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Your Questions on Running

Arthritis, bunions, knee pain and shin splints; it's a pernicious group of injuries that frequently conspires to keep runners off the road. And as the wear and tear racks up, runners dread their doctors' solution: Stop running. "Only runners understand that is a death sentence!" listener Ann Glenn wrote to NPR.

Dr. Mark Cucuzzella, an associate professor of family medicine at West Virginia University, faced the dilemma when arthritis in his big toes threatened to put an end to his running. Cucuzzella had surgery on his feet, and then looked for a lower impact way to keep up with his daily running. He found that techniques from Danny Dreyer's ChiRunning method worked for him. Here, the two marathoners answer your questions about how to make running work for you.

Answered by Danny Dreyer, Founder of the ChiRunning Method:

I keep hearing that I shouldn't expect to run forever. Why not? Does the body really wear out or do we just become more prone to injuries? -- Anna Scott, Scottsdale, Ariz.

Running does not hurt your body, but the way you run can. Almost all lower leg injuries are overuse injuries and that's because people are requiring those smaller muscles to do the bulk of their propulsion, and they just aren't designed to do that, whether it's your toe on up to your knees.

Are there any modifications to ChiRunning that could help walkers (especially faster walkers) and hikers? -- Tricia Sutton, Waukegan, Ill.

For fast walkers, we recommend a technique similar to race walking, which uses a quick, short stride. The upper body is tilted slightly forward so that gravity can assist in forward propulsion. In order to do this, you level your pelvis by engaging your lower abdominal muscles -- it feels like doing a slight crunch. Holding the crunch also allows your hips to swing freely. This way, the core muscles of the body are engaged to reduce the amount of work done by the leg muscles. This technique is covered thoroughly in our book, ChiWalking: The Five Mindful Steps for Lifelong Health and Energy.

On what part of the foot should you land in ChiRunning? Heel, mid-foot or ball of the foot? -- Cheryl-Ann Dunstan, Kingston, Jamaica

We have runners land mid-foot. It's landing with your entire foot all at once, and then you pick your whole foot right back up again, letting your heels float up behind you. It's not a traditional heel-to-toe roll, so there is no chance of landing heel first, which causes braking. There is also no chance of using your toes to push you forward, which leads to shin, calf and ankle injuries.

I am a 43-year-old who has attempted on numerous occasions to start an exercise regimen that includes jogging. After a few weeks, however, I develop excruciating shin pain. Can your method help avoid this problem? -- Millie Bires, Russell, Pa.

Yes, we have cured more cases of shin splints than I can count. We teach runners how to run without the use of their lower legs for propulsion. If you never engage your shin muscles, there is no way you can get shin splints. But if you push off with your toes, then at some point your entire body weight is being pushed forward by some of the smallest muscles in your body. That's really overworking those lower leg muscles.

If I practice basic tai chi exercises with no particular "slant" on running, would it help my running? -- Clark Harper Winston Salem, N.C.

Yes, it would help improve your running because it will train you to hold your alignment and to level your pelvis. Of course, this would depend on the level of ability of your tai chi teacher. Some teachers only teach the movements of tai chi, while others teach the internal focuses used in tai chi. This is the type of teacher you should try to find.

How is chi running different from the Pose Method advocated by Dr. Nicholas Romanov? I practice the Pose Method and it sounds very similar to me. -- David Boyce, Evanston, Ill.

ChiRunning and Pose share the same focus of leaning to engage the pull of gravity for propulsion. That is about the only similarity I can see.

With the Pose Method, Dr. Romanov has runners land on their forefoot, while ChiRunning has runners land on their mid-foot. Landing on your forefoot requires your entire body to be momentarily supported by your calf, which, for long-distance runners, is more than that muscle was designed to do.

The Pose Method uses the leg more. With ChiRunning, we have the runners relax their lower legs as much as possible at all times in order to reduce work to the lower legs (which is one of the main areas where running injuries occur). We have runners lengthen their stride and increase their lean to run faster, versus picking up the speed of their stride. If your cadence picks up, as I think the Pose Method advises, it takes more leg muscle to turn your legs over faster. That's OK if you're a sprinter, and your race is over in 10 seconds. But ChiRunning teaches long-distance runners to rely more on your lean than your legs, and ultimately, it saves your legs.

How can I take the pressure off my lower back more effectively? -- Mike Breen, Melrose, Fla.

The main remedy for lower-back pain is to level your pelvis by doing a slight crunch with your lower abdominal muscles. Leveling your pelvis will decrease pressure on the back muscles and discs. A stable pelvis also helps to prevent hip and IT band problems.

When I run, I use tai chi techniques to avoid injury, but nothing seems to work for my knee pain. Any tips? -- Sean Kingston, Pittsburgh, Pa.

There are two main causes of knee pain in runners. The first cause is striking with your heel in front of your body. This will send a lot of impact into your knee because you're essentially putting on the brakes with each stride. When you begin to lean forward (from the ankles) as you run, your point of impact will be more underneath your center of gravity instead of in front of it, thus severely reducing the amount of impact to your knee.

The second possible cause of knee pain is having a foot that turns out when you land. For many people, their right foot turns out because of driving for years with their heel resting in front of the brake pedal, while their toe is on the accelerator pedal. This position trains your foot to turn out instead of pointing forward when you run.

Train yourself to run with your feet always pointing straight forward, and it will reduce your chances of knee pain or injury.

