Book Review: Run For Your Life – How to Run, Walk, and Move Without Pain or Injury and Achieve a Sense of Well-Being and Joy

The book is written by Mark Cucuzella, M. D., creator of the U.S. Air Force Efficient Running Program. The content of the book is the result of more than three decades of study, practice, and science that the author shows in clearly illustrated (170 photographs and charts) and accessible text. He explains how easy it is, under his suggested approach, to run efficiently and injury-free, whether you are in your twenties, sixties, or seventies, for beginning runners and experienced marathoners.

Nick Feamster, professor at the University of Chicago and a great runner I had a chance to run with two times per week during my tenure at UChicago (8 miles each time we used to meet) gave me this great book as a gift prior to relocating to Phoenix, AZ. Nick is a good friend that runs an average of 80 to 90 miles per week, so I definitely jumped into this book right after I got it. It includes great and useful content presented in a clear, structured and engaging manner.

The twenty takeaways that I got out of this book are outlined below:

1. When treating runners, we tend to ignore “prehab,” the preventive solution: learn proper posture, strengthen the core muscles, settle into a good running pace, build endurance, understand mobility and efficiency of movement, and indulge a sense of contentment. Add to that restful sleep, good nutrition, sufficient recovery time, and even a sense of community, and you are solidly on the path to becoming stronger, to preventing injury, and to appreciating the magical gift of the human form. Simplicity of style begets efficiency of function… “What amazed me most was that the traditional runners of Mexico and Kenya appeared to be completely relaxed and happy, in contrast to having the pained expressions of so many of my running friends.”
2. The foot – maybe the least understood of all moving body parts- is the orchestrator and foundation of all motion. What we do know is that it is superbly designed for its most important functions; absorbing shock, sending signals to the brain to maintain stability, and propelling the body forward.
3. “Simply put, athletes and patients with running injuries receive too much treatment and not enough attention and thought. Medical schools and hospital residencies offer little guidance in the evaluation, prevention, and rehabilitation of overuse injuries. In med school, we learn how to treat parts of bodies (as if the body were a department store), not whole bodies. We were taught to treat the symptoms, not to address the underlying imbalances and weaknesses. True prevention means not allowing the condition to arise and develop in the first place. Take diabetes and heart disease. The best prevention is to eat a healthful diet, to avoid stress, and to go on a daily walk or run. And of course not to smoke…” “What’s needed is a new approach to running. Paradoxically, that approach involves less medical intervention for runners, not more. As a family doc, I generally ask patients what physical activities they like do.”
4. Our bodies are older than we think – Whether your goal is athletic dominance or simply to arrive at a healthy old age, we all share the goal of making the best of our lives while on the planet, in the healthiest and most productive way that we can… Throughout human history – for almost 2 million years as hunter gatherers, followed by 12,000 years as pastoralists and farmers – our ability to run, to walk, and to be physically active has been essential to life. By virtue of our existence – indeed, as evidenced by our domination of the planet – humans are succeeding. So far, at least… The “persistence hunting” theory, they would have needed to travel only fast enough to keep their prey moving and not resting… Our ability to travel long distances in an energy-efficient manner helped us with more than hunting. It also allowed us to relocate more readily to a new water source, for instance, or travel to a more bountiful area. Essentially, we could walk away from perils such as famine and drought, sometimes to distant locations, aided by an ability to efficiently store and utilize the calories we consumed.
5. Nurture or nature? – When it comes to running, there’s no evidence that the Tarahumara or the Kenyans are genetically superior to anyone else. Harvard evolutionary biologist Daniel Lieberman points out that people in these groups are prone, like all of us, to habits that can lead to illness and poor running technique, especially when they adopt Western diets and modern running shoes… Therein lies the inspiration for this book: the hope that we can become better, more functional, healthier humans and restore and nurture our connection to who we are and to how we were meant to live. This doesn’t mean finding a place of stasis and comfort. It demands that we actively resist the inborn desire to remain on the couch and eat whatever is within reach… We are living in a unique time in human history, one in which we have a choice of lifestyles.
