Marathon training season is here - learn the tips and tricks to training, running, and recovery.
Marathon training season is here - learn the tips and tricks to training, running, and recovery. Dr. Dennis Cardone and Dr. Joseph Zuckerman of NYU Langone Orthopedics are joined by NYU's Head Coach of the Track & Field teams Tyler Deck Shipley. From shoes and training programs to nutrition and injury prevention, they'll take you step by step through the best ways to successfully finish your marathon.
Introduction: SiriusXM presents an NYU Langone Orthopedics podcast. Orthopedics is just very important to the population in this country. Its ability to restore patient function. Problems related to cartilage, to someone who has more advanced forms of arthritis. Getting people back to their activities and the things that they like to do. Featuring NYU's experts in the field of orthopedics. Trying to figure out that problem before it even is a problem. Problems with solutions. Well beyond physical therapy, conservative pain management, to surgery. The best medical minds now come together, applying all of our minds to solve these problems. We're here to get people feeling better so they can get back to their lives. And that's really what we try and accomplish. These are the Bone Whisperers.
Doctor Dennis Cardone: Hello and welcome to the Bone Whisperer podcast. I am Doctor Dennis Cardone, I'm joined by my co host, the Chairman of the Department of Orthopedic Surgery, Doctor Joseph Zuckerman. And, uh, we're coming live or we’re coming to you from NYU Langone Health and department of Orthopedic Surgery at NYU Langone Health. And joining us is Tyler Deck Shipley. And Tyler is the running coach, the cross country and track coach for NYU Athletics. And we're talking everything, running and specifically, uh, training, getting ready for the marathon season coming up. The New York City marathon for one in November, but marathon training, and why don't I start off and just say hello to my co-host, Doctor Zuckerman. Thank you for joining us.
Doctor Joseph Zuckerman: Well, Doctor Cardone, thank you very much for inviting me. I want to clarify one thing. We are live now. You and I are alive now. This is actually really happening. But by the time these other people listen to it, it would, uh, come across as a recorded telecast. Right? So that's.
Doctor Dennis Cardone: We're live.
Doctor Joseph Zuckerman: We're alive. We're alive. And Tyler, you're alive also, right?
Tyler Deck Shipley: I'm also alive.
Doctor Joseph Zuckerman: Okay, so we have three live people here, right? We're not pre recorded. We are not. What are they called? Holograms or anything like that?
Doctor Dennis Cardone: Soon, um, next year, we'll be doing it in holograms. Let me start with Tyler. Tyler, let's open this up. We're talking about marathon training. If you were - So we're in July now, you know. In the office setting I see, I certainly see plenty of patients coming in the office, and they say, I'm starting my training - what do I need to do? So you're talking to a population, maybe, of some novice runners. What do you say to them? How do you get ready - we’re four or five months prior to marathon - what do you say in terms of what's proper for training, how to prevent injury, and how not to maybe come out of the starting blocks too quickly?
Doctor Joseph Zuckerman: Or, Tyler, is four months enough time to prepare for a marathon if you're running three times a week, you know, 4 to 5 miles?
Tyler Deck Shipley: Yeah. Quick answer. Yes. Um, long answer. I think the first conversation always has to start with where people are at. Where you see, like, injuries and kind of the start and stop into running is when we suddenly just change our habits into, like, jumping into serious training or jumping into training in ways that we previously haven't run. And I think that's the best way to start a plan is always, like, understand where someone is coming to you from and then slowly kind of introduce training from there. I think four months is plenty of time for anybody that has, like a brief running background. I think if you're probably starting from scratch, going from, like, never really running before, and then having a goal of running 26 miles in four months sometimes might be lofty, but doesn't mean that it's not possible. I think it's just like, slowly introducing things. And the number one goal is like, how do we prevent injury so that you can get across the finish line at the marathon whenever that does come.
Doctor Dennis Cardone: What if we started with basics? So say, you know, our runner, whoever it may be, this is really new to him or her. They walk into the running store. Do they need to select a specific running shoe? Is it the running shoe that's most comfortable for them is the right running shoe? Do they need to, do they need to change their running shoe during training, not just stick with one running shoe? How do you even - How do you even start?
Tyler Deck Shipley: Yeah, that's a really good question. And I think sometimes going to the local running store is the best way to do it. I'm a huge proponent of it as you get to try on a bunch of different things, and I think it really comes down to comfort. You will obviously want something that you're going to be comfortable in and, like, feel confident in running in for a long time. And normally, if you're about to start a marathon buildup, I would buy two pairs. Because by the time four months comes by, you probably are going to want to run the marathon in a newer pair of shoes, and you can kind of work in that probably two or three weeks before you really get going. And I think that's the best way to start. And, like, having conversations with people at the running store are usually is a good way, they're pretty knowledgeable about running itself. And I think just starting, seeing where you're at and being, like, comfortable in being uncomfortable while training for the first few weeks and then really settling in and start to kind of dive in and run more and kind of press yourself. But I think you said it well - getting a good pair of shoes is the best place to start.
