Many runners face constant negative mental battle when the run starts to get hard. If you are frequently struggling with negative thoughts, there is a way to win the mental battle.
Dr. Jacob Cooper has the answers.
Jacob breaks down exactly what you need to do and exactly when you need to do it, to convert your self-talk that’s telling you to quit, to an ally that lets the real you triumph. So if you want to perform better at running, or really at anything in life that's challenging, keep listening and be ready to apply Dr Cooper's techniques, and finally win the negative mental battle when running hard.
Jacob is a clinical sport psychologist who serves as the director of sport psychology at Appalachian State University in Western North Carolina. A former college athlete himself, he has worked with professional and amateur athletes, Olympians, and Paralympians. He has an extensive background in mental health and how it ties to performance. Jacob has developed a style of working with athletes that focuses on them holistically, with the goal of performance optimization in the pursuit of excellence.
Jacob Cooper Ph.D. - Full Bio
Dr. Cooper is a clinical sport psychologist who serves as the director of sport psychology at Appalachian State University in addition to his own private practice serving professional and amateur athletes. He is a member of the United States Olympic & Paralympic athlete mental health registry, which consists of a selected group of specialized sports psychologists who are thoroughly vetted by the USOPC and then made available to current U.S. Olympians & Paralympians.
As a former collegiate offensive lineman turned amateur triathlete and runner (Hello Clydesdale Division!), Jacob has worked with athletes at the Olympic, Professional, and Division-1 level over the course of his career. As a sport psychologist, Dr. Cooper brings an extensive background in mental health and performance enhancement. To this end, he has developed a style of working with athletes that focuses on them holistically, across the spectrum of future-oriented performance optimization, current personal barriers/stressors, as well as more significant mental health issues that can inevitably show up in the pursuit of excellence.
As a doctoral student at Boston University, he completed clinical practicums within a variety of settings, including the U.S. Department of Veterans Affairs (VA), the Federal Bureau of Prisons system (BOP) along with multiple D1 college sport medicine teams as a performance consultant. Additionally, he has published scholarly articles and cultivated a unique approach to working with athletes and teams that integrates the latest research, evidence-based strategies, and technology to help them reach their goals.
In addition to high performance populations, he has a unique background and training in the areas of rural mental health, trauma recovery, serving low help-seeking populations, and military psychology. He has provided performance optimization for military personnel prior to their deployments as well as counseling for veterans transitioning back to civilian life throughout Western North Carolina, Indiana, and Boston.
Dr. Jacob Cooper- Ph.D. Clinical Sport Psychologist.
Director of Sport Psychology Services at Appalachian State University
Licensed Clinical Psychologist & Health Service Provider (HSP)
U.S. Olympic & Paralympic Sport Psychology Registry Member
Education Background:
B.A.- (Psychology) Taylor University (Indiana)- 4 year scholarship athlete & team captain (Football)
Dual Masters Degree- Ball State University (Indiana)
M.S.- Sport and Performance Psychology
M.A.- Clinical Psychology
PhD- Counseling Psychology (Sport and Performance Track)- Boston University
Matched Clinical Residency - Charles George Veterans Hospital - Asheville North Carolina.
Questions Jacob is asked:
3:59 I first found out about you from an Instagram post that the folks at ZAP posted. You were working with the elites at ZAP helping them build some mental strength. Can you tell me a little bit about how you worked with them?
5:03 How do elite and regular runners find motivation and purpose when a lot of races have been taken off the board?
6:19 Maybe this pandemic is a silver lining or maybe it’s a gift because we can look at our running in a different way because we’re all going to get slower as we age and performance is a huge part of why we do it, at least for some people, but once you take those PRs and the clock away, why do we run? That’s got to be the most important thing, right?
7:28 We always talk about, “I want to get mentally tough,” because clearly it’s not just our bodies. We can train our bodies to do certain things but if the brain is not onboard, the train’s not going to get all the way to the station. So how do we train our brain to be mentally tougher when things get hard?