6. Quality of life: more important than quantity – Despite all chis medical attention, the disability-adjusted life expectangy (DALE) and the health-adjusted life expectancy (HALE) for Americans is only seventy years, which doesn’t even figure into the global top twenty… By some measures, average functional life spans in the United States have started to decline. This refers to the length of one’s healthy, active life, in contrast to the total number of years that one has been alive. In light of this, Orville Rogers, a one-hundred-year-old Masters record holder in the 200-meter run, quipped that our goal should be to “live long and die short…” How do we do that? Researcher James O’Keefe points out that the daily physical activity pattern of hunter-gatherers forms an ideal template from which to design a modern exercise regimen – one that works to realign our daily movement with the archetype encoded within our genome… For instance, endurance training (long, slow runs) was essential for persistence hunting; interval training (jogging punctuated with short sprints) corresponds to fighting and fleeing; strength training (such as lifting weights) replicates house building or handling large game; and mobility training (moving the body through its full range of motion) reproduces a variety of movements needed for survival. Rest and recovery is included front and center as well: hunter-gatherers spent plenty of time relaxing, too… To avoid the tantalizing perils of the convenient modern age, we need to reclaim a bit of our evolutionary past – by eating simple, natural foods, and by regularly putting our bodies through a wide range of movements.
7. Drills – The preliminary drills in this chapter involve balance, which requires the integration of our eyes, inner ears, and receptors in our feet and throughout the body. Balance is the foundation – the pre requisite, really – for the other exercises and activities described in the book. And good balance is the basis of healthy running’s single most important attribute: relaxation (see images in pages 12-16)… “Eighty percent of song people have back pain. The other 20 percent have no computer.” – Unknown… The most exciting, thrilling activities of earthbound folks involve gravity managing it, leveraging it, playing with it, trying to defy it… And it’s not how many hours of sitting that’s bad for you; it’s how often you interrupt that sitting that is good for you!… Standing all day in a static position isn’t good, either. If you try a standing or treadmill desk be sure to take some time to sit and relax. Avoid sitting back – treatment for back pain is at 80 million a year industry, despite a growing medical consensus that most modern interventions, from injections to surgeries, have little or no value, and often cause harm… We need to treat the position, nos the condition… Relearning to breathe – When you allow the lower belly to fill as you inhale, your powerful diaphragm contracts and you fill the lower areas of the lungs, where maximum oxygen exchange occurs. Try these antidotes to the epidemic of sitting: work at a standing desk; test run a treadmill desk; walk or ride an elliptical bicycle at work; take standing or walking breaks; stand up at meetings; sit more actively (for car and airplane seats, you may use a product called Backjoy, which better positions the pelvis and lower spine); sit on the floor… Reset your standing posture – stand against a wall; balance on each foot’s “tripod”; lengthen the back of your neck and make yourself tall; reach up, as if for a cookie jar on a high shelf; with your arms and your sudes, roll your shoulders blades slide down your rib cage… Reset your breathing – see some videos in the book’s website to learn more about this.
8. It may be that the role of the shoe has been misunderstood. The modern, comfortable, cushioned shoe was designed as a solution to a problem that was never clearly defined. It was intended to compensate for perceived weaknesses and hazards. In one sense, these shoes have eased the burden on our feet so that they need to work less. But our feet are designed to work hard. In doing work, they gain strength. Our ancestors did not have golf courses… A shoe’s most important function should be to protect our soles, the same way that work gloves protect our hands… Moving to lower-drop or minimalist footwear should be a process, not an event. The muscles, tendons, and ligaments in your feet and legs need time to lengthen and strengthen. While adapting a little soreness is inevitable but you should not be in pain.