Doctor Joseph Zuckerman: And getting good advice. I think the running store is a good idea because not all feet are created equal and not all runners are created equal. And I think somebody like me who weighs 210 pounds will have a certain shoe, as opposed to Doctor Cardone, who probably looks like he's maybe about 150 or so. Right?
Doctor Dennis Cardone: Listen, but you're six foot everything. I'm five foot nothing, you know, so.
Doctor Joseph Zuckerman: But that's, you know, that has to be reflected in the shoe because there's a wear and tear. There's how many hundreds of thousands of steps that are going to take place in training for a marathon. So the people in the running store can advise about this.
Doctor Dennis Cardone: Tyler, I'm going to ask you, I've heard this from running coaches and, uh, uh, you know, over the past few years, and it kind of surprised me. I've heard running coaches say they like their runners to change running shoes, to have, uh, different pairs, not only of the same brand type, but different types of running shoes and to alternate. Yes? No?
Tyler Deck Shipley: Yeah, 100%, yeah. Oftentimes when you're training, you should have two different types of shoes, and one is made for, like, faster running. So on days that you're going to run shorter and faster, that you would wear, like, a lighter pair of shoes, that allows you to kind of, like, be on your toes more and kind of facilitates that process. And then when you're running, like, longer, slower, your long run days on Sundays, where they're most traditionally on Sunday or Saturday, that you'd be wearing something much more padded and, like, heavier to provide a little more support while you're running. Um, and those are like the two ways that we see people cycle shoes. Oftentimes running people are encouraged to cycle out the same pair of shoes. So let's say you have a pair of Nikes and that's what you feel most comfortable running in, that you would alternate, like, two days running in the Nike Pegasus, and then you have your second pair of Nike Pegasus that you'd run two days in and you'd kind of cycle those in.
Doctor Joseph Zuckerman: Now, I do want to point out that Nike is not a sponsor of this program.
Tyler Deck Shipley: Uh, no, no, no. I knew I was going to get a little bit of that.
Doctor Joseph Zuckerman: Tyler's preference. Now, I also want to clarify. When you say on the faster days versus the other days, for many of us, it's a question of the slow day versus the slower day, right? It's the same thing.
Tyler Deck Shipley: Yeah, that's how you spin it. But everybody's running fast at some point, so I think it's a little more complimenting to, uh, call it the fast day.
Doctor Dennis Cardone: How about my last question regarding running shoes? Is it myth or is this old school to say 400 miles - change your running shoes. You know, does mileage matter? Should people change them? What do you tell your runners now? When should they change them?
Tyler Deck Shipley: That's a very good baseline to go through. And I think people that run a lot and get comfortable with a certain pair of shoes tend to see, tend to hone in on exactly what the shelf life of the shoe is. Some people really are hard on shoes, and, like, 250 and the shoes done. Other people are, I guess, much more gentle on their feet, and they can make it 400, 500, 600 miles. Myself, when I was running, like, if I got 300 miles out of pair of shoes, I was ecstatic. Uh, so I think it's really just 400 is a great baseline. And then just paying attention to, like, if your shoes feel really flat or the rubber starts to wear off or something along those lines, then it's probably a good time to switch them out.
Doctor Joseph Zuckerman: So, before we move off, shoes as equipment, what about the socks? Right. Because, you know, you go into a running store, there are racks and racks of different socks to wear. And also you see a variety of inserts, right? Are these, uh, areas, uh, that are not important? Are these things that you should also seek advice on? I mean, how do you make a decision about this?
Tyler Deck Shipley: Yeah, socks is trial and error. Number one thing for socks is just to prevent blisters. And so once you find a pair of socks that works for you, I would just stock up on them. It's kind of, everybody has a different preference. Some people prefer the wool blend, some people, all synthetic materials, some people live by cotton. And I think it's really just kind of like, what's most comfortable to you? Inserts- I try to stay away from. I think certainly going and getting orthopedic inserts, those are made by professionals. The ones that are kind of just like one size catches all doesn't really fit exactly what you specifically need is probably already in the running shoe in some capacity. So I think find a running shoe that fits for you rather than an insert that fits for you at the running store.
Doctor Dennis Cardone: Let me share a secret about socks with Doctor Zuckerman. There's a couple of companies I know of that they have lifetime guarantees of their socks. Like, you wear them out, no questions asked. Send them, they send you brand new pair.
Doctor Joseph Zuckerman: Really?
Doctor Dennis Cardone: Yeah.
Doctor Joseph Zuckerman: Well, we can consider, we should have considered them as a sponsor for this program.
Tyler Deck Shipley: Yeah, I was going to say I might need that brand after the podcast ends.
Doctor Dennis Cardone: Actually, let me tell you, there are two brands. Don't ask, one of them, I think I remember the name. The other one I don't remember. But anyway, just thought I'd throw that out there.