8:30 I’m going to use myself as an example. When I’m running really hard or trying for a specific goal, I have the devil and the angel on my shoulder. I have the voice saying, “Go, go, go. You can do this.” And then I have a very, very sweet devil saying, “Everybody still loves you no matter what you run. You can slow down. This is really hard.” So I’m fighting these two opposing things that are 100% me and I really want to tell the devil to shut up and I really want to keep moving hard. How do I do that?
11:30 So the feelings come and we’re supposed to say, “Oh hello, feeling,” and let it go on its way. Is that what we’re supposed to be doing when we’re trying to run that 400 meter repeat really hard?
12:43 Can you give us a few examples of mental tools that we can use? What’s in the toolbox?
14:37 What is radical acceptance in your RISE model?
16:32 What does the I in RISE mean?
23:50 What does the S in RISE mean?
25:23 Do you have any hints for people who don’t know what their optimal performance cues are?
26:18 When I’m running well in a race or in a group setting, I definitely lock on the dude in front of me. I’m laser focused on him and I pretend that I have a rope attached to him and I pretend that he’s pulling me. And I just link up to him like a train like I am not letting this person go. It works for me.
27:13 What does the E in RISE stand for?
29:06 Let’s talk about the difference between psychology of teams and the psychology of athletes that are in an individual sport. Can you address that a little bit? Or is it the same just on a different level? Are we all talking to ourselves like we would talk to a bunch of people?
31:58 What about teams of runners? What about groups of runners where they’re obviously not always running the same races but they train together? They are in a team environment where they eat, sleep, and work out together and it’s been proven that we work differently in a group setting. Can you talk about that?
33:31 Especially with the pandemic, we’re seeing more and more runners find support, find a tribe, find a group of people online that they haven’t been able to find before, and a lot of people are finding it incredibly helpful. Especially runners are typically Type A, loner, data nerds (or maybe I'm just speaking for myself!), but a group setting isn’t typically comfortable for people who love to spend hours alone running, so any advice for that lone runner who maybe shies away from a group?
35:48 You help athletes work on their mental health issues. And we think about elite runners especially as just having these super tough brains that are as tough as their bodies and they are able to do amazing things that the regular people can’t do. So we think that they are just some kind of machine when it comes to their minds but I suspect that you find some mental health issues. Can you talk a little bit about that?
39:36 People who drive themselves so hard to be excellent, they’re a specific breed of people and you look at them and you wonder if they did have some trauma. Why in the world are they pushing themselves to these extreme limits? Do you find that that is really the case that people that are just absolutely at the top of their game are more likely to have had some kind of trauma in their past?
41:58 One thing I really wanted to talk to you about is the whole concept of balance. When we are striving for something, whether it's athletics, a career, parenting, sacrifice is inevitable and balance is simply not possible (or desired). How can we reach our goals without letting everything else fall apart?
45:21 What is next for you and what questions in sports psychology are you looking to get answered in the future?
Questions I ask everyone:
48:54 If you could go back and talk to yourself when you started running, what advice would you give?
50:04 What is the greatest gift running has given you?
51:33 Where can listeners connect with you?
“That ‘why’ is such a valuable thing and it’s very easy in athletics to sometimes lose touch with that.”
“I think that it’s helpful to have multiple fuel sources because there’s costs to them all.”
“Your attention is a muscle. It’s like a spotlight that allows you to shift to what matters most right now. I call these optimal performance cues or OPCs.”
“Anywhere that there’s pressure and stress, we’re all capable of that impacting us and manifesting in the form of some level of mental distress whether it’s just some symptoms of anxiety, depression, eating disorders, trauma, or it’s like a full blown chronic disorder and something like that.”
“There’s going to be times and seasons of life that feel unbalanced. But I believe that in every season of life it is possible and worthwhile to live in a way that reflects our values.”
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We really hope you’ve enjoyed this episode of Run to the Top.
The best way you can show your support of the show is to share this podcast with your family and friends and share it on your Facebook, Twitter, or any other social media channel you use.
