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An Interview with Dr. Jason Kurian, Sports Orthopedic Surgeon and Elite Triathlete

What is the runner's biggest fear?

“A lot of runners are worried about 'bonking', or that they are simply not trained enough to finish the event.”

What is your best piece of advice to all the runners that are in the last few weeks of training for the Portland Marathon?

“Don't do too much, too late. The last month of training is where you work on running form and cadence. All your endurance training should be done by now and there aren't any gains to be made with endurance training in the last month. This is a good time for stride-outs and up tempos.”

What about the typical long 18-21 mile runs two or three weeks before the race that you see in beginner programs?

“Long runs are fine for the first time marathoner, but after your first one, your last month of training will change with experience.”

How can they make sure to avoid an injury in this stage of the game?

“Focus on rest and nutrition, and make sure you are fresh for race day. Don't over do it. Make sure your equipment is good. You may consider a new pair of shoes, but make sure they are broken in well for race day. You need new foot wear every 300-500 miles.”

Why is it that runners still develop nagging injuries like plantar fasciitis or achilles tendonitis, despite doing all the right things with there running program, strength and stretching program, complemented by a great diet?

“There is no answer to that question. Every person has different biomechanics and some runners may have biomechanics that predispose them to an injury. Another factor is proper rest and recovery that is often overlooked, or it may just be bad luck.”

For the runners out there who are nursing along a minor injury, any advice to them whether or not to run the marathon?

“Another difficult question. There is a wide spectrum of injuries from muscle strains, ankle sprains all the way up to stress fractures that can occur while training for a marathon. Advice to this question is dependent on what the injury is. When in doubt visit with a physician, such as a sports primary physician or a sports orthopedic physician, first. Then a decision can be made if it is wise to continue or to set new goals for a new race. Sometimes if we catch things early enough and little activity modification and therapy can often solve the problem.”

Does running cause arthritis? Are all runners destined to retire one day? Will we be forced to give it up or can arthritis be avoided or delayed?

“There is no study that has shown that running causes arthritis. Just because you are a runner does not mean you will eventually have to give it, nor can we predict who will develop arthritis. We do tell patients who have developed early signs of arthritis to keep activity levels up, keep there weight down, and reduce impact by choosing trails and grass over concrete for running. There simply is a certain segment of the population that cannot run a 100 miles per week and will have to cross-train by adding something like swimming or biking on there off-days to prolong there running career. ”

Is there any formula to predict whether your knees will go on to develop arthritis?

“Unfortunately no formula exists to predict if anyone will develop arthritis. We think other injuries in the knee such as meniscusor ACL tears can lead to arthritis of the knee, but new studies of recently popped up that contradict this belief. We do know that being overweight and inactive is worse than being active.”

Can supplements cure knee pain or prevent arthritis? Will it help me avoid injuries?

“There are no supplements that have been show with good research to do this. Follow the food pyramid with your diet and make sure to increase your calories in times of training. Some supplements like glucosamine have shown to improve knee pain, but we are not sure of the mechanism behind this. I recommend to my patients to make sure they check with their primary physicians to make sure any supplements won't interact with their medications. Then you should do as much research on the brand and type of supplement you are interested in. These supplements are not controlled. There haven't been any good studies that have shown that glucosamine increases performance or regenerates joint cartilage.”

Why does knee cartilage wear out?

“That is a pretty complex question. The bottom line is that some people's cartilage has a higher propensity to wear out than others. We don't know why. What we do know is that after a certain age, the body looses the capacity to regenerate articulating cartilage. One theoretical mechanism is that an injury of some level occurs that starts a cascade of events that leads to degradation of the cartilage. As a teenager, you have some capacity to regenerate cartilage. As you age, your capacity to regenerate cartilage essentially disappears after your growth plates close, sometime in adolescence.”