Doctor Joseph Zuckerman: So now we've got good shoes, we've got socks, right. And the person who is running three times a week, let's say 4 to 5 miles each day, now has to up their training, right? You have to come up with a plan. And basically, if we think it's July and the marathon is in November, they've got 13, 14 weeks to prepare for this. So, uh, what's the sequence? What should they be looking for in this?
Tyler Deck Shipley: Yeah, most common thing that you see introduction to marathon training programs, starting with three or four days per week of running. And the runs during the week all kind of stay the same, somewhere between three to 6 miles where there's a progression of long runs. And really it's about gradually increasing the long run until you are near, like, three weeks prior to the marathon that you're probably close to like 18, 19 miles, just so that you kind of can mimic what the marathon will be like, and then you have ample time to recover from that. So oftentimes you see is starting at 6 miles and gradually builds up to eight, then ten, and then usually have a down week and then builds up back up again. And that's kind of the most common progression that you see in kind of intro to marathon training programs.
Doctor Dennis Cardone: So I'm going to what I see commonly, a big mistake, is people sign up for these programs that are just too aggressive, where they're just doing too many long runs, maybe too quickly. And even just doing too many long runs even along the way in their training program. So obviously the question becomes, where does somebody go if they're looking for a program that you would say is a good program that's not maybe too aggressive in terms of running? And also, I'll give a second part to that question. Does your advice change for the 50 year old compared to the 30 year old in terms of recovery and days running per week, and again, in terms of injury prevention?
Tyler Deck Shipley: Yeah, 100%. And I think that's where understanding someone's running history and kind of their histories with injury is the most important thing. There's never a one size fits all. Even at, like, the collegiate level where I'm coaching someone from the age of 17 to 22, like, everybody's on a little bit different training plan. And I think if you're looking for something that - dealing with a real coach or a real life person that is able to engage with you in conversation and make changes along the way based on how you're feeling is the best part. And the nice thing is, is through technology that more and more often that you can get fairly affordable training plans from people for, like, $100, $200. And then you, like, you know, they normally up-charge you if you're going to call them once or twice a week. But there's several opportunities, especially in New York, there's endless amount of coaches that would be interested in, like, kind of helping you through a marathon or finding a plan that best fits you. And so, like, I always try to not paint myself in a corner when it comes to giving advice just because it's not a one size fits all. But I do think if you're injured, you're not running and you're not working towards your goal of finishing the marathon. So I always say it's better to be 85% trained and healthy than being 100% trained and being injured.
Doctor Dennis Cardone: With that said, let me just. For all our listeners, let me just say you're listening to the Bone Whisperer, NYU Langone Department of Orthopedics, part of NYU Langone Health. Here in studio, Doctor Joseph Zuckerman, chairman of the Department of orthopedic surgery. I'm doctor Dennis Cardone. And joining us is Tyler Deck Shipley, uh, coach of the NYU cross country and track team. And we're talking about marathon training. And this is our welcoming to our new podcast.
Doctor Joseph Zuckerman: So, Tyler, getting back to the training schedule, when you say three or four days a week, are you talking about Monday to Friday with a longer run on the weekend?
Tyler Deck Shipley: Yeah. So, uh, most often you see, like, Monday, Wednesday, Friday, long run Sunday, and then you would take that next Monday off, and then it would go like, Tuesday, Wednesday, Saturday, long run Sunday. Oftentimes you see, like, it alternating between four days of running and three days of running. And those are, like, the most common introduction to running programs. I think especially for more injury prone runners, you can reduce the days of running and supplement that with swimming, aqua jogging, biking, something that mimics the aerobic work that you get through running without having the impact.
Doctor Joseph Zuckerman: So some type of cross training activity to reduce the risk of, uh, overuse and injury. And you think, let's say long run, you can, let's say if you start off with a six mile run and then bump it up to a seven or eight mile run, you're increasing that each week, and the target should be 18 to 20 miles for your final long run, would you say?
Tyler Deck Shipley: That's if things go well in the buildup, if you get to twelve or 14 miles and you're just absolutely kind of beat up or don't think that's sustainable, then I think it's okay to really just stay there and then understand that the marathon might be a little bit more of an endeavor once you get there. But if the goal is to finish, and finish healthily, that I think that's the best way to approach it is again, be a little under trained and then go in and understand that you might be a little in over your head at certain points, but with the goal of finishing, that's the best way to get to the starting line healthy.
Doctor Joseph Zuckerman: And always, you would suggest a day of rest after a long run during training.
Tyler Deck Shipley: For newer runners. You see elite marathon runners running 160 miles a week, 140 miles a week, that's just absolutely kind of crazy numbers. Certainly that's professionals and much different than what we're talking kind of about. But, yeah, I think, especially if injury is concerned, that I think having a rest day is crucial.