The more people who know about the podcast and download the episodes, the more I can reach out to and get top running influencers, to bring them on and share their advice, which hopefully makes the show even more enjoyable for you!
How many marathon runners have acute kidney damage after they cross the finish line? According to a Yale University study, the answer is a shocking 55%. So if you’ve ever run a marathon, the odds are slightly better than 50% that this has happened to you.
But don’t worry. The damage tends to be temporary, resolving itself after a few days. So we heal, get stronger, and move on. But what if something goes wrong?
Dr. Sherry Mansour and Dr. F. Perry Wilson are kidney doctors or nephrologists at Yale, and they share their expertise on running and your kidneys. Dr. Mansour actually led the research on marathon runners and kidney research. They talk to Coach Claire about who is susceptible to acute kidney damage from running, what we can do about it, and what we still need to learn.
They also discuss ibuprofen which can cause kidney issues, and how it can be used safely by runners. They also delve into kidney stones. If you’ve ever had one, you know they are extremely painful. They cover how to minimize the risk of kidney stones and what precautions kidney stone sufferers need to take when running long distances.
If you are a runner with kidneys, this is one conversation you don't want to miss!
Dr. Sherry Mansour grew up and attended medical school in New York. She graduated in 2010 and received the Highest Academic Achievement Award. She was elected valedictorian of her class and was also inducted into the Psi Sigma Alpha National Osteopathic Scholastic Honor Society. She went on to complete residency training in Internal Medicine at Stony Brook University Medical Center, where she was chosen as chief medical resident. She was inducted into the Alpha Omega Alpha Honor Medical Society, Stony Brook Chapter in 2012. She then joined Yale New Haven Hospital in 2014 as a Clinical Research Nephrology fellow. She also completed her Master of Science from the Yale School of Public Health in 2019 with a focus on Chronic Disease Epidemiology. Since her arrival at Yale, Dr. Mansour has been working on identifying novel repair biomarkers in blood and urine to better predict long-term kidney and heart disease outcomes after AKI, and improve overall patient care. Her K-23 proposal is focused on understanding the role of a vessel repair pathway, known as the Angiopoietin pathway, in graft outcomes after deceased donor kidney transplantation.
A link to Dr. Mansour’s full biography including links to her research and publications is:
Yale Medicine Profile - Dr Sherry Mansour
Dr. Wilson grew up in Connecticut, before attending Harvard College where he graduated with honors in biochemistry. He then attended medical school at Columbia College of Physicians and Surgeons, before completing his internship, residency, and fellowship at the University of Pennsylvania. In 2012, he received a Masters degree in Clinical Epidemiology, which has informed his research ever since. At Yale since 2014, his goal is using patient-level data and advanced analytics to personalize medicine to each individual patient. He is the creator of the popular online course "Understanding Medical Research: Your Facebook Friend Is Wrong" on the Coursera platform.
A link to Dr. Mansour’s full biography including links to his research and publications is:
Yale Medicine Profile - Dr F Perry Wilson
Questions Dr. Mansour and Dr. Wilson are asked:
6:33 Dr Mansour, you did a study a couple years ago at Yale that studied the effects of marathon running on the kidneys. Can you explain how the study was conducted and what you found?
7:50 So marathon runners have markers like people in the ICU. That sounds horrible. Should we be worried?
8:31 Why do runners suffer from Acute Kidney Injury? Is it unique to running? Do swimmers suffer from this too?
9:23 Sherry, you said that you just run for fitness, so I assumed you would be a marathon runner since you studied the effects of marathon running on kidneys. Can you tell me why you chose to study marathon runners?
10:38 Perry, are you a marathon runner?
10:48 Perry, what questions do you have when it comes to kidneys and running? Have you experienced dehydration? Have you tested your own urine after a race?
12:13 What role does dehydration, your sweat rate, and sodium play into the types of injuries that the kidneys have after endurance racing?
14:28 It’s very difficult and actually not advised to drink the same amount of fluid that you actually lose during a race. What kind of advice would you give for somebody who says, “I know I sweat a lot. How much do I drink? How much salt do I put in my water?” Are these questions that you’ve been able to figure out yet?
