Jenny Kincaid Boone

Jenny Kincaid Boone has been running since she was in eighth grade. She competed in cross country and track at Fort Defiance High School (Fort Defiance, Va.) and at Roanoke College, where she was all-ODAC in cross country for four years. When her knees and legs aren't aching from the wear of years of competition, she hits the 19 to low 20-minute range for a 5K.

Recent columns

• A five-miler at the Lake
• Virtual running
• Giving triathlons a try
• Packing energy for the long haul

Dr. Thomas Miller’s experiences caring for runners have taken him to Canada, Australia, Russia and everywhere else in between. As medical director for the U.S Triathlon Team from 1989 until this year, Miller has seen it all, from elite athletes who won’t slow down long enough to recover from an injury to different doctors and physical therapy practices from all over the world.

His experiences stretch back to his orthopedic work in Roanoke, where he specializes in sports medicine, arthroscopy, and knee and shoulder reconstruction at the Roanoke Orthopedic Center. Although Miller does not solely treat runners, his own experience as a runner has helped him learn what makes runners tick, what worries them and what triggers pain.

Miller, who has competed in three U.S. National Triathlon Championships and an Ironman, sat down recently to share some advice on how to make running as pain-free and thrilling as possible.

Q: What percentage of your patients are runners?
A: I’ll see two or three running related problems in a week. It’s not a huge percentage of the number of patients I see in a year, only 5 or 10 percent of my practice volume. But what I see is a lot of non-surgical stuff. I’ll see four or five people with heel pain. Most running problems don’t require surgery. It’s very rare to operate on anybody with a running related problem.

Q: What are the most common injuries that you see in runners?
A: People will come in with some type of knee pain. I think the numbers are 45 to 48 percent of runners will have some sort of knee pain associated with running at some point. And you see certain things over and over again. They kind of get lumped together. But what you can break it down into, is it the backside of the knee cap, do they truly have irregularity of the cartilage? Or do they have a problem with how the kneecap runs in its groove?

Dr. Thomas Miller, an orthopedic surgeon in Roanoke, has been the medical director for the U.S Triathlon Team from 1989 until 2004. He also has competed in three U.S. National Triathlon Championships and an Ironman.

The history that you take from somebody is the same as anybody else. When did it start? What brought it on? What makes it better and what makes it worse? And when you’re done with all of that, you’ve got a pretty good idea of where it came from.

The other thing, and it’s something that we see more than we used to is people who have lateral knee pain or IT band pain. Certainly it isn’t as common, but it’s more debilitating. It’s harder to take care of. It’s hard to stretch it.

People forget how much of it’s related to hip abductor strength. If your IT band is tight at your knee, then it’s tight at your hip. A lot of people come in, and they get focused on their knee and their hip gets ignored. You need to work through all of that.

And the things that people do hear about are stress fractures…Why do people get running injuries? -- Too much, too fast, too little, too old.

The last is we see a fair amount of runners with heel pain. People come in, and they have plantar fasciitis. They all have morning pain and it loosens up a little bit. It all gets worse after they sit down for a little while.

They all come in after they’ve had it for six or eight weeks.

The vast majority of things that we see are some sort of a training error. I don’t know how else to put it because you can lump them all into overuse injuries, but under appropriate timing and with appropriate muscle balance and flexibility, the body is incredibly capable of adapting to a lot of this.

Q: How can runners prevent these injuries?
A: These are the questions that at least as a physician you need to ask somebody. How much are you running? What was your build-up? Do you have a race coming up? Did you just do a race? If you did the race, what was the terrain like? What kind of roads do you run on? Do you run Mill Mountain once a week? If you do, when did your knee start hurting, did it start on the ascent or did it start on the descent? Do you run on the [Blue Ridge] Parkway on Sunday?

You kind of go through this and you’re able to start sorting things out. And it’s a lot of times, you’ll kind of see the light come on. And some of it is to know to start looking for injuries.

One of the things we look at is trying to do things in roughly six-week blocks of time… And what you’re doing is instead of the typical somebody gets injured at about six to eight weeks into a training program, you try to avoid that. Rather than have the unexpected break in training, you try to build in a mandatory break. People go crazy when you do that. But the goal is not to get you through six weeks. The goal is to get you through 12 or 16 weeks.