Doctor Dennis Cardone: Doctor Zuckerman, nobody knows you better than I do. You've run two marathons. So, you know, what about now or what have you noticed, getting older? Right. Most people, when I talk to older runners, the thing that they say most, what's different at age 50 compared to age 30? It's all about recovery. They say recovery is different. Uh, so you trained for two marathons, and if you think back when you were training then, compared to if you were even thinking about training now, what would be some major differences to you?
Doctor Joseph Zuckerman: Well, I think that, uh, every person's biology is different. I'm amazed that I ran my marathons when I was, I think, 29 and 30 years old. The training was straightforward. There was nothing, not a whole lot scientific about it. But just as Tyler said, you try and keep increasing your long run and maintain it during the week. But, uh, people have to pay attention to their biology. There are people that can run marathons at 40, 50, 60 because their biology allows it. When I say biology, it's basically the structure of their joints. You know as well as I do that joints deteriorate potentially as we get older, and they don't deteriorate at the same rate in the same people. So some people will be able to sustain running without injury, and, uh, some people will have to switch to something else. And they have to pay attention to that because it affects everybody a little bit differently. Now, I've given up running completely because the impact on my joints, maybe from doing all that running when I was younger, in part, has taken a toll. Now it's easier to, uh, do other things that are not, uh, repetitive, impact type activities.
Doctor Dennis Cardone: I have a friend, he's 86. Not anywhere near anybody's age on this podcast, for sure, but he used to do the New York City marathon, was in Central Park. And he said when he was doing that marathon, it was in the 70s, that they purposely told all the runners, they told them, you cannot drink anything during the marathon. It's bad for you. You could drink what you want before, but don't drink during. I'm just thinking, you know, when you ran your marathons, you know, was there anything very different at that time in terms of training or nutrition or buildup and anything compared, uh, to present day?
Doctor Joseph Zuckerman: Well, I will tell you that I happen to have run the Seattle marathon in 1979 and 1980. And even though it was raining both days, as you would expect in Seattle, there were not the water stations set up along the way. It was a whole different approach to hydration and how you take care of yourself. And I think that we should talk a little bit about that hydration, because I think that's now appreciated where it was underappreciated. Listen, when you and I were growing up, you know, you played sports. They would tell you, you know, on a hot day, don't drink, all right? Because you're going to get cramps or something like that, and that's completely different now. So, uh, Tyler, how critically important is hydration during a marathon?
Tyler Deck Shipley: Yeah. During these marathons, you weren't taking, like, any nutrition or food at all, either.
Doctor Joseph Zuckerman: You mean, like, stopping off for a hamburger along the way?
Tyler Deck Shipley: No, no, no.
Doctor Joseph Zuckerman: What do you mean?
Tyler Deck Shipley: Like gels or, like, oftentimes, you see people take kind of, like, these sugar drinks or those types of things. So there's, like, no, no type of nutrition either?
Doctor Joseph Zuckerman: You see it now, but it wasn't certainly wasn't standard back then, that's for sure.
Tyler Deck Shipley: Yeah, that was, that was my question. Yeah, hydration is critical, and I think something that's really important to practice in your long runs is taking liquids and taking gels during the run, to practice what it feels like to try to ingest things while you're running. And kind, uh, of the, uh, for the marathon, you often hear like, a rule, every 30 minutes you should be taking in some type of liquid and some type of, like, carbohydrate. Most often you see it gels or like these little, like, kind of blocks that are, that are kind of like fruit snacks, I guess, is the best way to explain them. And you see people take those every 30 minutes while they're running. So if you're out there for 4 hours, you're, you're taking eight stops. If you're out there for two and a half hours, you're taking five. And I think it's just important to kind of really make sure that you're staying hydrated, as obviously that's when our bodies work best.
Doctor Dennis Cardone: I'm going to challenge you on that a little bit and only, or just throw it in. From a medical perspective, one of the problems is hyponatremia, a loss of sodium. And, uh, for our slower runners, right, I mean, they've looked at the studies. The runners who are very slow, they're stopping at all the stations, or maybe putting in a five-hour-plus marathon. For that, and agree that's just a very different population, but that population should not be necessarily stopping at all the water stations. And then also, and this certainly, I would ask you about the gels and the goos. If you take too much, is it some risk for stomach cramps or other GI problems, or it's really just what the runner is accustomed to, what they've done in the past?
Tyler Deck Shipley: Yes, certainly, if you show up on race day and then start taking goo that are, you know, these sugary substances that you're not used to at all, you can probably expect some stomach issues. I think that's probably why, at the elite level, um, you most often see people, like, practicing taking these substances just to make sure that their bodies, uh, can perform at a high level all the way through the race. Um, and I think trying to do that even at kind of a more local or recreational level, I think is important, too, just because our bodies probably still need to compete at the same level. I'm curious, how come, for the people that are out there for 5 hours, that it's not great to stop at all the water stations?