16:28 Runners, especially older runners, worry about salt because their doctors say they shouldn’t intake a lot of salt if they have high blood pressure. Or if they have other kidney problems, they might have been advised to be on a low salt diet. How does that play into while you’re exercising? Should you continue to not consume much salt just because you’re supposed to be on a low salt diet?
17:46 Runners hear a lot about ibuprofen. A lot of people call it Vitamin I and take it when they’re feeling sore. Some people even take it before a race so they won’t feel sore, and we as coaches try to advise against this. Can you talk about the link between ibuprofen and kidney injury?
22:08 One of the reasons I wanted to have both of you on the show is because I recently suffered from a kidney stone, something I haven't talked about until today. I’m a healthy, athletic person and did not expect it. It was the worst pain of my life and as an athlete, I'm struggling to find good advice for hydration for kidney stone sufferers. Perry, can you give me some advice?
25:00 Through my research I’ve found that kidney stones are fairly common. Is that correct?
25:16 What do kidney stone sufferers have to do as far as exercise goes? I’m absolutely dehydrated at the end of a marathon. Is that more dangerous for me than it would be for someone who doesn’t have a kidney stone history?
26:59 I haven’t heard of people talking about how endurance runners and kidney stones interrelates at all, so I think there’s a lot of people out there that are hungry for this advice. Like I said, that’s why I want to have you guys on the show. So we can still run, we can still get a little dehydrated, but our risk is going to be a little higher is what you’re saying?
28:21 I think most runners now take Tylenol instead of ibuprofen, which hurts our liver instead of our kidneys. There’s also some evidence that Tylenol actually affects your brain and makes your perception of effort go down. So any time there’s something like that, runners are like, “Give it to me. Give it to me.”
29:25 Acute Kidney Injury from marathon running is typically temporary. When do we have to worry that something could be wrong and damage could become chronic?
31:17 Have you looked at people who you measured right after the race and then looked at them a few days later to see if the damage was resolved?
32:15 If you could go back and talk to yourself when you started running, what advice would you give?
33:41 Where can listeners connect with you?
34:12 Do you know why students at Yale aren’t allowed to run outside?
“This urine really we see in the hospital all the time when patients are in the ICU when their blood pressure is really low so we didn’t think that we would see something similar in runners but that was sort of the main finding that kind of surprised us.” (Dr. Mansour)
“I wish I were a runner. Every time I do studies with marathon runners, they’re so inspiring, they’re so dedicated. It’s really a great crowd to be around, but I’m just not like that. I don’t have the stamina.” (Dr. Mansour)
“There might not be that much of a correlation between how you feel and what’s going on in your kidneys because I was convinced I was going to see the most terrible stuff based on how I was feeling at the end of that race and my kidneys kind of shrugged it off.” (Dr. Wilson)
“A kidney stone is painful but it isn’t going to kill you either, so you have to think about the benefits.” (Dr. Wilson)
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Article: Marathons and Kidney Damage: What Runners Should Know
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We really hope you’ve enjoyed this episode of Run to the Top.
The best way you can show your support of the show is to share this podcast with your family and friends and share it on your Facebook, Twitter, or any other social media channel you use.
The more people who know about the podcast and download the episodes, the more I can reach out to and get top running influencers, to bring them on and share their advice, which hopefully makes the show even more enjoyable for you!
When you’re running hard, pushing yourself to extremes, which do you think is the more limiting factor, your body or your brain? Alex Hutchinson has done extensive research on exactly that question.
The Toronto-based author and journalist focuses on the science of endurance and fitness. You may know him from his book ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance or from Outside magazine where he’s a contributing editor and writes the Sweat Science column.
Alex believes that our limits are elastic, stretchable, and as of yet, undefined. He and Coach Claire discuss those limits, and also tackle hydration, fueling, carbohydrates, strength training, aging and more. And just for fun, they also get into the science of why Coach Claire loves an out-and-back course way more than a loop!
