November 20


Adaptation to Running with Iyad Salloum

By Wil Seto

November 20, 2023

leg pain

Mark:  Hi, it's Mark Bossert. I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC, Canada. He's the Clinical Director at the Physiotherapy Clinic and we're talking about running. How you doing, Iyad? 

Iyad: Doing well, Mark. How are you? 

Mark: I’m all right. Adaptation to running. So what's, isn't it just your legs?

Iyad: Yeah, it's a really good question. Well, it could be just your legs, but also we want to think about what's in your legs. So most people we see in the clinic that come in, who just started a running program. They tend to focus a little too much on too many things, basically, like, how they're, let's call it their cardiovascular systems adapting, like your heart, how well that's doing, and then your lungs you're breathing.

So I think we measure exertion purely by those means sometimes, and then, you know, new runners will notice that the first run you do, your abs are going to be sore, your back's going to be a little tight, your calves and your probably quads and hamstrings are going to feel a little bit of tension depending on how fast you went and how long you went.

And I feel like we tend to kind of leave it there as far as most of us are aware of, like, these are the systems that are at play for running. I wanted to just draw a bit of attention to some other things that maybe people neglect when we think about the running. So we do have a cartilage in our joints and cartilage does love weight bearing.

So, you know, there's a bit of a misnomer out there that running is bad for your cartilage, and I think those are probably borne out by some of the extreme examples, maybe. So, yeah, if you're putting a lot of mileage, I'm talking like a huge amount, like, well, over 50 to 60 kilometres a week. Yeah, you could potentially tip the scale in the negative direction. But what we see is actually that recreational runners have healthier cartilage than sedentary people. 

So I kind of really want to highlight that. And there's been like, huge reviews where they've sampled millions of people in the big studies, and then we find that actually could be argued that it's good for you and protective against these cartilage related issues like knee osteoarthritis.

Obviously, the key thing to keep in mind is that this is somebody who's adapted to that run over a period of time and not just somebody who got off the couch and started running 10, 12, 15 kilometres at a time. 

The other piece that is often neglected is bones, you know, like our bones experience impact. And when we impact or stress bones the reaction to them is that after a while, they too tend to adapt and get stronger. You have examples of this all over your body. 

So, for example, if your shoe has a bit of a heel cup, that bone in the back of your heel gets a little thicker due to the stress. And that's not always a bad thing. You know, people call these bone spurs. Sometimes the bone spurs just, well, it's adapting to the force you put it on, so it has to lay down bone to kind of help shore up the area.

And we see this, for example, with lifting. If you're lifting weights, we know bone loves load, and that actually is very protective to your bones and to your system.

Where I think people neglect this in running is you just add mileage because your aerobic system, you're like cardiovascular systems adapting really nicely. And you're like, oh, my God, I can run another 2K now. And then we tend to progress a little too fast. 

So then things that might be a little slower to adapt than our muscles and our heart, like our tendons, for example, people get Achilles tendon pain quite often, or like our bones, so people will get small reactions in the bone that could be anywhere from a tiny bit of inflammation to a stress fracture to a complete fracture, so it's a bit of a huge spectrum. There's about five stages of bone injury that you go through as you're repeatedly loading it. 

So, just things to keep in mind when you're considering the running plan and considering starting running, especially if you are not a usual runner, and you haven't had a long training history with running.

Mark: So when somebody comes into the clinic and says, okay, I want to start running, I imagine that's not that often, but maybe it does happen. How do you prescribe what sort of routine program that maximizes their adaptation to running? 

Iyad: So we actually do get quite a few people who do this. And a lot of our therapists are involved in different sports. So then, you know, depending on like, which sport environment you're involved in, you'll see people from that. So, we do see quite a few of these, and then what we end up doing is do a pretty thorough history. And the history is not just like taking into account injury history, because that's a huge factor, obviously.

So, if you've come and seen me after you've had a surgery 2 weeks ago, or 2 months ago, that's a different story. We're going to have to kind of address that piece 1st and try to figure out what's happening. But then the other thing that we really kind of want to dive into is their training history.

We want to get a really good idea of how experienced this person is with running. How experienced this person is exercise. Are there other comorbidities? So, for example, if you have someone who is training with hypertension, which is high blood pressure or any form of diabetes or other metabolic issues, and they're on medications. Well, that's going to really change how we draft that training plan up. 

So, for example, if you have blood pressure, which is controlled with medication, well, that's going to change the way your heart rate is going to change with exercise. Because part of that control to blood pressure is to try to lower some of these things.

So, I've seen people who follow heart rate on their watches, for example, and they're running and they're like, oh, I'm still really under my 120, 130, but I'm freaking tired. What's going on here? And I think that's 1 of the things that it's really important for them to be aware of that. Like, you know, that's going to cause a bit of a change and you're going to just need to maybe do things a little differently.

So we'll do a bit of an assessment with that. We will probably get them running to just see how comfortable they are. Their initial impressions. And then what we would do is like, if somebody is a complete newbie starting on a run walk program, and depending on the experience again, if they're completely new on the conservative side. If they're pretty experienced, but just went through a period of absence, maybe like a big family event or a vacation or travel or moving that kept them away from training that we would drop something a little more appropriate. And then the 2nd stage would be to actually have good load tracking. 

So we would ask everybody to track the distance or time that they ran, how they felt, what was it like? What are the things they noticed? What was aching? What was sore? All kinds of different things. Or if they felt really good, because sometimes that's really, really important. And then part of that running program, we would also want to train different systems. 

So your energy systems, the way you use fuel, let's talk about that. So we would kind of try to buy us a bit more of that slower pace running, maybe at 1st, just to get them more used to the idea of being out there and impacting. And then we can kind of ramp up and put a bit more of the fast workouts in their program. And as part of that, obviously, we'll also build them a resistance exercise program, which really will help complement that training and kind of also provide them with some adequate protection.

It tends to really help with things like, you know, people get knee pain when they run, especially pain at the kneecap or at the IT band. We really kind of want to supplement a good running program with a good resistance program. So that cross training is super valuable. 

Mark: If you're looking to get started running, or you have some issues with pain, get in to see the experts at Insync Physio, they have an office in North Burnaby. You can reach them online at to book. They also have an office in Vancouver as well. North Burnaby office, you can call them to book at (604) 298-4878. Thanks Iyad. 

Iyad: Thank you.

Wil Seto

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