Doctor Dennis Cardone: If they keep taking too much water in and with loss of sodium, for example, with sweating, they drop their sodium level to potentially to what can be a dangerous level and can, uh, have catastrophic consequences. So for the really slow runners on the course, we tell them not to stop at every water station. And it's interesting how the water recommendation goes through cycles, right? I mean, at one point, whatever, years ago, they were saying hydrate like you're saying hydrate even if you're not thirsty. But now I thought the current, more current is to say you can wait until you are thirsty. That's probably some combination, some moderate middle road probably works best.
Doctor Joseph Zuckerman: So let's just understand the reduced sodium concern. Because basically you're sweating and you're losing electrolytes and you're replacing it with pure water, which has no electrolytes. So basically you're diluting whatever electrolytes you have, and that's how you get into the hyponatremia. Now, if you replaced, uh, if you hydrated with some electrolyte solution, that would be potentially more beneficial. And some, uh, ah, running courses do use electrolyte solutions, right? Is that your experience?
Doctor Dennis Cardone: Yeah, that is true. But it's also interesting because a lot of the sports drinks that you think you get in the electrolytes lack sodium. So in many, just like you said, at the many running stations, they actually have these salt packets that they'll give people, which is good, a good idea to take.
Doctor Joseph Zuckerman: So, Tyler, it sounds like this hydration and use of, uh, the carbohydrate gels or goos needs to be part of the training cycle as well. You can't just do that on race day. So somehow you have to accommodate to that. Now, in terms of hydration, I see people running around with these water packs on their back with the flexible straw that comes over their shoulder. Is that something that you would advise people to use on a training run?
Tyler Deck Shipley: To be honest, I think training with that is kind of laborious or probably uncomfortable. I think the easiest way is if there's a way to build in a stop where there's a water bottle that you place somewhere, or you have a friend meet you at mile five, or you have a loop that you do where you can just like grab the water bottle quickly and then take a sip or, you know, have your goo. That's probably the easier and more comfortable way to do it than slogging a backpack with water around for 10 to 14 miles or however long you're going that day. And I think, you know, it's important to practice what you're going to be doing on race day. And if that's taking hydration or taking nutrition, then you should probably practice that as well.
Doctor Dennis Cardone: Doctor Zuckerman, I'm going to jump topic a little bit. The 50 year old patient wants to run a marathon, your patient in the office, some mild, mild, maybe even moderate hip or knee arthritis. And as a joint specialist, what do you say to that patient? Are they wearing down their joints faster if they decide they want to run a marathon?
Doctor Joseph Zuckerman: Well, I think there's a few aspects with that. So first of all, you want to know their running history, are they doing any training now and how they've accommodated that? But let's assume they're the casual jogger a few times a week like we described before. I think to train like this for a marathon, you need to look at body habitus. I think somebody who is 215 pounds is different than somebody who's 150 pounds, because the repetitive impact of running is directly related to weight to a certain degree and how much stress you put on the joints. I think that will take its toll. So that's one aspect of it. The second, even before you get to that point, is everybody, before they start a concerted or structured running program, needs to make sure that they're medically able. The 50 year old is different than the 30 year old. The 30 year old can just assume they're okay. The 50 year old can't do that. I think they really have to make sure they get a sign off by their primary care physician and make sure they're in good shape to do this.
Doctor Dennis Cardone: So, I would say, like, maybe ten years ago, you might say to the patient, you know what? You've got some mild, moderate arthritis. You go out there, you pound the pavement, you do your running, and potentially you're going to wear that joint down faster. Some of the, more recently, it almost seems like maybe it's actually beneficial to have, uh, some of the impact, and maybe in some way it's lubricating or protective or just to stay active. Or maybe the answer is, we don't know.
Doctor Joseph Zuckerman: Well, that's where you get into the whole biologic variation. Every body is different. Some joints can tolerate it, may be benefited by it, some can't. And you'll know that pretty soon by how you can tolerate the training activities that you go through. So a 50 year old, get approval from your medical physician, start training, do everything Tyler said about proper shoes, proper socks, gradually increase it and see how your body responds to it.
Doctor Dennis Cardone: All right, here's a myth buster for Doctor Zuckerman. For Doctor Z. Should you have a big pasta dinner the night before a marathon?
Doctor Joseph Zuckerman: Well, let's see now. Is that with red sauce or white sauce? So, listen, carbohydrate loading, was always a critically important piece of the whole training activity, right. But I think that's been disproven to a certain extent that the benefits of carbohydrate loading are not near as, uh, significant as they were. I mean, Dennis, what's been your experience or knowledge about it?
Doctor Dennis Cardone: Yeah, I would echo the same exact thing. Exactly the same. I mean, it used to be such a big thing, carbohydrate loading, big pasta dinner. Everyone gets together the night before the marathon, and it's kind of gone out of favor. Where, again, I think it always comes back to moderation. Tyler, what do you say?
