What Can We Learn From Meb?

On July 12, 2014, in Sports Medicine, Uncategorized, by Dr. Dino Pappas

The Story of Meb

Perhaps the greatest American marathoner of this generation and maybe of all time

Perhaps the greatest American marathoner of this generation and maybe of all time

Summer running season is heating up and with the warm weather comes injuries. I tell patients that I’d much rather see them at the grocery store, at a local adult watering hole (aka pub) or at the finish line of a race than at our clinic injured. A runner that can’t run is like a dog lover/owner that just lost their dog. For more on that read this http://thecfim.com/rest-fixes-bad-mechanics. And now onto the real point of this article, the story of Meb.

The Greatest?

Meb will go down as perhaps the greatest American distance runner or at the very least the best American marathoner of this generation. Perhaps, Meb ran his “best” race in the most recent 2014 Boston marathon at 38 years of age, an age where many elite marathoners have all but faded from the podium. So what gives? Why the resurgence at 38?

Strategically and philosophically Meb learned 2 things: 1). TRAIN SMARTER NOT HARDER 2). RUNNING FASTER AT LONG DISTANCES IS ABOUT MORE THAN MILES.

Cold, Hard Facts

1. 30-70% and more likely 50-70% of runners are injured in a given year (1, 2, 3).

2. Exposure is a key predictor of injury risk in many settings and fields including sports medicine and running. Exposure in running is consistent with overuse injuries from over training. Estimates call for 50-75% of all running injuries as a result of over training (1).

3. Distances over 40 miles weekly significantly increase the injury risk (4).

4. Once injured, recurrence rates of the same injury are high with estimates ranging from 20-70% (1).

5.  The best single predictor of future injury is current injury (6). This is true for many injuries and many sports including running.

6. Too little stress to the tissue = No Adaptation & Poor Performance…Too much stress to the tissue = Increased Injury Risk & Poor Performance….Optimal stress to the tissue = Optimal Adaptation & Improved Performance

Where on this graph do you want to be?

Where on this graph do you want to be?

Injury Risk

Our best estimates indicate that a range of 30-70% and more likely 50-70% of ALL runners are injured in a given year. This means that runners of all shapes, sizes, and abilities stand the likelihood of being injured. So, yes even Meb has faced injuries. Over the years Meb has learned that quality training training mattered more to his end result than the volume of miles or intensity of training (7). So what does this mean? It means train smarter not harder and that running faster at long distance is about more than miles.

Meb is quoted that he had no idea what his exact weekly training mileage was in the months between January-April 2014 (7). These were the months leading up to his 2014 Boston Marathon victory. Let’s put it this way, a world class, high volume (greater than 100 miles/week), detail-oriented runner did not have a clue about his weekly or monthly training volume in the most important race of his life. You would expect that strategy would be one of failure rather than victory; however, it demonstrates the principle of more quality miles and less “wasted” miles. “Wasted” miles are miles run past the point of fatigue (physical and mental), where form goes awry. These are bad miles that break you down, rather than build you up. These are miles that inhibit recovery and therefore inhibit your next training session. These are miles that contribute to injury rather than performance. Meb is later quoted as saying, “I’m trying to avoid injuries…I could do it (run faster and more miles in training), but the whole point is to stay healthy.” Meb didn’t want to take unnecessary risks. So if you want a strategy to train well and run well how about this “STAY INJURY FREE!”


Another cold, hard fact that occurs in sports medicine, sports performance and occupational medicine is exposure risk.  One of foremost experts in this area, Stuart McGill, describes this risk in the following video (https://www.youtube.com/watch?v=P0tcnQ-9Jcs).

Stuart McGill is an accomplished professor, author and researcher in the area of spinal injuries, sports performance, and occupational injuries. He is sought out by governments, large corporations, research institutions to teach and consult. More info on Stu McGill can be found here (http://www.backfitpro.com/).

Let me explain. McGill broke down a set of research that says that sprinters and cross country runners that “moved better” on functional movement screening (squats, lunges, etc.) had a higher risk of injury than those that did not move well. The athletes that “moved better” in his studies were the higher skilled athletes and therefore played or ran the most (most events/most miles). With the increased exposure (playing time, miles ran, etc.) came increased injuries. You would expect otherwise.  You would expect that athletes that didn’t move as well would have higher injury risk, but that didn’t occur when sifting through the data. The moral of the story here is that exposure is a HUGE variable in repetitive stress/repetitive motion injuries like running related injuries and yes even elite athletes get injured as a result.

Similar concepts occur with injuries such as disc bulge, disc herniation and carpal tunnel syndrome. The more time spent in lumbar flexion (bending forward) the greater the stress to the discs in the low back leading to injury and back pain. More time spent at a keyboard translates to increased strokes, increased stress to the tissues of the fingers, wrist and forearm and increased chance for carpal tunnel syndrome. The moral of the story here is that in many different settings and fields INCREASED EXPOSURE = INCREASED RISK.

Safe Distance & Training Recommendations

So if you want to reduce injury risk and possibly improve performance, you have to start thinking about exposure and that means staying away from “wasted miles.” The best research indicates that the risk of running injury increases dramatically with weekly mileage exceeding 40-45 miles. Many of the marathon or greater distance runners we treat far exceed that amount. Now, I’m not saying that you shouldn’t exceed 40-45 miles miles/week if you are a distance runner. I AM saying that you should proceed with caution when weekly mileage exceeds 40-45. If you are a data junkie, monitor your times, paces, distances, heart rates, climate and terrain changes and look for trends in the data indicating diminishing returns. You are looking for decreased performance with higher outputs rather than higher outputs leading to improved performance. If you are simplistic like me, live by the mantra “Run By Feel.” If you are feeling good, don’t be afraid to run a few extra miles that week. If you aren’t feeling good, scale back that week and live to fight or run another day injury free. This strategy worked for Meb. It works for me and it can work for you. Remember, injuries have a strong tendency to negatively affect performance, have a strong tendency to linger without sufficient training modification or treatment, and have a strong tendency to return. So train hard, train smart, and avoid injuries at all costs!

