiovascular strength.

Focus should be on multi-joint, compound movements that build functional strength. If you want resistance training to benefit your running the most, try lifting heavier weights through fewer repetitions. Physiologists suggest 8-12 reps of compound resistance work instead of 2-3 sets of lighter weights. This recruits more muscle fibers for each motion and therefore more fibers will become strong to defend against injury and you will have increased power for push off the ground, making you faster. This is opposite the common notion that runners should lift light-weights through high repetitions. Fact is, runners get that light weight/high rep workout while running.

Cross training decreases injury rates in lower body sports. In other lower body sports such as soccer, cross training cut the injury rate in half. It makes sense that diminished the cumulative level of repetitive impact while growing strength will decrease overuse injuries.

Weight and cross training improves running economy. A study out of the University of New Hampshire found that when female runners, logging more than 20 miles per week, added weight training 3 times per week for 10 weeks they increased their running economy by decreasing the amount of oxygen consumed at a variety of paces. A control group, who did not weight train, did not improve oxygen use.

Cross training with spinning intervals increases speed. High power bike intervals work your legs even harder than uphill running, but without the impact of hard running. Use burst intervals at high resistance for two periods of 30, 45, 60, 45, and 30 seconds. Between each burst, lower the resistance and recover. Do burst cycling a couple of times a week to prepare for hills.

Cross training is ideal for injury recovery. Even with a leg injury, the runner still has two arms, a core, and cardiovascular system to keep in shape during their recovery. I always suggest thinking outside the box for running injury recovery. For those lucky enough to have access to an underwater treadmill get on it. If not, deep-water pool running is ideal for maintaining running fitness. Using a kick board will improve ankle flexibility. In addition, there are multiple cross training options for runners including:

  • Yoga: resistance training with body weight and increased flexibility
  • Cross country skiing: superb cardiovascular workout without all the pounding. Additionally develops hamstring, calf, and lower back flexibility
  • Ice or Inline skating: low impact workout for quads, butt, and lower back when recovering from legs and foot injury


The Total Body Cross Training Pre-test

You cannot know where you are going unless you know where you are starting. When training my runners, I always look at where we are starting with three simple standard tests of total body strength. Test yourself! 

How F.A.R. Can You Go?

Vertical leap
Lower body strength and power- HILLS
Upper body strength and stamina
Core strength and stability

The Vertical Leap:

  1. The runner stands side on to a wall and reaches up with the hand closest to the wall.
  2. Keeping the feet flat on the ground, the point of the fingertips is marked or recorded. This is called the standing reach height.
  3. The runner then stands away from the wall, and leaps vertically as high as possible using both arms and legs to assist in projecting the body upwards.
  4. Attempt to touch the wall at the highest point of the jump
  5. The difference in the distance between the standing reach height and the jump height is the score.
  6. The best of three attempts is recorded.

Vertical Leap Score- Lower Body Strength and Power

Score     M (inches)    F (inches)

Excellent    >28               >24
V. Good     24-28           20-24
>Ave         20-24           16-20
Ave            20-16           12-16
<Ave         12-16             8-12
Poor           8-12               4-8
< Poor         <8                 <4

Push Ups: Upper Body Strength and Stamina

  1. Group assumes the standard push up position on hands and toes
  2. Elbows close to trunk
  3. Body in a straight plank
  4. Count pushups lowered to neutral with body and elbows level with shoulders
  5. Count total number

SCORE: goal for average strength
         Male >22
         Female >11


Core strength and stability: Proper strength in the core of the body—or, more specifically, the abdominal and low-back areas—is incredibly important in almost every sport, because core strength maintains stability of the upper body during movement. If core strength is poor, the torso tends to move unnecessarily during motion, wasting energy; if core strength is good, an athlete can move with high efficiency.

  1. Assume the prone position, with full body weight supported only by your forearms and toes. Your body should be absolutely linear as you do this and your pelvis tucked (for proper tucking, tighten your butt muscles so that the bottom of your pelvic girdle moves forward or—in this case—towards the ground).
  2. Hold the basic position (weight on forearms and toes) for 60 seconds, then lift your right arm off the ground for 15 seconds, supporting your full body weight on your left arm and the toes of both feet (keeping your body linear and your pelvis tucked).
  3. Return your right arm to the ground and raise your left arm for 15 seconds, again keeping your body in the proper alignment.
  4. Return your left arm to the ground and raise your right leg for 15 seconds, then return it to the ground and repeat on the other leg.
  5. Finally, elevate your right arm and left leg simultaneously for 15 seconds, then your left arm and right leg simultaneously for 15 seconds more (don’t try lifting both legs or both arms at the same time).
  6. Return to the basic position, and hold for 30 seconds to finish your core test.


Factors Affecting Performance

Whether you are stepping away from the couch for the first time in 20 years to take on the marathon challenge or a seasoned runner hoping to increase your performance and minimize injury, there is never a time nor skill level that you cannot increase strength, speed, or endurance. Our bodies were designed to move!  

We have an amazing core, three layers of butt muscles, and two powerful legs ready to propel us down the road. Despite this fabulous set of equipment, many of us recognize changes in our performance and bodies with aging.

I began studying masters athletes in 2001 because I was intrigued by these athletes who brushed birthday candles aside and continued to outperform many younger competitors. When I looked for research articles to tell me why some people were capable of such amazing feats, I found little. Most studies documented the effects of sedentary aging and did not ask the question of what happens to us if we are chronically active. I published my first in a series of studies looking specifically at the musculoskeletal effects of chronic exercise in 2005 asking the question “what are we really capable of if we age actively?” The answer is, “more than we ever thought possible.”