Tyler Deck Shipley: Yeah, same thing. Um, I remember back in my high school days of running that, like, I would just eat pasta till I was sick the day before the race, thinking that that was the best possible thing for me. Where now it's just like eating a diet that's very similar to what you normally eat, as that's what your stomach's used to, and best to be able to respond off for an early start for a marathon. And that's really what we kind of encourage through our team, as well.
Doctor Joseph Zuckerman: Yeah, I think you have to be careful. You don't want to change things. You've gone through a training program that's structured, carefully designed, and you don't want to have these significant perturbations where you're doing something so differently. So I think the whole, I don't think any marathon has a big pasta dinner anymore the night before. Then at some point, I think they went, the theory was to do it two days before so your body had a chance to acclimate. But I think that's all gone by the wayside.
Doctor Dennis Cardone: You're listening to the Bone Whisperer podcast. Welcome to our new podcast, brought to you by the NYU Langone Department of Orthopedics, part of NYU Langone Health. And I'm Doctor Dennis Cardone. I'm joined by my co host, the chairman of our orthopedic department, Doctor Joseph Zuckerman. And a special guest joining us, Tyler Deck Shipley, who's the coach of the cross country and track team here at NYU Athletics. The Bone Whisperer podcast the Bone Whisperer.
Doctor Joseph Zuckerman: Now, I've never been known to whisper, so I'm just going to talk about this. So now, somewhere along the line with anybody's training program, injuries can often occur. Now, sometimes these are, you can be running, fall and trip and break your ankle. That's not the kind of injury that we're talking about. We're talking about the overuse type injuries. So, as somebody who's training for a marathon starts to have specific pain in an area, right, from, probably from overuse - how do we treat that? What advice would you give first, Doctor Cardone and then Tyler. Right. What do you tell a runner about that?
Doctor Dennis Cardone: The first thing I would say is, you know, the things that you always hear, and it's really true - Listen to your body, right? So it's certainly okay to maybe have some soreness, some achiness, uh, that maybe it could be after a long run, after any run, maybe lasting for a couple of days. But symptoms that are persistent and certainly if they're worsening or progressing, all athletes need to take seriously. And those are the ones that probably should get checked early on. You know, we could talk specifics, but the big thing, anyone who's putting in mileage, doing endurance training, long, long runs, we think about bone injuries. So stress injuries of the bone, everything from what we call a stress reaction, irritation of the bone to kind of develop into a small little fracture or stress fracture or a small little break in the bone.
Doctor Joseph Zuckerman: But before, before you go there, what about shin splints? Everybody talks about shin splints, though - my legs hurts, I have shin splints. What is that?
Doctor Dennis Cardone: So common! And that's part of that bone stress injury. So bone is living tissue, every day getting built up and broke down a little bit. So if someone goes out, does a lot of impact, a lot of pounding, the bones getting irritated, maybe the bones, uh, getting inflamed, getting irritated faster then the body can heal it. So it starts to get a little uncomfortable. And that's shin splints, where I usually feel it in the shin, usually the inside part of the shin. And that's kind of an early warning sign that the bone's starting to get irritated and injury is coming down the road, and potentially lead into maybe a stress fracture. So someone with shin splints, you need to pay attention, maybe back off on your running like we talked about. Add more recovery days, decrease your running mileage, and see if things can get better over a period of a week to ten days. And in the more severe symptoms, then you really need to take time off completely from running. And like Tyler spoke about earlier, do cross training, bike, swim, elliptical.
Doctor Joseph Zuckerman: So as you said, you really have to listen to your body. Now, the other thing I would say is when you're going out for a run, let's say you're on your ten or twelve mile run and at mile four or five, you start to have pain in a specific area and that pain persists and gets worse. That's telling you something. I mean, the concept of running through something and running through pain sometimes happens. You can get some stiffness, right? Then it feels better. But if it's not getting better and it's telling you something and you're only going to add additional insult to injury if you just keep pushing yourself through the run because that may knock you out of the action completely.
Doctor Dennis Cardone: And that runner will never make it to the start. Just like you said, it'll take them out. So they really do need to listen.
Doctor Joseph Zuckerman: So a lot of people ask about the use of anti-inflammatory medications preventatively in a training program. You know, taking even some over the counter Advil, Aleve. Doctor Condone, do you think there's any role for that in training?
Doctor Dennis Cardone: The quick answer is no. No role for anti-inflammatories. They can be very irritating, especially to runners. So in terms of stomach upset, if someone uses it frequently enough, it can lead to an ulcer and problems. And it's just hiding symptoms. So it's not therapeutic. It's really just being used as an analgesic pain reliever. And in that sense, no, it should not be used. No reason to use anti-inflammatories.
Doctor Joseph Zuckerman: Well that has to completely alter my training program now as a result of that. So I want to thank you for completely disrupting my entire exercise existence, Doctor Cardone. Because when you get to a certain point, although you're not training for a marathon, you really kind of rely on these things.