Alex also writes the Jockology column for The Globe and Mail, and his writing has appeared in Canadian Running magazine, Popular Mechanics (where he earned a National Magazine Award for his energy reporting), the New York Times, and he was a Runner’s World columnist from 2012 to 2017.
Prior to ENDURE, Alex wrote a practical guide to the science of fitness called Which Comes First, Cardio or Weights? Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise, which was published in 2011. He is also the author of the 2009 book, Big Ideas: 100 Modern Inventions That Have Transformed Our World.
Alex started out as a physicist, with a Ph.D. from the University of Cambridge, followed by a few years as a postdoctoral researcher with the U.S. National Security Agency, working on quantum computing and nanomechanics. During that time, he competed as a middle- and long-distance runner for the Canadian national team, mostly as a miler but also dabbling in cross-country and even a bit of mountain running. He still runs most days, enjoys the rigors of hard training, and occasionally races, but hates to think of how he’d do on an undergraduate physics exam!
Alex’s best-selling book Endure has a forward written by Malcolm Gladwell, another famous Canadian runner and writer, and the updated version is now out in paperback.
Questions Alex is asked:
3:34 You are an author and a journalist, but you really seem like a scientist at heart. How did you get into writing about fitness and endurance sports?
5:22 What fascinates you most about how the body works when exercising?
6:10 Your book Endure, if you could really sum it up, I would say that it is trying to discover whether it’s the body or the brain that’s mostly the limiting factor when you’re trying to go to extremes but it’s clear that it’s a mix of the two. You can’t say, “Oh, it’s just the brain” or “It’s just the body.” Can you talk a little bit more about how they’re interrelated and what we are finding out?
7:41 Tim Noakes is a South African scientist that has been very controversial. He’s written a lot of things that turned out to be totally true and then he’s written a bunch of things that maybe people have not found to be true. Can you talk a little bit about the controversy, both the good and bad things that Tim Noakes has contributed?
10:35 I would love to distill the lessons that you’ve learned so far about things that can help runners do better. The two main topics I would love to get into are hydration and fueling. Let’s talk about hydration specifically for the marathon. Hydration needs are different for every type of body. Are there any rules of thumb that recreational runners should think about when coming up with a hydration plan for the marathon?
15:25 ‘Drink to thirst’ is starting to become more popular but there are some populations that their thirst isn’t reliable. I’ve heard that as you age, your sense of thirst is not as strong. Have you heard that as well?
18:05 We could talk about fueling during the race or we could talk about nutrition in general, but what I have found is that human studies are just notoriously bad when it comes to nutrition because we’re not rats and we can’t put humans in cages and measure everything. So what would you say are the limitations to studying nutrition on humans?
23:53 Let’s get into the great carbohydrate debate. As I often tell people, what’s frustrating about the word carbohydrate is that lentils, lollipops, and lumber are all carbohydrate. And if you say do eat carbohydrates or don’t eat carbohydrates, clearly those three things are processed differently in your body. First of all, why do we lump carbohydrate? It’s an absolutely massive category of food and clearly our body treats it differently. Carbohydrate is the preferred fuel of the brain. It’s the preferred fuel of the muscles. So why isn’t everybody on the carbohydrate train?
25:35 Sugar or simple carbohydrate is bad if you’re not exercising but it’s exactly what you need if you are trying to run a fast marathon.
27:29 A keto diet could be exactly what an ultramarathoner would want to do. They’re not so concerned about ultimate speed; they’re concerned about eating all the time. Isn't that what they say about ultras is that it’s not really a running race; it’s an eating race?
28:58 What’s the point of all this science if the answer is always “It depends?”
30:22 Let's talk about strength training. What is the minimum effective dose for a runner who is highly active and competitive but not at the elite level?
34:36 What is the minimum effective dose of strength training for somebody who is actively training to be competitive in a race but still at a sub-elite level?
40:10 I think a lot of what we attribute to normal aging is actually more of lack of activity, and all the decline is mostly for the couch potatoes, the more sedentary people, and we runners think that maybe we’re immune to all of that stuff. Would you agree a little bit with that?