9. The care and feeding of your fascia – Foam roll the “knots”: First thing every morning, take a few minutes to fully stretch out, head to toe. Then with a foam roller, “tissue floss” by rolling your legs, hips, torso, and back- gently and slowly while remembering to breathe from the diaphragm. Your body will tell you where it needs attention. Roll from the middle of the muscle group up to its insertions, while avoiding the joints… The calf region is especially prone to restriction, and needs regular attention. The Mountain Climber is remarkably effective at opening up and releasing your hips, as well. It can be done before a run or a walk or after an activity – or anytime, really (see images in pages 68-70)… Developed by Dr. Lawrence van Lingen, the Awesomizer is one of the easiest and most effective ways to release tightened hip flexors and tune the fascia of your pelvis and legs all the way down to your feet… The dynamic burpee is a bit more advanced. This exercise, created in the 1880s, is a combination of a squat, push-up, and jump, and is the ultimate full-body fascia exercise. It requires significant flexion and extension, and when it is done well you can feel the body dynamically spring off the ground (see image in page 71)… The couch stretch. Perfect for stretching the rectus femoris, while loosening the hip flexors. Start with your foot against a wall or couch, then progress to holding your own ankle (see image in page 72)
10. The elements of style – five principles of good running – The first principle is to maintain proper posture. Run tall. Think of your body as a straight, vertical line. Keep your neck straight and your head from drooping forward… The second principle is to maintain a strong and stable core, which includes your abdominals, pelvis, hip stabilizers, glutes, and even your shoulders. Visualize a can of compressed air in your belly… The third principle is to use your arms and hands to set your rhythm. Keep your elbows at an angle of 90 degrees or less, and drive the elbows back with the strong muscles of the lower trapezius and shoulders – but in a relaxed manner, such that your arms reflexively come forward… The swing of the arms helps in four ways, by: providing stability; counterbalancing the movement of the opposite leg; balancing the pelvis; and helping maintain forward momentum… The fourth principle is to ensure that your feet actively moderate the impact. Each foot should land with the full foot making contact at a position to load the spring and not the brake… The fifth principle of good running form is cadence, or rhythm. Efficient, springy runners maintain a cadence close to 180 steps per minute – regardless of the terrain or steepness, up or down… Run tall with a strong core. The arms are relaxed, elbows bent. Lead from the hips and power from the glutes (see image in page 82). Top it off with a soft, full-foot landing and natural rhythm.
11. The Engine That Runs Us: Building Endurance. “You are not training to run an event. What you are training for is to live a long and productive life and maintain health optimally. For that there is no question that whatever is sustainable is the best type of training” – Dr Tim Noakes… Slow and steady wins the race: Many believe that high-intensity, push-the-envelope workouts make you stronger and fitter than low-intensity workouts. This may work temporarily, but can create a toxic, acidic environment in the muscles, inhibiting the aerobic development that we seek… The 180 formula (see information in page 111)
12. Move more and exercise less – Modern humans share with zoo animals the diseases of captivity: We exercise to compensate for restricted habitat and range. And we regard exercise as we do nutritional supplements. Just as supplements shouldn’t be the foundation of our diet, exercise routines shouldn’t form the bulk of our daily movement… Invisible training: “When I’m asked, ‘What is the best position or movement?’ I respond by saying, ‘Your next one.’ If you have remained in any single position for more than twenty minutes, change it up. As you do, expand the ways you reposition your tissues and load your joints. Each time you stress and move new areas, local blood circulation increases. Mix up the ways in which you interact with the environment – just as our ancestors did constantly.”… Exercise snacks between meals – they can help break up the day and get the blood flowing. If you work in an office, exercise snacks will keep you healthy and flexible. You can stand while chatting with a colleague or student, and phone conversations offer more opportunities to stretch and move. When working from home, interrupt your day by going outside and completing chores, especially those that demand some physical effort. When you return to your desk (preferably a stand-up variety), you are physically and mentally refreshed, and noticeably more productive… The wall squat – To further assess the mobility of the thoracic spine, stand with your toes close to the wall (or, ideally, right up to it). Raise your arms high overhead, and try to drop down into your basic squat. Can you get your thighs to a level parallel with the ground? Can you drop your bottom all the way down? Do this routine especially if your upper back is restricting you.
