Joey Wahler (Host): If you've not been exercising, you'll want to go about it the right way to maximize your efforts and avoid injury. So, we're discussing preparing for a workout or a run. This is Be Well with Skagit Regional Health. Thanks for listening. I'm Joey Wahler. Our guest is John Ruff, an orthopedic physician assistant for Skagit Regional Health. John, thanks for joining us.

John Ruff, PA-C: Hello, Joey. Thanks for having me.

Joey Wahler (Host): So, this is an important topic because some people tend to do too much too soon if they've been inactive for a while. So first, especially for those that haven't been exercising, why don't you describe, please, your recommended pre-run or pre-workout stretch routine? Because there are people like me that until later in life didn't even stretch at all, believe it or not.

John Ruff, PA-C: Yeah, exactly. My pre-run recommendations before starting a new workout or routine is really about, like you mentioned, the prevention of injury. So, the most important thing that you focus on is warming up before you stretch. So, I see some people starting to stretch before they've done anything, and that actually can almost make injury more likely to happen. So I kind of compare this to people, the difference between stretching cold taffy versus warm taffy. So, I recommend people get the blood flowing into the muscles first to warm them up. So, you can do this by, you know, simple jumping jacks, walking in place or you can do like a little mini jog before you stretch.

So, most athletes start to bead a little bit or start to sweat, meaning they've gotten some good blood flow and warmth into their muscles before they start the stretch. That's really important before a workout to avoid injury. So, it's important when you're stretching. Many people in studies refer to more dynamic stretching, which means, the people that are jumping around, swinging their arms instead of bending over and stretching for 30 seconds. If you overstretch the muscles, it can actually cause them to strain a little more than you want. So, some sort of activity to get the muscles flowing, get the blood going and then you do some shorter stretches before you actually start the exercise itself. And I think that really helps prevent injury for those who, like you said, have been sedentary and haven't been running too much and aren't used to that level of activity.

Joey Wahler (Host): Gotcha. So it seems your message there simply put is even when stretching or prior to that, when warming up, there is a method to that as well. So, what injuries can occur from not properly warming up, stretching and training before you engage in an intense workout or a distance run? What can happen if you don't follow the rules, so to speak?

John Ruff, PA-C: Yeah. People get kind of a little adrenaline rush and probably run like they did when they were in high school or go a little too far too fast. So, usually, you'll see things like stress fractures, tendon strains, ligament sprains, cramps and spasms are the main ones. So if you don't warm up, your muscle or tendon gets pulled a little farther than it's used. And so that's why that warm up and that stretch before to get the elasticity or stretching back in those tendons of ligaments before you start really helps avoid any of those injuries we mentioned.

Joey Wahler (Host): So, besides the stretching, is there anything else people can do to prevent soreness either before or after workouts or runs, again, especially if they've been more sedentary for a while?

John Ruff, PA-C: I recommend to people avoiding quitting activity once they've started up in a new exercise for more than three weeks. Because after three weeks, if you haven't done pushups or running or used a certain muscle group, then you get what's called delayed onset muscle soreness. And that's where you get this lactic acid build-up after your workout and then you have a lot of that post-workout day one and day two severe soreness. So actually, maintaining a workout once you do begin or maintaining slowly building up that level of activity is critical, and not taking more than three-week vacations to make you feel better after exercise. And if you avoid that downfall of that severe soreness afterward, then people are a lot more likely to stay active and keep exercising, which is really our ultimate goal.

Joey Wahler (Host): Yeah, so basically, even if you're not going to keep up your usual routine for a week or two, at least do something so that you're not starting from scratch, right?

John Ruff, PA-C: Exactly. People always worry about being a hero or being back to their fastest run or their optimal weight. But if you maintain even just a low level of intensity and maintain those muscle groups staying active, it really helps avoid that negative recovery phase.

Joey Wahler (Host): So, how about diet? What are some of the best things to eat or not before or after exercise?

John Ruff, PA-C: Yeah, that's a great question. So, one of the most important things I tell people about diet before or after is if you're going to have a big meal, you want to have that about four hours before your exercise. And then if you're hungry and you're getting closer to the run or the workout about an hour before, 30 to 60 minutes before, you can have a lighter meal.

