Johns Hopkins’s Orthopaedic Surgeon in Chief Makes the Case for Running

Dr. James Ficke discusses the benefits and drawbacks of running…

Originally published in the Fall 2015 issue of Robb Report Health & Wellness as “Q&A with James Ficke, MD

Run for Your Life 

Endurance athlete, ultramarathoner, and the orthopaedic surgeon-in-chief at Johns Hopkins Hospital makes a case for running the distance.

Why run?

Research shows that of 26 different sports, running and soccer are the most beneficial to your heart, to your metabolism, and to your overall mental fitness. The risk of dying from any cause or from a heart condition is substantially reduced by jogging at a relatively slow pace two to three times a week for a total exercise time of more than 50 minutes weekly. In my own experience, running is time-effective. I can run and get a decent workout, whereas if I biked or did something else it would take much longer. Also, running is a way for me to recharge. I’m an introvert, and it has always been an opportunity to collect my thoughts and energy.

The conventional wisdom is that running is hard on the joints, so it is a young person’s activity. What’s your response?

I say, bring it. Young people often believe in running at blistering paces, but I believe in running for enjoyment. You may be 20 and doing 4.5-minute miles or you may be 50 and running 10- or 11-minute miles; either way, it is your own race. There is some data that show if your joints are in good shape, then running does not damage the knees or hips. It helps maintain muscle strength, which protects the joints.

You advocate midfoot running. Why?

A traditional heel strike, when the heel hits the ground first, creates large impact forces in the foot and leg. It is like driving a nail into the ground. When you land on the midfoot, there is more of a pushing motion. While the energy absorbed is similar, the spread of the impact is dissipated more broadly. But a midfoot strike is not intuitive. Seventy-five percent of people naturally run heel-to-toe, so runners need to retrain themselves.

What about barefoot running?

We are seeing more injuries attributable to minimalist footwear and barefoot running, both of which have a higher risk of stress fractures and tendinitis.


Who should not run?

People who have arthritis. The cartilage is already damaged, so it not only gets drier and harder as normal aging occurs but it also has cracks and chips in it. Those irregularities are more susceptible to damage. This also applies if you have torn ligaments: The joint is not stable, and that can increase the risk of cracking.

What strategies can help one continue to run as one ages?

Do not overdo the distance, the frequency, or the speed or you can cause overuse injuries that set you back. Consistency is also important. We know that if you have to stop for winter, starting back up in the spring gets harder the older you get. If you can run just one-third of what you do in the summer or you do it on a treadmill, that helps. Last, have fun. If you do not like running, try another activity.

What advice do you give patients about shoes?

See a good shoe salesperson, get your feet analyzed, and use a shoe that fits your foot and your running style. Replace them frequently, every 400 to 500 miles.

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