13. Eating to go the distance: Nutrition and Health – “People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food.” – Wendell Berry… Recovery Is the Training – Racing is optional. But rest and recovery after any vigorous activity is mandatory. Recovery is the time when your body repairs and strengthens, which doesn’t happen while you are exerting. Recovery should not become a routine of rehabilitation and physical therapy… The fastest way to recover from more intense workouts and races is to eat a healthy meal within the next hour. Recommended post-activity nutrition depends on your metabolism, muscle mass, genes, and goals. If you simply want to run for general health and fitness, without a specific goal of fat loss or diabetes reversal, then include some healthy whole food carbs with your fat and protein. The carbohydrates will elevate your blood sugar slightly, signaling the pancreas to release insulin.
14. Running a Marathon – “It’s very hard in the beginning to understand that the whole idea is not to beat the other runners. Eventually you learn that the competition is against the little voice inside you that wants to quit” – George Sheehan, M.D… “Everyone should run one marathon. The rest is optional” – Meb Keflezighi… (see several notes and hints between pages 185-197)… “Running is how I get a front-row seat to the calming, enjoyable spectacle of experiencing endorphins as they do their magical tap-dance inside my brain” – Bill Katovsky.
15. Zone Out: Running can be a great escape, a chance to “zone out.” Plug into some music, a podcast, or an audiobook, and distract yourself from worries, obligations, endless to do lists, and the monotony that can accompany a long run… Zone In: Be 100 percent present, and deeply connect to the moment. Running makes an ideal movement meditation, beautiful in its simplicity and accessibility. Practice mindfulness by simply observing. (This may be especially relevant when you are trail running.) Embrace whatever appears before you and whatever sensations, thoughts, and emotions arise. Sleep builds our capacity to respond and adapt quickly to a stress. There’s no substitute. Relax, and do it well and completely.
16. Outsmart Injuries with Prevention – Runners are at fault, too, though not intentionally. When we feel pain or an incipient injury, we tend to shift our gait or posture. But a compensation like this (along with the drugs or orthotics) can hide the original condition or trigger another injury in a different area of the body. Sometimes a domino effect of injury works its way up (or down) the body’s kinetic chain… All of this underscores how essential it is for us to maintain – on our own, without too much intervention – the delicate relationship between our interconnected moving parts. It’s mainly up to each of us to build the ability to respond to and prevent injuries. Running should not cause injury. It should make us injury-resistant, and injury-resilient. We run so we don’t get hurt… Prehab, not rehab: Running injuries aren’t inevitable. Most injuries are a product of too much, too soon, too hard, or too fast. Or a combination of these. We can prevent injuries in the first place by doing prehab: realigning the body’s symmetry, maintaining posture, strengthening the feet, expanding the range of movement, learning gentle rhythm and relaxation, and remodeling movement patterns… Reset, not rest: Misperceptions abound. Some injuries require rest and rehabilitation, but many don’t… If you are suffering from a running-related pain, the joints – indeed, all parts of the body – generally benefit from movement of the affected area, not immobilization. Running (and walking) the right way is an excellent treatment for degenerative injuries sustained from running the wrong way.
17. Healthy at any age – With age, we tend to lose the habit of natural, fluid movement that came to us automatically as children. But this is not an inevitable loss. Indeed, relaxed, efficient movement has been trained out of us by work (sitting), by our environment (cars and mechanical aids), and by the downright dangerous myth that we should “take it easy” when we grow old… It’s well known that physical activity and cardiorespiratory fitness are associated with higher cognitive functioning. A study led by Agnieszka Burzynska and colleagues at the University of Illinois suggests that high-intensity physical activity has a protective effect on neural processing in aging, too. This is because exercise triggers the production of BDNF, which stimulates the growth and differentiation of new synapses and neurons, especially in areas vital to learning, memory, and higher thinking. In other words, physically fit older adults are more flexible – cognitively and in terms of brain function- than their more sedentary peers.