Doctor Dennis Cardone: Acetaminophen
Doctor Joseph Zuckerman: Tylenol, that's helpful also. But doesn't that just also mask the pain?
Doctor Dennis Cardone: It does, right? You know, but you can't say but as, so I'm going to go with that as we are getting older, sometimes it does help a little bit just to keep you in the game. But agree, you know, that you don't want to be, you don't want to use it day in and day out. Occasionally here and there, I think can be appropriate in certain settings.
Doctor Joseph Zuckerman: So Tyler, uh, you go through the training program, you're going through this 12 to 14 weeks. You've got shoes. You got, you've overlapped your shoes over the last three or four weeks. Now, you know you've got at least two pair of shoes to choose from. You've figured out your hydration module. Then it comes to the day of the race or the night before the race. Most people will tell you if they're running their first marathon, two things happen. They have trouble sleeping because they're excited about it. And usually, if you're not an elite runner, you have to get there about 3 hours ahead of time, like in the New York Marathon, to get out to the Verrazano Narrows Bridge. So you're there from 06:00 a.m. And the race doesn't start until 09:00 a.m. So how are you supposed to keep yourself ready to get started when you've got so many delays?
Tyler Deck Shipley: Yeah, it's always crazy how early everyone has to be there, and I guess when you have that many people, it makes sense. But to be honest, just staying relaxed, that's the number one, the number one objective. Just not getting too worked up and understanding that you're probably going to be a little nervous the night before. You probably won't sleep that well and kind of expecting that and knowing if you're just, like, laying in bed and doing your best to sleep, that you're doing everything you can. And the more relaxed you can stay and the more kind of on schedule you can be to your normal routine, that if you drink a cup of coffee 2 hours before you run, that, go find a coffee shop and grab a cup of coffee 2 hours before. Just kind of relax and get ready for when the race does start. Doesn't need to be anything special, and just kind of stick to the same routines that you've had as that's what's led you to that point.
Doctor Dennis Cardone: And what about running the marathon? So, like Doctor Zuckerman saying it is marathon time. What do you say? It seems like a lot of people just maybe, you know, they're so excited, they're so pumped up, maybe they try to just come out too quickly, too soon, except maybe in the New York City Marathon, you can't move it's so crowded. But in general, what are some mistakes people make? And, um, what kind of guidance do you give to get them through those 26 plus miles?
Tyler Deck Shipley: Yeah, you're always gonna feel like you're running way slower than you are in the beginning just because you have all this excitement, you have all these nerves and just staying calm and understanding that running a little bit slow in the beginning is 100% okay. Because you have 26 miles or 3, 4, or 5 hours to really kind of go through the entire race and just letting it kind of come to you and just making sure that you get through halfway feeling good. And if you feel good at halfway, that you can kind of check in with yourself and decide if you want to pick it up a little bit or back off a little bit. And I think always getting to halfway and feeling like there's a little more to give is the best way to go for the marathon, as you never want to be at mile 22 feeling like you can't really continue. Um, and the best way is just to be a little conservative.
Doctor Dennis Cardone: Doctor Zuckerman, what was it like for you two marathons? Take us back to race day.
Doctor Joseph Zuckerman: Well, it's interesting. Again, I was a resident of Seattle. I was younger, and literally, it did rain the whole time on both days. But years later, I started the New York City marathon, right. And I had not had an opportunity to train near as well as Tyler talked about. And for some reason, I had this goal in my mind that it wouldn't really count if I had to stop anywhere along the way. I wanted just to do it without stopping. Call that youthful exuberance or stupidity. So I got to mile 18 or 19, it was clear that I was not going to be able to do this without walking some of the way. And then I decided to stop. And, uh, I didn't finish. And it continues to be a disappointment for me because it's unfinished business, and I'll never have the chance to do it again. So it's very exciting, but you have to have set realistic expectations for yourself. Most people, we're talking about runners here who train and running a marathon or completing a marathon, let's just say completing a marathon, could be the pinnacle of their running career, because these are casual runners. These are people that do it for exercise, for fun, and for achievement. So any way you get across the finish line in 3 hours, 4 or 5 hours, walking or anything else is an accomplishment. And that's how you want to look at it. So whatever it takes to start at mile zero and finish at mile 26.2 makes it a success. And I think that's most important. That's the most important aspect of the attitude to have.
Doctor Dennis Cardone: So why didn't you finish? Was it more it just total exhaustion, pain, hit a wall, or mentally weren't ready for that kind of mileage?
Doctor Joseph Zuckerman: Well, again, I was running, and I was waiting for that runner's uplift. Everybody said in the New York City Marathon, when you come over, uh, the, uh, Queensborough Bridge and you get up to First Avenue, all the crowds of that's going to make you all excited. Didn't make me that excited. And again, faced with knowing that I was going to have to stop somewhere along the way, my wife was at home, she was pregnant on bed rest. Somebody had to be in the house, you know, to take care of things. I figured I was probably better off at home.