The biggest tip I give on food groups is you can have some fats, that's totally fine, and you can have some proteins, that helps as well. But the real winner to avoid that exhaustion and that lack of energy halfway through your workout are carbs. So, that's where you get into the carbohydrates, the grains, that's what really maintains that energy throughout the workout and will make you feel good.

Now, as far as after the workout, you can increase protein a little bit. I think sometimes people go a little overboard on the protein by doubling or tripling the amount of protein they take in for that meal. And that can help. Like I said, maybe one and a half times if you did heavy weightlifting where you have a lot of muscle burnout. But really, what you want to avoid afterward is not taking new foods, and before. So, don't go find some exercise bar or something your stomach has never seen before and load up on those, because that won't really help you for the run. You really just want to focus on carbs and grains and things that your body is used to, to really keep your energy up during that workout.

Joey Wahler (Host): Okay. And speaking of things people shouldn't be doing, how about what mistakes do you most often see when people train for a run or start a new workout routine?

John Ruff, PA-C: The biggest mistake I see is people causing themselves pain or discouragement. I think people push too hard and they make the workout or the run too painful. Whenever that happens, they're much less likely to ever return to that workout or run again. So, motivation is critical in keeping people building up to an exercise or becoming a walker, becoming a jogger, becoming a runner. It's really the mental side of not burning yourself out, because we've all been there when you do that really hard hike or that hard work out and you say, "Oh man, I'm never going to do this again." So, discouragement and burnout from pain or discomfort is the most important thing. It is totally okay to start slow and to find things that you love. Like you say you're going to run in a race, you don't have to be in the front. If you find the enjoyment of the sounds of the shoes, the fresh air, the social aspect of being out and exercising with people, focus on that and keep that positive instead of trying to push yourself so hard that you end up not enjoying that activity.

Joey Wahler (Host): Besides running, and we're going to get back to running in just a moment, but besides that, what's a good, well-rounded workout for people just starting to exercise regularly or starting to do so again after they've been away from it?

John Ruff, PA-C: Yeah, good question. So there's a lot of value in resistance training. Now, when people hear resistance training, they get nervous and think about workouts and weightlifting and these really big built men and women in the gym. It doesn't have to be that way. But it just has to be resistance work out in a way that you are pulling those muscles and tendons against your bones. That actually helps prevent osteoarthritis. It helps prevent injuries. It maintains a healthy back, a healthy neck where everybody will be able to use their body in a way that's functional and helps them do everything they want in their life. So, I compare this example to people using exercise bands. We have people doing exercises with their arms who are in wheelchairs. They can use soup cans. You can use items at home that have weight, but that resistance against the muscles and bones helps prevent injury and also has, when used in a high-intensity workout, a lot of the same benefits as aerobic exercises they're finding for the body.

So when someone's starting new, once again, it's key to warm up and start with low weights, half a pound, a pound, two pounds. Many of these exercises can be gained from your healthcare provider or a physical therapist just to start slow, but that resistance has so many benefits that are underappreciated. Aerobic exercise, like you said, with a run, is not the only way to maximize one's health.

Joey Wahler (Host): When people now go to look for clothing to wear for an athletic endeavor or athletic shoes, sneakers, there's so much out there, John, it can make your head spin. So, what are a few tips you have in terms of what you need, what you don't, the characteristics of the things you're going to buy, fashion aside, right?

John Ruff, PA-C: Right. Good question. So, the hot tips that I mentioned with that one would be if you are running, walking, doing a lot of motion activity, when you select those shoes, I try to make sure people have at least a half an inch, if not a full inch in the toe box, meaning your toe is nowhere near there. Because when you're running, there's going to be some front and back motion just a little bit. Now, with shoes, if you're doing a lot of exercise, a lot of motion in those, I usually recommend not going more than six months, definitely not a year before getting a new pair. Now, the reason is because of the cushion. So, every time you run, you walk, you're doing a workout, there's impact. There's spring in your shoe. And if you lose that spring, then the rest of the impact is absorbed through your ankles, your knees, your hips. So, you want a shoe that's comfortable. You don't want a shoe that's too tight on the sides. You don't want any pressure points. So, if you're getting blisters or hot points, what we call them, in the ankle or the heel, that shoe is not right for you. It should fit snug and it should not slide, but you don't want any pressure points on the side. So, the right shoes is critical, and we want a good cushion on the bottom to take away that impact.

