Insights from an Orthopedic Surgeon and Veteran Marathoner: Avoiding Pitfalls of Long-Distance Running

As the countdown to the Life Time Miami Marathon & Half on Feb. 2 draws closer, runners training for the event are finding that the road to the starting line is not just about logging miles. Staying injury-free is vital to success in any endurance race, especially the grueling 26.2 miles of a marathon.

As someone who is also preparing for his first full marathon, Alexander van der Ven, M.D., orthopedic surgeon with Baptist Health Orthopedic Care Medicine Institute, shares personal insights about how he's managing his own training. He spoke with someone who is very familiar with the challenges of a marathon: Frankie Ruiz, co-founder of the Miami Marathon 22 years ago. He is also the founder of the Baptist Health Brickell Run Club, the largest weekly, free run club in the Southeastern U.S.

The conversation took place while the two runners jogged around the lake at the sprawling Baptist Health Baptist Hospital campus, offering a unique – but appropriate -- setting to discuss the physical demands of marathon running.

(Watch video: Alexander van der Ven, M.D., orthopedic surgeon with Baptist Health Orthopedic Care, shares personal insights about his training for the upcoming Life Time Miami Marathon and Half Marathon. His running partner around the lake at Baptist Health Baptist Hospital: Frankie Ruiz, co-founder of the original Miami Marathon 22 years ago.)

"I’ve had shin splints and low back issues in the past," admitted Dr. van der Ven, who has previously run a half marathon. "But I’ve been careful to make my transition slowly and not overtrain." He believes this gradual approach is essential, especially for those new to long-distance running. "When you’re increasing your distance, it’s crucial to take breaks between your runs," he emphasized.

Additionally, Dr. van der Ven pointed out that a little preparation can go a long way when it comes to minimizing injuries. He encourages runners to listen to their bodies. And when in doubt, seek medical guidance. "If you start to feel something isn’t right, it’s important to get it checked out before it becomes a bigger issue."

A Passion for Marathon Running

During the course of their conversation, Mr. Ruiz mentioned how his passion for running ultimately led to the launch of the Miami Marathon in 2003. That first year, the marathon attracted 3,400 runners. Since then, the race has developed into an internationally renowned event with a field of 25,000 runners from all 50 states and over 80 countries.

"I feel so lucky to be part of a community that shares my love for running," Mr. Ruiz said, adding that he’s grateful for the support from Baptist Health South Florida in both his personal running journey and the broader community.

Mr. Ruiz added that he has been passionate about running since childhood. "I wasn't the tallest kid, so I didn't feel like I had control in other sports. Running was something I could do on my own," he recalls. “The more you did it, the better you got. I just realized I wanted to do something related to running. I ran cross-country in high school, and did track as well. And I competed in college at FIU (Florida International University). And then I realized that Miami was missing a marathon.”

Baptist Health’s Support for Marathon Runners

As the official medical provider for the Life Time Miami Marathon & Half, Baptist Health plays a crucial role in supporting runners along the full 26.2-mile route. The Baptist Health team will be stationed at various first-aid and medical stations throughout the course, providing staffing and equipment to ensure that runners have access to medical care if needed. The medical director for the Miami Marathon is Thomas San Giovanni, M.D., orthopedic surgeon at the Baptist Health Orthopedic Care and the co-medical director is Michael Swartzon, M.D., primary care and sports medicine physician.

“We have a great deal of experience handling the medical operations for these mass scale endurance events,” explains Dr. San Giovanni. “We’re now going on our 13^th year as Baptist Health has proudly served as the medical provider for the Miami Marathon, equipping our team to handle any situation that arises — whether it’s minor scrapes from a stumble, painful muscle cramping or spasms, dehydration-related overheating or more serious incidents that require basic or advanced CPR skills. For the participants, there’s reassurance in knowing that expert medical care is readily available should the need arise.”

Both Dr. van der Ven and Mr. Ruiz are excited to see the continued growth of the Miami marathon and to support runners as they push themselves toward their personal goals. "It’s an incredible experience to see the community come together around this event," Mr. Ruiz said.

Dr. van der Ven, a seasoned expert in joint replacement surgery, provided critical insights into maintaining a healthy body during long-distance running. Dr. van der Ven specializes in hip and knee replacement surgeries, which has given him an in-depth understanding of the stresses the body faces while running. He also noted that his practice involves treating a range of patients — from those recovering from surgery to athletes aiming to prevent injury.

Common Injuries and How to Avoid Them

A key topic discussed was how to avoid the common pitfalls that many marathoners face, particularly as they ramp up their training. Dr. van der Ven emphasized the importance of not overdoing it, especially when increasing the distance of runs.

"At anything -- any sport -- if you overdo it, you're going to get an injury," Dr. van der Ven explained. "You’re going to neglect those other protective muscles." This is why he strongly advocates for a balanced approach to marathon training.

He stresses the need for a ”cross-training routine” that combines cardiovascular exercise with strength training.

"Strength training -- as well as injury prevention, stretching, and balance work -- are all crucial," Dr. van der Ven said, urging runners to think of themselves as elite athletes. "If a professional athlete needs therapy, why does a weekend warrior neglect themselves?" he added, highlighting the importance of caring for your body just as you would if you were a professional.

Throughout the course of their conversation, Dr. van der Ven pointed out the most common injuries that runners face. He noted that overuse injuries, such as tendinopathies (tendon disorder that causes pain, swelling, and reduced function), shin splints (pain and tenderness along or just behind the large bone in the lower leg), and foot and ankle strains, are prevalent in the running community. He also mentioned that low back issues are more common than many might expect, as running can take a toll on the spine.

One significant factor contributing to these injuries, according to Dr. van der Ven, is rushing into training too quickly. "A lot of times, runners jump into intense training without proper conditioning, which sets the stage for injury," he said. “It's important to make sure that you’re gradually increasing your intensity and taking breaks between harder efforts."

The Impact on Knees and Hips

As a hip and knee surgeon, Dr. van der Ven says that one of the most common questions he gets is: How does running hurt your knees or does running hurt your hips?

“There's this misconception that running is bad for your knees,” explains Dr. van der Ven. “And, in fact, there may even be some thought that running is protective … So, if you've got a chronic injury, you do have to be careful. If you're getting recurrent swelling or pain, that may be a problem. But a sore knee at the end of a run is a totally normal response and there's nothing wrong. You're not doing any damage.

“And they've done studies where they looked at ultra marathoners, these are the 50-mile runners, and they compared their knees to the couch potato. And the rate of arthritis is exactly the same on those two. So, absolutely it is safe to run on your knees. Of course, it's important to maintain a healthy weight. That’s good for general fitness.”

The Role of Proper Equipment and Surface Choice

While many runners worry about the surface they run on, Dr. van der Ven believes that surface-related injuries might be somewhat overrated compared to other factors like footwear and training habits. "I think appropriate shoe wear is more important than the surface you run on," he shared. The right shoes can help mitigate the stresses placed on your feet, knees, and joints.

As for running surfaces, Dr. van der Ven does not dismiss them entirely but encourages runners to be more mindful of their training habits. “It’s really important to maintain a variety of surfaces in your routine, but more important is to avoid doing too much too soon,” he explained. For example, if you're training for a marathon, he advises mixing harder surfaces like concrete with softer trails to allow your body to recover.

The conversation returned to the crucial topic of allowing the body time to rest and rejuvenate. Dr. van der Ven strongly advocates for proper recovery between long runs. "You have to be disciplined about rest," he said. "Your body needs time to recover, and that’s when you get stronger."