The Long Run: Marathon Training Takes Healthy Knees and More

As a runner, Giovanni Paraliticci, M.D., knows the problems one can face with their ankles, hips and especially their knees. As an orthopedic surgeon with Baptist Health Orthopedic Care and Baptist Health Miami Cancer Institute, he knows how to treat and prevent these injuries, which he says are extremely common for both elite athletes and “weekend warriors.”

Getting the proper training matters

Dr. Paraliticci says he typically sees an increase in patient volume this time of year as thousands of runners take to the streets of South Florida training for the Life Time Miami Marathon and Half in late January. A lot of them are novice runners who injure themselves attempting long-distance runs without proper conditioning workouts and exercises.

“An endurance event like a marathon requires months of physical and mental preparation,” says Dr. Paraliticci. “Many of my patients come in with injuries caused by inadequate training – an injured meniscus, a torn tendon, tendonitis, or synovitis, an inflammation of the synovial membrane that lines the knees and other joints.” He says synovitis is very common, especially for patients with inflammatory arthritis.

Giovanni Paraliticci, M.D., orthopedic surgeon with Baptist Health Orthopedic Care and Baptist Health Miami Cancer Institute

Finding the right exercise matters

Dr. Paraliticci used to play volleyball and basketball in high school and college but injured his knee 10 years ago. He suffered a torn anterior cruciate ligament (ACL) and a torn meniscus, the structure that provides cushion between the bones of the knee. He had to have surgery and was told to avoid impact exercises, which meant he would have to find another way to stay active and fit.

His doctor, who also happened to be his mentor, suggested he take up jogging. “He told me it would help increase my motion, decrease my inflammation and keep me active,” Dr. Paraliticci recalls. “Decades ago, the thinking was that if you had bad knees, you should never run. It was considered bad for your joints and thought to worsen arthritis and accelerate the degeneration of cartilage. But newer studies have shown the opposite. Light jogging actually helps your mobility and your joints and reduces inflammation.”

Dr. Paraliticci started off slowly, eventually working his way up to longer and longer runs and has since run a number of 10K races. He says running a marathon, specifically the Miami Marathon, is on his bucket list.

Leading an active lifestyle matters

Stressing the adverse health effects of a sedentary lifestyle, Dr. Paraliticci says that running any distance is beneficial, whether it’s a mile around your neighborhood or a marathon around Miami.

“Life is motion,” he says. “The more active we are, the more lubrication we get in our joints – our ankles, knees, hips, shoulders and elbows. This helps us prepare our muscles for a marathon or any type of activity.”

Dr. Paraliticci advises his patients to walk for 15 minutes at least three times a week and then keep ramping up duration. “Starting off slowly and gradually increasing intensity and duration is important. As long as you’re doing something to stay active on a regular basis, it will help decrease your inflammation.”

Wearing the correct shoes matters

Choosing properly fitted footwear is important, too, says Dr. Paraliticci. “So many people run with the wrong type of shoe. It’s one of the easiest ways to injure your ankle, knee or hip.” He adds that most running stores have machines that analyze your gait and the way your foot hits the ground.

“These machines can determine if you have neutral pronation, meaning your foot lands straight and flat; supination, in which your foot rolls inward slightly; or overpronation, where your foot rolls outward slightly,” Dr. Paraliticci says. “Knowing if you’re neutral or a supinator or an overpronator is essential for a properly fitted running shoe.”

Eating the right food matters

For anyone interested in being more active – whether it’s running on a treadmill or competing in a marathon – Dr. Paraliticci also stresses the benefits of maintaining a healthy diet and body weight.

“A healthy diet includes less meat, more fish, more complex carbohydrates like rice, beans, fruits, vegetables and other “earthy” foods,” says Dr. Paraliticci. To help decrease inflammation, he recommends including turmeric in your diet and avoiding processed foods, which can make your body more prone to inflammation. Staying hydrated is critical, too. Instead of swigging sodas, he suggests drinking lots of water – especially here in South Florida, where we tend to sweat more than the rest of the nation.

Maintaining a healthy weight matters

Dr. Paraliticci says that obesity is a real problem in the United States, where 41.9 percent of adults are obese, according to the U.S. Centers for Disease Control and Prevention (CDC). Black and Latino adults have the highest obesity rates, at 49.9 percent and 45.6 percent respectively, the CDC says.

Our hips and knees are the joints that literally bear the brunt of that extra weight, according to Dr. Paraliticci. “Imagine trying to work out or doing some sort of exercise. Now imagine doing that while carrying two – or maybe four – five-pound bags of sugar. All that extra weight transfers directly to your hips, your knees and especially your ankles. You’ll find that losing excess weight can dramatically help reduce pain and discomfort in your knees.”

Getting the best treatment matters

“At Baptist Health Orthopedic Care, we try to minimize injuries and prepare the patient to be as ready as possible for participating in the Miami Marathon or any other type of activity they enjoy,” Dr. Paraliticci says. “We create a plan in consultation with the patient and help educate them on proper technique and training in order to prevent injuries prior to the marathon.”

Are you feeling more pain than typical in your knee? Does your knee ever lock, causing a sudden, stabbing, highly localized pain? These are all too common complaints for many runners and, unfortunately, they can’t be wished away, says Dr. Paraliticci.

“It could be some sort of internal derangement of the knee, such as with the meniscus, which you should have checked out promptly,” he says. “The sooner we can diagnose and treat your injury, the sooner you’ll be back to running again.”

Dr. Paraliticci says there are a lot of ways to reduce knee swelling and relieve knee pain, including anti-inflammatories – oral or topical, prescription or over the counter (OTC) – and ice, which he says “certainly helps” with swelling. “However, for patients with a high degree of swelling, caused by knee effusion or water on the knee, we have to drain the fluid from the knee to reduce pain and speed healing.”

For patients with chronic knee pain, Dr. Paraliticci says a cortisone injection can help provide relief but it’s not necessarily a permanent fix and it shouldn’t be relied upon repeatedly in the same knee or joint.

Additional non-surgical options for treating knee pain include stem-cell treatment, which is being used increasingly to treat all types of joint pain and is much more accessible and affordable than before, according to Dr. Paraliticci.

Having a positive attitude matters

Other than getting the proper training, leading an active lifestyle, wearing the correct shoes, eating the right food, maintaining a healthy weight and getting the best treatment, what advice does Dr. Paraliticci have for runners in the Miami Marathon?

“Have a positive attitude and enjoy the camaraderie that the event offers,” he says. “Running is a very satisfying solo experience – it’s almost like meditation for me – but there is a lot to be gained from training with a group of fellow runners. They can help you push through the occasional aches and pains and times of low motivation, which are sure to happen at some point along the way.”