Today on the Doc On The Run podcast, we’re talking about the top 3 coronavirus mistakes for runners.
Right now all of us are inundated with rapidly changing circumstances and a wide variety of news stories about the coronavirus. With all of the uncertainty, none of us really knows what we are supposed to do.
As a doctor who focuses solely on helping injured runners get back to running, most of what I do is recognize mistakes in training and mistakes in the recovery process which may be causing failure to improve.
But what I do know is that right now, all over social media, I am seeing examples of completely avoidable mistakes which could have serious consequences.
Make no mistake, I think runners should keep running, even when they begin to encounter an overtraining injury. But it’s all about taking a sensible approach. It’s about managing risk. And some activities are riskier than usual right now.
1. Group Runs
Group runs are unquestionably the backbone of prolonged training blocks. We need social interaction. We need encouragement. And we need do enjoy being outside with our friends.
The director of the World Health Organization said, “We have a simple message for all countries: test, test, test.” At the time of this recording a grand total of only 38,000 Americans have been tested for the Covid-19. By comparison in South Korea about 20,000 people a day are getting tested. Just in the last 2 days more people in South Korea will have been tested then the grand total of Americans tested so far this year.
This is a problem. Right now the virus is spreading without detection. The World Health Organization has very clearly stated that rapid widespread testing is one of the keys to preventing the spread of the coronavirus illness.
If we don’t have tests available, and the healthcare system has not yet figured out a way to quickly test you, or the other people in your running group, that really only leaves you one reasonable approach. Social distancing.
The local authorities are doing their best but obviously are creating confusion through policy. I watched the live update of the mayor of San Francisco and all of the chief medical officers for each of their respective counties in the area stand in solidarity declaring a legal order of “Shelter in place.”
The officials went on to explain you should not leave your home. We cannot be allowed to move around spread the virus. Sounds like a good idea, right?
But what followed actually made me laugh out loud.
Paraphrasing here, “We know this order seems extreme. But don’t worry. We’ve made reasonable accommodations. None of these rules will apply to homeless people. Public transit will still be running as usual. So I guess it’s okay to get on a crowded BART train with a few hundred other people. It’s okay to jam into a city bus. It’s okay to run out for “essential errands” like going to the drugstore, or the grocery store, or to your local Chinese restaurant to pick up some wontons to go, if you really truly need them, of course. And it’s also okay to go to work. We also want to reassure people that it’s okay to ride your bicycle or go out for a walk for exercise. Of course just stay 6 feet from other people.”
So the truth is, the “legal order” to “shelter in place” is really nothing more and a recommendation.
A few days ago I received an email from one of our local running merchants who was not only keeping their store opening but was still encouraging large group runs beginning at their the establishment.
Running with a group of friends who seem to be fine is not safe. It’s only safe if you know for a fact that no one else has been exposed or infected. But nobody here is getting tested.
If you live and sleep in the same bed with your boyfriend, girlfriend, husband or wife, it probably really doesn’t matter if you go run with your partner or not. But if you’re going out to run with a large group of runners, or even a small group of runners, you have no idea and no way to measure the extent of risk involved in that group run.
Much of the true extent of communicability or vehicles and transmission of the COVID-19 virus are still truly unknown. We know you can get it from person-to-person contact.
Do you really believe if you’re standing 7 feet away from someone at the grocery store and they cough in your direction, do you feel safe that you won’t get infected? I don’t know that. I don’t know what hundred percent certainty that 6 feet as a safe distance.
They’re only a few things that we really do know, and that’s not even based on real research with the specific COVID-19 virus.
Based on the most recent research published in the New England Journal of Medicine suggest that the SARS -CoV-2 virus can survive for up to four hours on copper, 72 hours on stainless steel and plastic and about a day on cardboard. When aerosolized, meaning spewed into the air in tiny droplet form, like when you cough or sneeze, viral particles are detectable in the air for up to three hours.
So, since we don’t have much else to go on at the moment, let’s just assume for a second that’s all accurate and real. You maybe thinking, “Sure hope the delivery driver isn’t coughing in the car with those delivery packages or take-out food orders.”
But here’s something you may not really want to think about.
Think about when you can see your breath in the air when you run on a cold day. That humidity caries particles with it. That is what it means for something to be “aerosolized.” You can see it. It’s in the air. And that cloud of breath may carry pathogens. Do you want to suck that breath cloud into your lungs? I don’t.
Do you really want to be breathing deeply churning up a hill through the woods with a group trail run with 50 other runners?
For that matter, do you really want to run full tilt behind another runner, for even a few minutes?
Our home has two doctors. One of them, happens to be on the very front lines of this outbreak. Do you really want to go for a run with me? I’ll bet not. Do you want to follow me up a trail on a run. I wouldn’t either. So when you’re out on your run just assume that person in front of you the one that you’re catching up to… just imagine that person is me. And choose a different direction.
So yes, for full disclosure, I am still running. I hope you will pardon the pun, but when I’m running I avoid people like the plague.
Ibuprofen is the most commonly consumed over-the-counter medication in America. Based only on that, I am willing to bet that Ibuprofen is the most commonly consumed pill among runners.
I’m not going to beat on this issue because I have done many other episodes in which I discussed the risks of NSAIDs like ibuprofen, and the unique risks for runners.