The other thing that I recommend for people when it comes to selecting clothes and different things to work out is you want to avoid any skin-to-skin areas. So, after a workout or running in particular, people will get rubbing points, either in their legs, their arms, or even between their toes. So, there are a lot of clothes that fit tight, so that you avoid the skin-to-skin rubbing, because friction and heat are what cause blistering and irritation and, once again, pain from working out, which makes people not want to work out again.

One of my favorite things that I've found recently for runners or people who are in their shoes a lot are those toe socks. Have you ever seen those?

Joey Wahler (Host): No.

John Ruff, PA-C: So, they're the socks, kind of like those toe shoes that there's a little sleeve for each individual toe. It's kind of like gloves versus mittens. So when you wear those toe socks, it avoids that rubbing in your shoe between toes, and some people get hotspots or blisters between their toes. And it's been a really fun item for runners to avoid those friction source. So, that's kind of a fun one if people are looking for something to solve that problem.

Joey Wahler (Host): Okay. Interesting. Toe socks. Couple of other things. For running, be it a rubber track, a road, dirt, the sidewalk, good old-fashioned pavement, what's the best surface to run on? 

John Ruff, PA-C: So, the best for your joints and avoiding injury or stress fractures, the softer, the better within reason. So, grass is pretty soft. But obviously, there's no guarantee you're not going to roll an ankle, so you have to be careful if the surface is too soft. So, my favorite is the rubber track because it has a little bit of give. So, every time you jump, it adds cushion. So, all of that impact is not absorbed through your ankles, your knees, and your hips and your back. So, rubber's the best, and then gravel or dirt is okay. The hardest and most unforgiving is concrete and asphalt. So, you have to be careful how much time you're running on those because that can lead to stress fractures or injury if you're not used to that surface. But once again, if you have good shoes and you have a good running gait, where you have a good cushion and you're not landing too hard on your heels, you can kind of compensate for some of that and do okay.

But the last thing that comes to my mind when it comes to surfaces is lots of the roads have quite a bit of slant. So, if you're always running or walking on the left side of the road, slanted to the left, you might want to be careful and make sure you're spending some time with a flat or a slant to the right, if that makes sense, because it stretches your foot on one side, on the inside of your right foot and the outside of your left foot, and it makes you more susceptible to have these tendonitis or, you know, ligament overuse.

Joey Wahler (Host): And then, finally, let's say you're a first-time runner preparing to take part in a fun run. So, you want to be able to finish ideally, right? Whatever the distance is. And of course, you don't want either eight-year-olds or 80-year-olds to be flying by you. So, how do you get the most out of the experience and feel like you achieved something while again not overdoing it?

John Ruff, PA-C: Yeah, great question. So, my biggest recommendation would be your kind of need to set a goal three to six weeks before the run if possible. You want to prepare; you want to build up. You don't want to go from zero to 100 overnight. That's where injuries occur. So, you want to start at 30%, say 30% of your goal speed and your goal distance. And then, after a week or two of building that up to 40%, maybe 60%, you can slowly increase to where the day of the run, you've done that distance, you've prepared for this, you know your comfortable speed, and then you're able to run it without suffering and being painful. So if anything's painful, you want to slow down and just pace yourself. There are plenty more runs, and plenty more time to get to your optimal spot if you didn't prepare for the race.

But the most important thing is to search for something you love. Some people love the sound of cleats, the sounds of feet running by them or next to them. Some people love the sounds and getting out with others or competing and seeing that next person pass them. But as long as you use that as a motivation or a goal to get you excited to participate in that exercise again, then you're right on track. So definitely, don't overdo it, prepare if you can, but make the experience enjoyable, especially if it's your first fun run.

Joey Wahler (Host): And you said right on track, John. I think that's a perfect way to end the running tip portion of our conversation, right?

John Ruff, PA-C: Exactly. Exactly.

Joey Wahler (Host): Well, folks, we trust you're now more familiar with preparing for a workout or a run. John Ruff, great information. Thanks so much again.

John Ruff, PA-C: You're welcome. Thanks for having me.

Joey Wahler (Host): And for more information, please do visit SkagitRegionalHealth.org. Again, that's SkagitRegionalHealth.org. Now, if you found this podcast helpful, please share it on your social media. And thanks again for listening to Be Well with Skagit Regional Health. Hoping your health is good health, I'm Joey Wahler.