This Saturday was the first annual EnduraHealth Summit, hosted by TriColumbia and Virginia Hospital Center. Curious everyday athletes asked medical professionals and professional triathletes any questions they had about what it takes to be an endurance athlete. We rounded up some of the best answers on injury prevention from the Q&A session with Dr. Ben W. Kittredge, an orthopedic surgeon and Washingtonian Top Doctor, who has worked with the Philadelphia Eagles, Flyers, and Phillies. Kittredge is an athlete himself—running 50 to 60 miles a week is the norm for him.
What are the most common injuries you see in triathletes?
Most of them are overuse injuries. Once you get to the elite level, the injury instance goes down dramatically. It’s really the people who are ramping up who I see problems with. With cycling, the most common injury is breaking your collarbone when you crash, but that’s not really an overuse injury, per se. Swimmers end up having some shoulder problems, but by far what I see most are stress fractures.
How often should you change running shoes?
When you buy running shoes, they’re good for about 300 to 400 miles. Be uptight about knowing how many miles you have on them. Once you’ve done 300 miles in them, throw them away. Don’t even walk in them. A lot of people think walking on the weekends won’t count. But it absolutely counts on total miles per shoe.
Since I have some knee problems, I try to substitute some runs with the elliptical. Does the mileage carry over?
No. The elliptical doesn’t count. It’s not weight-bearing. So swimming, biking, using the elliptical trainer, roller-blading—those are minimal weight-bearing activities. You can ride 100 miles on a bike and it doesn’t have any impact on your mileage.
Is there any major value to training on soft surfaces versus hard?
Probably not. Softer surfaces mean less stress on your legs, knees, or joints—but the reality is that we live in a paved city. It’s very difficult to get out to a trail. Trail runs are great, but I tend more to focus on [the importance of] shoes. I think it’s so important to pick the right kind of shoes. There are three varieties: cushion for high arches, stability for medium arch, and for really flat feet, there’s motion control.
What are your thoughts on ice baths for injury prevention?
Icing in general is a great symptomatic treatment for a lot of different things. But I don’t think it will prevent injury. I think if you run and then soak a part of your body, or do 30 minutes on and off, it’s certainly a very reasonable thing to do. However, whether it’s a ice bath or a bag of frozen peas on your leg, I don’t think it will make a giant difference in injury repair. It’s a great pain reliever, and in the first 48 hours of injury, it does decrease inflammation. But after that, it’s just a pain reliever.
Do you have an opinion on those Vibram Five Finger shoes?
So here’s the deal. You’re talking about the book Born to Run. It’s a good story, but the thesis of that book is that we should all be running barefoot. I would tell you there’s no scientific evidence to support that at all. I think it’s fine to run in minimalist shoes, but you have to use them gradually. For the recreational athlete who’s just starting to run, I’m not sure it’s the best move. I bought a pair, and I’ve worn them once; I’m afraid to wear them because I run 56 miles a week and I don’t have any problems. I feel like they’re a solution to a problem that doesn’t exist.
What is the best way to prevent further injuries, especially if you have a history of hurting your ankles?
Ankle sprains are super common. The proactive thing to do is strengthen the muscles and tendons around the ankle. Also be aware of your surroundings if you can. If you’re running on a trail and it’s going downhill, you want your feet pointing straight downhill, not out to the side.
Sometimes I find that during some competitions I’ll average an eight-minute mile and others I’ll run a nine-minute mile. Do you think that difference is a result of me overtraining at some point?
The bottom line is I don’t think you have enough rest. You can overtrain, but rest is key. Sleep is really important and is maybe under appreciated. All the things add up, like making sure your shoes aren’t worn out, you don’t have an injury—all those things will impact your training. I’m sure your diet makes a difference, too. Eating chips for dinner is probably not a good thing.
The temperature outside also make a huge impact. For example, when the temperature is warm outside, I worry because that’s when I see more problems. The ideal temperature to run marathons is 54 degrees. When it’s cooler outside, to some extent, times may improve.