A lot of people have a steady exercise program that they cruise along with. It’s "I run five days a week, and I always run the same distance." Those people never come in here. I never see them, because they’re in a program. It’s their maintenance program. That’s what they’ve been in forever, without any variation and assuming that they don’t do anything dumb, they cruise along with that.

But that same person who decides, "Okay, I’ve been running 10Ks for years, and I’m bored. I’ll run a marathon. I’m in pretty good shape, so I should be able to run a marathon two months from now." It’s not going to happen.

If you work it from both ends, people can sit down and figure out a program that by planning the biggest parts of their workout schedule and by building in rest intervals into it, they can get through that thing without getting hurt.

Q: What tips would you give to beginning runners?
A: There are two things. First is there are plenty of books that talk about how to start a running program. And all of them talk about easing into it gradually, having a realistic goal and being willing to move forward and back off on occasion. I think any of them, whether it’s a first time runners’ program or your first marathon program, is to look and say, "Okay, I have a goal and I want to set a realistic time frame of reaching it. To do that, yeah, I need to at least have some sort of a plan."

And it’s not a carved in stone plan, but it’s some sort of a reasonable progression other than "Gee, a mile felt good, so I’m going to run three tomorrow and five the day after that, and not be able to walk for the next however many weeks."

The other, and it sounds silly, is running doesn’t require a whole lot of bells and whistles. You can go out there in a baseball cap and T-shirt and a pair of swim trunks. It’s one of the few places that actually investing a little bit of money in a good pair of shoes that match your general gait cycle and recognizing that those shoes wear out. That if you’re going to be in this for an extended period of time, that you’re going to wear your shoes out. Look how much this costs compared to a health club membership or stopping for a cup of coffee on your way to work. Or how much a race entry fee costs. Think about how much time you’re going to put into this. They don’t have to be the most expensive shoes in the world. But they do have to be something that fits, and you keep track of how long you’re wearing them.

The thing that I see most commonly, when we eliminate dumb mistakes that everybody that runs makes, is the "too long." Most people come in and start to notice that their legs are uncomfortable. They start to get the nagging little things. They go back and look at how long they’ve been running in a pair of shoes, and they can’t remember how many miles are on them. They have a fixed life.

Q: How often should a runner buy new shoes?
A: It’s typically between 350 to 500 miles, depending on the terrain you’re running in. If you’re running in wet weather, the mid-sole tends to wear out quicker. If you have one pair of shoes and don’t alternate shoes, the mid-sole takes about 48 hours to recover its impact capabilities. If you have someone who runs on an everyday basis, what they’re doing is every day they’re compressing the shoe down a little bit more. So, they’re running on worn out shoes even though they’re not worn out. Those are the people who I tell, if you’re going to run every day, you really need two pair of shoes.

You really need to alternate them. Otherwise, you’re running on shoes that don’t have the impact, motion control and cushioning abilities that they were designed to have. Same thing goes for running in wet weather. If you’re running in wet weather, most of the shoes that have any of the absorption materials lose about 50 percent of their shock absorption when they get wet. So, you imagine somebody running in the summer, their shoes are all wet and sweaty; the same thing applies to them.

Miller also discussed the differences between caring for competitive runners and recreational runners.
I see people come in and they say, "You know, I’d be really happy to run a 10K, but this is when I get hurt, or this is what bothers me." Those are people that if you put the on a strengthening program and you address some of their biomechanical issues they’re thrilled. They’re thrilled because they’re doing something that they didn’t expect that they were going to be able to do. So, although their injuries are the same, they’re willingness to make modifications to be able to run at all, are a whole lot different.

And a truly competitive person is much harder to take care of because it’s hard to get them to back down. By the time they come in, they’re usually pretty beat up. Their injuries are more extensive than a lot of the recreational runners. And if they can’t get back to 100 percent, then they’re not recovered at all.

Local and upcoming races:

Dec. 18: Linktrack Winter Classic, Bisset Park, Radford, Web site

Jan. 29: The Ground Hog Scurry, Blacksburg to Christiansburg via the Huckleberry Trail, Web site

Feb. 26: Blacksburg Classic 10 mile & 5K, Blacksburg, Web site

Feb. 27: Anheuser-Busch Colonial Half Marathon and 5K, Williamsburg, Web site