44:12 You recently wrote an interesting article about the science of finish lines or teleoanticipation and you related it to not knowing when the pandemic will end. Can you explain?
47:46 I like out and backs better than loops because I know what to expect on the way back. There’s science that proves it, right?
49:28 The brain loves knowing what to expect and it predicts what’s going to happen whether it’s right or wrong, right?
49:42 What questions are left unanswered? What kind of science are you looking forward to in the future?
51:33 I think everybody wants to figure out how to make their brains stronger, not just in running but in life and dealing with little kids.
Questions I ask everyone:
52:22 If you could go back and talk to yourself when you started running, what advice would you give?
53:32 What is the greatest gift running has given you?
53:58 Where can listeners connect with you?
“For every situation that you think of the answer is both. The answer is “Yes.” It’s just like nature and nurture. The answer is your fate is 100% nature and it’s 100% nurture, and your physical performance is 100% your body and 100% your brain.”
“If you look at the list right now of the top 100 men’s marathon times ever run, 98 of them have been run by Kenyan or Ethiopian marathoners so if they’re doing something wrong, I want to do it wrong like they’re doing it because they’re pretty successful. And if you look at the data, in both cases they’re getting more than 60% of their calories throughout the day from carbohydrates. And for the Kenyans, apparently it’s more than 20% of their calories come from the added sugar that they put in their oatmeal and their tea. So is this healthy for a couch dwelling office worker in North America? Probably not. But if you want to run fast or if you’re training hard, sugar is not only like you can use it, but like you said, you need it.”
“There is some pretty interesting evidence showing that older runners like Masters runners get a much larger and more immediate benefit from weight training for their running than younger runners do because the younger runners have more muscle to spare.”
“Your body knows, even parts of your body that you wouldn’t think know exactly where the finish line is.”
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Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance
Alex Hutchinson | Outside Online
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We really hope you’ve enjoyed this episode of Run to the Top.
The best way you can show your support of the show is to share this podcast with your family and friends and share it on your Facebook, Twitter, or any other social media channel you use.
The more people who know about the podcast and download the episodes, the more I can reach out to and get top running influencers, to bring them on and share their advice, which hopefully makes the show even more enjoyable for you!
Kim Clark’s 110,000 Instagram followers know her as Track Club Babe. Kim microblogs daily offering inspiration, encouragement, and rock-solid training advice learned over years of running. Fun note: The Run to the Top was the very first running podcast she listened to!
Kim ran her first marathon in high school. It was a six-hour disaster but she survived. Years later, in her late 20s, Kim decided to train seriously for another marathon and record her journey. Today she has a 3:11 PR and a massive following of runners.
Kim is a former human rights lawyer turned commercial real estate agent in her hometown of San Diego, CA, who creates her social content each evening. She’s done a ton of research throughout her running career and has of course had her ups and downs and is happy to teach and share her positivity with her online community.
In this episode, Kim shares her story along with some great running knowledge including what she eats to fuel and recover, training mistakes she’s made, over-training, and her thoughts on weight loss as it pertains to runners. Enjoy listening to running influencer @trackclubbabe!
Questions Kim is asked:
3:42 When I invited you to be on the show, you said the sweetest thing about how this was a full circle moment for you. Can you explain?
4:49 You chopped almost three hours off your marathon time. Tell us about your journey.
7:59 What made you want to start a blog and give yourself the nickname Track Club Babe?
9:45 What were some of your early training mistakes?
12:57 What do you eat now before running?
14:08 You have a really big following on Instagram and you give training advice and things that work for you that people just absolutely eat up. What do you get asked about the most?
15:34 Your running journey hasn’t exactly been perfectly smooth so I would love to hear about some of the times you’ve had plateaus and you broke through them.
20:14 Results are addictive when you get big PRs. You just think, “Well, if I just do a little bit more… “ But clearly there’s a breaking point.
26:26 One post of yours I noticed recently was about weight loss to get faster. Can we talk about this?