18. Diet is an actor in the aging process, too. A Stanford study found that in basically healthy people, the presence of insulin resistance is a strong predictor for a variety of age-related diseases, and for Alzheimer’s in particular… Running into old age: So, will running help you to live longer? Despite some scares in the media that running is dangerous, the answer is yes–at least the majority of the evidence points that way. As sports medicine pioneer Dr. Gabe Mirkin says, “The only mechanism ever found to prolong life and delay aging is exercise. There is no data whatever to show that antioxidants, vitamins, or anything else prolongs life.” This is partly because when you take supplements and anti-oxidants, you don’t get the “training effect” – meaning your body isn’t stimulated to produce these substances on its own… Life Span is not equal to Health Span: Medical science counts our modern-day gain in life expectancy, and the statistical decline in age-adjusted death rates, as victories. Longevity–the quantity of our lives–has increased slightly in recent years, yet we haven’t seen a corresponding extension in the quality of our lives. Nowadays, a higher percentage of us are reaching advanced ages – over eighty, for instance – but it isn’t clear whether, on average, our functional life spans are longer than they were decades ago… Genetics plays a role in how you age, but how you live is a larger factor – and it’s within our control, after all. Considering our busy, high-stress culture, “Don’t worry” is perhaps the most overlooked piece of advice. Stress hormones routinely flood through our veins as a physiological response to the numerous psychological challenges that greet us nearly every day… The Mayo Clinic cautions that the stress response is activated so often in many of us that the body may not have adequate opportunities to return to normal, leading to a state of chronic stress (indicated by prolonged high bloodstream levels of cortisol, the “stress hormone”). Chronic stress impairs cognitive performance, suppresses thyroid function, and causes blood sugar imbalances (such as hyperglycemia), decreased bone density, decrease in muscle tissue, elevated blood pressure, lower immunity, slowed wound healing, and inflammatory responses throughout the body.
19. The Nature Cure: “In every walk with nature, one receives far more than he seeks.” – John Muir… Nature is something we tend to forget, or take for granted, yet it ties much of this book together. The natural world is the source of the food we eat, the air we breathe, the water we drink, and the resources that go into the products we consume. Evidence strongly suggests that exposure to nature benefits physical and mental health in a variety of important ways, and can derail disease before it develops… Humans are a species – highly evolved – that is inextricably linked to the natural world… An epidemic of e-devices: The average number of hours per day that people spend indoors on digital devices seems only to climb, while our time spent outdoors – and in nature, especially – declines. Children and “screenagers” are especially vulnerable to a physically non demanding but attention-robbing indoor lifestyle, such that we are broadly witnessing what Richard Louv (author of Last Child in the Woods) has termed “nature deficit disorder.” The habit of remaining indoors continues even as we learn how interior, manufactured environments (along with the poor nutrition and lack of physical activity that tend to accompany them) contribute to obesity, high blood pressure, type 2 diabetes, heart disease, depression, and many other illnesses.
20. The End is the Beginning – The running races, the healthy food programs, the community outreach – and the shared exhilaration of effort and movement – are small but important ingredients in the recipe for restoring public health. Through self-reliance and dependence on one another (rather than on professionals or the Internet), we can help rebuild a culture of community and sharing. One by one, we can initiate this by joining a tribe of like-minded joggers, hikers, or whatever – any group whose members share a passion for movement, activity, and health.

It may sound paradoxical, but the author feels that “The goal of this book will be reached when you don’t have to think about the principles and the drills described here. This eventuality will come when you have fully integrated its contents into your daily life – your movement, your work, and your relaxed state of mind. And ultimately, it is not about the running. It’s about the merging of body, soul, and community into a healthy way of being.”

The author also shares that, by applying the principles outlined in the book, he now holds the world’s longest active streak (thirty years) for consecutive years of running marathons in under 3 hours.