Over the last 10 or 15 years I have definitely told more runners to not use anti-inflammatories than I have prescribed for runners. Yet when I lecture a medical conferences on running injures, I still, almost every time, seem to have doctors asking me about the best way to use non-steroidal anti-inflammatory drugs in the treatment of running injuries. Even doctors are in disagreement about how to use this common over-the-counter medication.
Not surprisingly, there are now conflicting recommendations about the use of nonsteroidal anti-inflammatory drugs like ibuprofen in relation to COVID-19 symptoms and coronavirus treatment.
Now, listen closely, you get to pick which side you’re on and who you choose to believe.
I’m going to break it down for your really simply. The two sides are the World Health Organization and the people who manufacture and sell ibuprofen. Any guesses on who is recommending you take it and who’s recommending you don’t? Again, these are diametrically opposed viewpoints.
But before I begin let me just tell you that one of my favorite quotes is,
“It is very difficult to get a man to understand something, when his livelihood depends upon him not understanding it.”
On March 17, 2020 the World Health Organization officially recommended avoiding taking ibuprofen for COVID-19 symptoms after French officials warned that these kind of drugs could worsen the effects of the virus. In short, a study published in a reputable medical journal called The Lancet hypothesize that Ibuprofen boosts an enzyme that can worsen COVID-19 infections.
It may not surprise you to hear the spokesperson for a British pharmaceutical company who manufactures one of these kinds of medications came out with a public statement stating basically that consumer safety was their number one priority and that ibuprofen has been safely used for many years in the self-care of fever and pain reduction including viral illnesses for more than 30 years. Furthermore they don’t believe that there’s any proven scientific links between over-the-counter use of ibuprofen and any trouble with the Coronavirus infections.
This immediately brought to mind the incredible scene of the Chief Executive Officer’s of the big tobacco companies testifying in televised hearings, under oath and under penalty of perjury, all of them, one after another saying, “I do not believe that nicotine is addictive.”
3. Train Hard
The overwhelming majority of runners who call me for help through a phone or webcam consultation are serious runners with normal jobs. When I say serious runner this doesn’t mean that you must an Olympic athlete. It doesn’t mean that you’re a marathon champion. It means that you run consistently and you have been running for a long time. You take your training seriously. But you’re busy. You have lots of commitments. You have to work, you have to take care of your kids. And you have to do it all on the same 24 hours as everyone else.
I believe right now there’s an overwhelming temptation for runners like you, who are forced to work from home, or have been placed on some other kind of restriction, it actually leaves you bored and with an enormous amount of free time as compared your usual schedule.
Most hard-working athletes would look at this as an opportunity to take advantage and build massive fitness in the free time available.
I contend that is a huge mistake. One of the best episodes of the Doc On The Run Podcast is an episode where I got to sit down and talk to 6-Time Ironman World Champion Mark Allen. It is Doc On The Run Podcast episode number 225. You should definitely check it out.
Long before antigravity treadmills, carbon fiber frames, power meters, or cadence sensors, Mark Allen was winning Ironman World Championships and helping other athletes figure out how to succeed. Years ago he explained to me that the biggest key to success in endurance sports is avoiding injury or illness. If you get sick or injured, you lose all of your fitness while you are recovering. Game over.
All runners are worried about stress fractures or some other kind of injury that’s going to set them on the sidelines. But when you train hard your immune system gets overworked repairing all of that tissue. When your immune system gets depressed because you been training at your limit, you are simply more susceptible to illness.
I got pneumonia right before I left for Hawaii to compete in the Ironman World Championships. After nine years trying to qualify for Ironman Hawaii, this was a rather inconvenient time to get sick.
I would argue that right now, with the certain but undetectable spreading pandemic around us, now would be a very inconvenient time to get sick.
I know it’s going to be tempting to train hard in the time you have available right now. But you need to resist that temptation. You need to figure out how you can run and avoid exposure and decrease your risk of contracting the virus.
But I think almost as important as making sure that your immune system is as robust as possible. And this means decreasing stress. Of all the 12 different forms of stress I discuss which may affect your body’s capacity to heal and fight off disease, I believe that when you run you actually improve about half of them. So, I believe that running will actually help decrease your stress as long as it’s done in moderation. If you’re training for a marathon that was just canceled moderation may be 18 mile runs. But if your longest run in the last couple of months it Was only 8 miles, you probably shouldn’t go run 18 miles today just because you have the time.
You have to decide what is moderate for you. All runners know how much is too much. All runners know and can tell when pushing hard. I would argue now is not the time to push hard. This is a time when you should maintain your fitness and maintain your sanity by choosing safe reasonable runs.
And don’t ever forget, running is only one form of stress. Running is biomechanical stress. But there’re many other forms of stress that influence your capacity to absorb injury and fight off illness.
I’ve created a free worksheet for you to help you assess the 12 forms of stress that can slow a runners recovery and frankly I think also make you more susceptible to contracting an illness or potentially even suffering a more severe illness once contracted. Go to DocOnTheRun.com. You can go to the show notes for this particular episode and download it. It will help you work through a series of questions to ask yourself if you want to the overall amount of stress in your system that can help you recover faster after runs and hard workouts.
Keep running, but do it safely. Be reasonable. And if you think of all the stuff is alarmist just remember, “Just because you’re paranoid, it doesn’t mean they’re not after you.”
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