All of these techniques require rewiring your nervous system -- how your brain communicates with your muscles. And it does take time to disconnect those neural links and establish new ones. Some psychologists say it takes 40 days to build a new habit. It is difficult, but one way to look at it is that it's only difficult for 40 days.

Using the elliptical machines seems better than the pounding I get on the treadmill. But I still feel the strain to my feet after a 45-minute workout. How can your running style assist? -- Damon Williams, Trenton, N.J.

The problem with an elliptical trainer is that the foot pads on most models are placed too far apart and many times cause an increased load on the outside of the foot and leg. This is because your foot is not allowed to come down underneath your center of gravity, but instead, off to the side. This, unfortunately, is not correctable given the design of the machines. I would suggest doing indoor workouts on a treadmill -- using the lower-impact methods of ChiRunning -- where your foot strike can be more natural and lands closer to your centerline. You can also reduce the impact by keeping the treadmill set at a slight incline and running more slowly than you would outdoors.

The following questions are answered by Dr. Mark Cucuzzella, associate professor of family medicine at West Virginia University and winner of last weekend's Air Force marathon:

ChiRunning seems more efficient. This got me wondering something. If I'm more efficient in my running, will I burn fewer calories? Perhaps I should strive, then, to remain inefficient! -- Lukas McKnight, Westfield, N.Y.

Great question. You burn calories most effectively by using large muscle groups which have been trained for endurance. This is the core muscle group (abdominals, back muscles) and large movers such as the quads and hamstrings for running. For example, doing multiple sets of wrist curls will burn few calories -- as will running using inefficient muscles. Those muscles will fatigue before the real calorie burning happens.

And being hurt or sore will interfere with calorie burning, as you will not be able to run or will run so slowly that your engine is still in first gear. The ultimate goal is to train pain-free each day and avoid overuse fatigue. So the short answer is that it pays to be efficient for lifelong calorie burning, injury-free running and enjoyment. You can have your cake and eat it, too, if you can burn 1,000 calories a day on your run.

What are your thoughts on barefoot running or the Nike Free shoes? I've heard that no shoes or shoes with less cushioning will improve your biomechanics. -- Nina Crews, Brooklyn, N.Y.

The Free was designed to work with the normal anatomy of gait and barefoot movement. If you have done a lot of barefoot activity throughout your life, you can adapt easily to these minimalist shoes or no shoes because you have developed proprioception (awareness of fine motor movement) and small-muscle strengthening. Most of us Westerners have not evolved this way, so use caution.

For a runner blessed (or trained) with good biomechanics and a nice, soft surface (grass or beach), barefoot running is a great way to train. For the average recreational runner, I would not recommend this on a frequent basis (at least at first), but maybe as supplement if done without pain. Like any new activity, there should be a gradual progression in a pain-free zone.

Is there a body weight beyond which it is advisable to lose weight before undertaking a running program? Can you be so heavy that you must lose weight to avoid joint injury? -- Jack Edelbrock, Flossmoor, Ill.

There is no body weight "cutoff" which makes running ill-advisable. Excess weight, when combined with poor form, leads to overuse injury and problems with posture. For example, it's difficult to maintain proper lower-back and pelvic alignment if you're carrying 50 pounds on the belly. That being said, running is still the best way to burn calories to reduce your body fat, as long as you can do it safely.

To really burn the calories, you should exercise on average an hour a day (this can be in segments). So it might make more sense to walk/jog for starters, at a level of intensity you can sustain for an extended workout. Eventually, you will likely progress to running. Check out Arkansas governor Mike Huckabee's story, who followed this progression.

What procedure did you have on your toe and what running shoe are you wearing since having your foot repaired? -- Barbara Rabold, Kodiak, Alaska

I had "halux rigidus" in both feet, which is extensive arthritis, and lack of mobility and pain in the big-toe joints. You need this joint to function well for a normal gait. I had bone cut from the joints in both feet to give more mobility and relieve pain, knowing that this would be a temporary fix if I kept pounding them.

I use lightweight trainers such as the Asics Gel Speedstar for training and racing (no minimalist competition shoes for me). I have a Superfeet insole to keep my foot supported when I land, as well as an extra Spenco pad (green neoprene pad) with a cutout at the large toe to essentially ease the pressure on my big toes. It is kind of a "rigged" setup for my specific problem, but it works for me. Having a knowledgeable footwear person to tailor a shoe to you is priceless. What I do is irrelevant to you or others. What's important is knowing your foot type, how you run, what problems you are having and what has worked for you previously.

I've been running since I was 13 (30 years!) and have been plagued with injuries. I have run five marathons, but I inevitably end up hurt. I am getting the same message you got: Stop running. Only runners understand that is a death sentence! -- Ann Glenn, Richmond, Va.

I, too, have been running nearly 30 years now and hope to run for 30 more. Certainly improving your form and having footwear that's tailored to you will help you be able to enjoy your daily addiction (a positive one). I am not familiar with Richmond, but as a University of Virginia Medical School grad, I know they have a "runner's clinic" in the sports medicine division. Call the source of all running in Virginia, The Ragged Mountain Running Shop in Charlottesville, and they can give you more information on this.

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Vikki Valentine
Vikki Valentine is a senior supervising editor on NPR's science desk. She oversees the network's global health and development coverage across broadcast and digital platforms. Previously, Valentine was the network's climate change, energy, and environment editor and in this role was a recipient of a 2012 DuPont Award for coverage of natural gas drilling in Pennsylvania.