The most interesting runner in the world and yes he whines like a little girl when he's injured too!

The most interesting runner in the world and yes he whines like a little girl when he’s injured too!

Training Threshold & Adaptation

There is an optimal training range. A range where just enough training has injury prevention and performance benefits. Likewise, too much or too little stress is counterproductive.  Everyone’s range is a little different, but the principle is sound. Meb found his ideal range and success ensued. See the graphs in this document for a better overview of the scientific principles you should adhere to.

Undertrained?  Overtrained?   Optimally Trained?

Undertrained? Overtrained?
Optimally Trained?

Another great set of resources on this topic can be found right here (http://www.therunningclinic.com/medias/pdf/quantifying-mechanical-stress.pdf). The linked file and website has some outstanding resources for runners, sports scientists, performance coaches and sports medicine professionals.

Back to Meb

Enough of the science and back to Meb now. Meb used a combination of tempo runs, intervals, long runs,cross training, strength training, core training and the dirty little word “rest” for success. Click here for some core and strength training exercises that can be utilized in runners http://thecfim.com/strength-training-runners-101.Variability in training led to different tissues getting different stress at different points in time leading to the much sought after training response needed to propel him to victory.

Meb described the rest he took in the following quote, “The rest depends on how I feel. I might do 12 miles  if I feel great, or I might run less if I don’t feel as good. I might skip a short second run on a day, because it’s all about staying healthy.” (7). Meb’s training and rest strategy allowed the adaptation necessary to perform at his best. Meb also focused his attention to diet and nutrition in an effort to hasten recovery and improve performance. It’s something that he emphasized in his last several years of competitive running. Click here for some general nutrition tips http://thecfim.com/10-nutrition-tips-endurance-athlete.

The Lesson

We learned from Meb that he trained just as hard for the 2014 Boston marathon as his other races, but his training was much smarter. His performance was amongst his best as a result in the shift of training philosophy. We learned that running faster at long distances is about more than miles. Weekly mileage totals don’t necessarily translate into success. Let’s finish with this, ” If you run a personal best, whether it’s by 1 second, 10 seconds, 2 minutes, you better celebrate, because they don’t come very often.” – Meb Keflezighi


1. http://www.ncbi.nlm.nih.gov/pubmed/?term=van+Mechelen%2C+W.+Running+injuries%3A++a+review+of+the+epidemiological+literature

2. http://www.ncbi.nlm.nih.gov/pubmed/22217561

3. http://www.ncbi.nlm.nih.gov/pubmed/?term=van+gent%2C+R%2C+Siem%2C+G%2C+van+Middelkoop+M%2C+et+al.+incidence+and+determinants+of+lower+extremity+running+injuries+in+long+distance+runners%3A+a+systematic+review

4. http://www.ncbi.nlm.nih.gov/pubmed/?term=fredericson%2C+m%2C+anuruddh%2C+M+epidemiology+and+etiology+of+marathon+running+injuries

5. http://www.ncbi.nlm.nih.gov/pubmed/18057673

6. http://www.ncbi.nlm.nih.gov/pubmed/17883966

7. http://www.runnersworld.com/boston-marathon/how-meb-keflezighi-trained-to-win-the-boston-marathon?page=1

 About The Author

Dr. Dino Pappas, DC, MS, ATC, CSCS, CKTP, cert MDT: Dr Dino Pappas is a chiropractic physician, certified athletic trainer and certified strength and conditioning specialist. Dr. Pappas blends the best of physical medicine with the best of integrated medicine to help patients and athletes of all shapes and sizes. He utilizes tools such as chiropractic manipulation, soft tissue work (Graston, Active Release, Myofascial Release and joint mobilization), biomedical acupuncture, functional movement based assessment, the McKenzie Method,  strength training and conditioning, customized nutrition and specialty laboratory testing (blood, saliva, urine, and stool) when needed.  Dr. Pappas’ clinical focus is sports medicine, conservative orthopedics, rehabilitation and integrated medicine. His sports medicine interests are endurance athletes, overhead athletes (pitchers, throwers, volleyball players and tennis players), contact sports athletes (football, rugby, lacrosse, field hockey, soccer and basketball) and Crossfit athletes.  He reads and interprets the medical literature daily to stay abreast of cutting edge advances in his field. The doctor is currently the team chiropractor for the Windy City Thunderbolts minor league baseball team and a sports medicine volunteer for Andrew High School in Tinley Park, IL. He is an avid runner and aspiring triathlete having completed 4 marathons, 3 half marathons and numerous 5 and 10k races. The doctor is also active in the local, suburban Chicago running scene. He has goals of qualifying and competing in the Boston and New York Marathons, the Ironman in Kona, Hawaii, and climbing Mt. Kiliminjaro in Kenya, Africa. One day he hopes to serve his country as a team chiropractor for the United States Olympic teams and serve as a team chiropractor for one of the professional teams in Chicago.  His mantra is “Why Put Off Feeling Good?”  He can be reached by email at drdinopappas@gmail.com or at 708-532-2346.

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