Doctor Dennis Cardone: Hey, Tyler, you read a lot of running programs. Actually say, you know, a run walk program on marathon day could actually even improve your time. Is that good? What do you say to runners about running and walking?
Tyler Deck Shipley: Yeah, certainly depending on what your goals are, if that's what you practiced. And, like the run walk is, gets you to kind of where your goal time is, and that's realistic, 100%. Sometimes running for 26 miles is a little too ambitious, and having these check marks where you walk for a mile after running a certain amount of time, really kind of helps get you to the finish line is 100% a great way to tackle the goal.
Doctor Joseph Zuckerman: So, before we finish up, Tyler, all right, let's just talk about the post race. So you finished the marathon, you've run, walked some of it, you've got past the finish line. You've got your, your medal, your family and friends are there. You feel a great sense of accomplishment. What should an individual think is going to happen the next day? How are they going to feel? And what should they do to basically make sure that they can still go back to work the next day and walk around after what really is a tremendous expenditure of energy?
Tyler Deck Shipley: Yeah, that's a really good question. You know, I can speak from experience that from my one marathon, what not to do is just like, sit down, go eat the hot dog that's at the end of the race, and then not move for a few hours because you're so exhausted. I think, you know, really trying to get something in your body that can kind of help with the recovery process, whatever that is that you're most comfortable with, and then really take it easy for the rest of the day. But also, you don't need to be completely just sitting down all day. Walking around and making sure that you're still kind of moving to loosen things up and continue kind of a recovery pattern. And just hope that you're not too sore and those types of things to kind of continue. I would be curious to kind of hear your take on that because I don't have the best advice for the recovery part of it.
Doctor Dennis Cardone: Well, you know, it's kind of interesting. The first thing you know, from a medical perspective, when you cross that finish line, just like everyone's saying, don't stop and sit down or fall to the ground. Those are the ones, that's when you have a passing out episode, a syncope episode. So you got to keep moving. And it's kind of interesting, I think there's some controversy about even when to get back to running after a marathon. When should somebody get back? When is it safe to get back? And certainly everything we're talking about recovery, right, so make sure hydrate well, nutrition, protein, talk about intake after a marathon. There's some studies that say some of the compression clothing can help on the lower extremities in terms of, maybe, the jury's out on this one a little bit in terms of recovery, some of the compressions. But I think there's going to be soreness, right. Maybe even for some of the most elite runners, there's going to be some soreness. And recovery is going to be key. Taking recovery days.
Doctor Joseph Zuckerman: In the next few days, you're obviously going to be sore. And I think you have to respect that aspect of it. You're also, no matter how much you drink or try carbohydrates during it, you're going to finish the race somewhat dehydrated and electrolyte depleted. So how you replenish that has to be thought about. Don't finish the race and have a celebratory few beers with your friends, right? That's not going to work. That's only going to dehydrate you even more. So you have to think about how you handle that also afterwards, and it's going to ease yourself back into it. And I think that's also age related. The younger you are, probably the more latitude you have, how you're going to recover and the methods you use. The older you get, the more careful you have to be with this.
Doctor Dennis Cardone: Tyler, any final thoughts?
Tyler Deck Shipley: Yeah, I just, even at the most elite levels, you see people take like, two full weeks off of running after marathons just because it is such a big feat. So I 100% kind of agree with you guys.
Doctor Dennis Cardone: You've been listening to the Bone Whisperer, our new podcast coming to you from the NYU Langone Department of Orthopedics at NYU Langone Health. We want to thank you for joining us. I'm Doctor Dennis Cardone. I'm joined by my co host, the Chairman of our Department of Orthopedics, uh, Doctor Joseph Zuckerman, and a special guest joining us, Tyler Deck Shipley, NYU Athletics Coach for cross country and track teams. Really been a pleasure having us all together.
Doctor Joseph Zuckerman: Thank you, Dennis. Thank you, Tyler. And I'd just like to wish everybody good luck in their training. We hope this discussion has provided you with information that will make it easier and eminently more successful for you. So thank you.
Tyler Deck Shipley: Yeah, thank you, guys. Always excited to talk about my favorite subject.
Conclusion: The Bone Whisperers is a co production of NYU Langone Health and SiriusXM. The podcast is produced by Scott Uhing. Sound design by Sam Doyle. SiriusXM's executive producer is Beth Ameen, and senior operations manager is Emily Anton. Narration and additional sound design by Michael Luce. Don’t miss a single episode of the Bone Whisperers, and subscribe for free wherever you listen to podcasts. To hear more from the world renowned doctors at NYU Langone Health, tune in to Doctor Radio on SiriusXM M Channel 110 or listen anytime on the SiriusXM app. For the Bone Whisperers podcast, I'm Michael Luce. Join us next time for the latest advances in orthopedics on the Bone Whisperers.