30:37 I think it’s super helpful to spread that message that thinner is not faster so I’m really glad we’re talking about that.
32:57 Let’s talk about food. What’s your favorite recovery food? What do you like to fuel up on when you’re in marathon training?
33:53 With your Instagram following being so big and working on your blog, are you still working as a full-time realtor as well?
35:25 What’s it like during COVID with no races for you?
37:01 How did you get through all the mental baggage of taking time off from running?
39:11 What’s next for you?
Questions I ask everyone:
42:36 If you could go back and talk to yourself when you started running, what advice would you give?
43:20 What is the greatest gift running has given you?
43:55 Where can listeners connect with you?
“We all love to run and no matter why you’re running, whether it’s just for the joy of it or competitively, it makes it more fun when it feels a little bit more effortless and you can go a little bit longer and a little bit faster, and it just makes it more fun.”
“I think the internet’s an awesome place for just teaching you so much, and then just being connected with so many runners around the world helps so much to read from their experiences, learn from them.”
“I figured out how to qualify for Boston and I figured out training for me. The key for every person is just figuring out what is going to connect for you and your body and for where you’re at.”
“There’s so many things that you can be doing that have nothing to do with weight that are going to move the needle on your speed, and that’s what we should be focusing on and not just being so obsessed with weight, which honestly, if you want to try to be frail and run fast; that’s not going to work either. You want to be under-fueled and try to run fast; that’s not going to help you.”
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We really hope you’ve enjoyed this episode of Run to the Top.
The best way you can show your support of the show is to share this podcast with your family and friends and share it on your Facebook, Twitter, or any other social media channel you use.
The more people who know about the podcast and download the episodes, the more I can reach out to and get top running influencers, to bring them on and share their advice, which hopefully makes the show even more enjoyable for you!
What is it with runners and knees? If you run, you’ve heard “I used to run but it hurts my knees.” Although running is not inherently bad for your knees and staying active helps keep your knees healthy, a lot of runners eventually stop running because it hurts their knees too much.
Older runners, especially men, have to be particularly diligent in their strength training and stretching to avoid knee pain. So which is it? Does running cause people knee problems or are certain people predisposed to knee problems and would have issues regardless of whether they ran or not?
To get to the bottom of this issue, Coach Claire speaks with Yale orthopedic surgeon, Dr. John Fulkerson. Dr. Fulkerson specializes in sports medicine and focuses on treating patella instability, which refers to the kneecap sliding in and out of position.
Dr. Fulkerson has been at Yale for over 40 years and he is leading the way in cutting edge technology to help those who suffer from debilitating knee issues. He talks about who’s most at risk for knee problems, what does and doesn’t work for prevention, the simple exercise that you can do today that can help keep your knees running smoothly and pain free, and why those of us who are fortunate enough to be runners should feel gratitude for our running, even on those bad run days!
Dr. Fulkerson received his medical degree from and also completed his internship and residency at Yale University. His awards include a Lifetime Achievement Award from the Patellofemoral Foundation, a Sports Medicine Fellow Educator Award from the Department of Orthopedic Surgery at the University of Connecticut, Connecticut Orthopedist of the Year, the San Francisco Bay Area Lifetime Achievement Award, U.S. News and World Report Top Doctors, and the Wisdom House Community Service Award (with his wife Lynn).
He founded the International Patellofemoral Study Group and the Patellofemoral Foundation. He has been head team physician for the NHL Hartford Whalers and Hartford Wolfpack, and a team physician for the U.S. Olympic Men’s Ice Hockey and Trinity College in Hartford.
Dr. Fulkerson is known for orthopedic surgical innovation and has lectured worldwide. His publications include Disorders of the Patellofemoral Joint as well as many other chapters and monographs on the same subject. He also published the non-orthopedic book Thin Lines: A Vineyard Journey.
Questions John is asked:
3:00 What every runner wants to know is, is running bad for your knees?
4:44 What other people besides older people need to be careful about running safely? You said that there are some people that maybe aren’t as well suited to running as far as their knees go at least, so who are we talking about here?
5:53 Your specialty is patella instability. Can you talk about exactly what that is and maybe give us a quick anatomy refresher here?
7:11 So patella instability is when the kneecap is actually moving around is what you’re saying?
7:42 The patella groove depth is just genetic, you get it or you don’t? It’s just how you were born? Or does it have anything to do with the activities we do?
8:24 Can you talk about some of the specific problems that runners face with their knees? Give us a definition of what’s runner’s knee?
10:30 You mentioned core instability, and that’s something as I coach I talk to my runners about is that often knee problems are actually a symptom. They’re not actually the problem. It’s something higher up in the chain. The hips, the core, or maybe in the lower part of the leg or the ankles, something like that. Can you talk about how the knee is related to everything else that’s going on in the chain?
11: 57 What are some other exercises besides jumping rope that you recommend that can help with people who complain about knee issues?
12:24 How do you stretch the knee?
13:47 Let’s say we have a runner who complains of knee problems. He is doing everything he’s supposed to be doing, all the stretches, all the strengthening, rock solid core, but still cannot get away from the knee pain. At what point is surgery the best option?
14:59 How does 3-D printing work as a diagnosis tool for knee pain?
16:10 This sounds like cutting-edge technology at Yale. Is this something that is spreading across the country? Are we going to be able to find this in Kansas? Or is this pretty limited at the moment?
17:44 When we’re talking about knees and joints in general and aging, the next thing that tends to come to mind is arthritis. And when I was researching this before interviewing you, I learned that there’s all sorts of different kinds of arthritis which I was not aware of. I thought arthritis was just arthritis but apparently it’s not. Can you talk about arthritis, especially in the knee, that runners are likely to encounter as they age?
20:07 My dad used to jog three miles every other day and he stopped in maybe his 60s because it hurt his knees too badly. Am I going to have the same fate? What do you think?
23:34 Let’s go back to cartilage. You mentioned the various things that happen to our cartilage as we age. Is once the cartilage is gone, it’s gone, or it degenerates to a certain point? Does it regenerate? What exactly is going on with our cartilage?
25:00 How do we take good care of our cartilage? Is it just listening to your body and eating well? Is there something that we can do that will help prevent it if we happen to be prone to this?
26:47 As far as running shoes go, would you say nice, cushioned shoes or a nice drop? I would imagine you’re going to say no barefoot running. What would you say about shoes?
26:41 I have a runner who is in his late 50s and has always had knee problems since I’ve been working with him, and his big thing is downhill running. Downhill running is really, really tough on him. Can you give some insight on why that is and maybe some advice about what he should do?
30:51 Are you saying we shouldn’t avoid downhill running if it doesn’t give us pain?
30:59 A lot of people say that most of the symptoms that we tend to associate with aging are actually more associated with inactivity, and I wanted to get your thoughts on that because I know a lot of people who are runners and their friends say to them, “Oh, well that’s just bad for your knees. Maybe you shouldn’t run.” What’s your take on that?
Questions I ask everyone:
33:48 If you could go back and talk to yourself when you started running, what advice would you give?
35:27 What is the greatest gift running has given you?
36:53 Where can listeners connect with you?
37:17 What are you working on next?
“I think that running is a natural activity for people. We wouldn’t be here if we weren’t descended from people who could run. I think it’s a survival skill. So I’d say for the majority of people, it’s very natural.”
“Runner’s knee is a broad term. It’s basically any runner that has pain in their knee.”
“Core stability is the first thing we recommend for many people with anterior knee pain, is just maximizing the core, working on the hip external rotators.”
“One of the things I like to think about is running really is a privilege. For those of us who are able to run, I think it’s great. And we love it, and it’s so hard for people when they lose that ability for any of the reasons that we talked about. It is a privilege that we should enjoy if we can. And so I don’t have the feeling at all that people should not run to protect their joints or something like that. If everything lines up and they’re the right structure, then it’s not a problem. Enjoy it.”
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John Fulkerson, MD < Yale School of Medicine
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