Starting to Run: What Your Body Actually Needs
As we step into a new year, many of us are thinking about improving our health, regaining consistency, and finally committing to the fitness goals we tend to push aside. The truth is simple: consistency and discipline outperform intensity every time. Small, repeatable actions stacked over time build stronger, healthier, more resilient bodies than short bursts of extreme effort ever will.
THE BASICS
Running as Medicine — and Why It Has to Be Approached Wisely
One of the most common New Year fitness goals is to begin or return to running. Whether the goal is to get back into shape, complete a first 5K, or train for a marathon, running remains one of the most effective and accessible ways to improve cardiovascular health, endurance, and mental well-being. There is a compelling physiological reason for this: training for endurance running has been shown to nearly double the density of mitochondria — the energy-producing organelles within muscle cells — improving cellular health and metabolic efficiency in ways that extend well beyond athletic performance. Running is powerful medicine. But like all powerful things, it needs to be approached wisely.
Great health requires multiple pillars: quality sleep, proper nutrition, meaningful social connection, mindfulness, and physical activity. When it comes to exercise specifically, two modalities are essential and complementary. Resistance training is critical for muscle preservation, metabolic health, joint protection, bone density, and longevity. Cardiovascular training is equally critical for heart health, endurance, brain function, energy efficiency, and disease prevention. We need both. Strength keeps us capable. Cardio keeps us thriving. Running conveniently addresses the cardiovascular requirement while providing weight-bearing benefits for bone and joint health when approached with appropriate progression.
STARTING RIGHT
Beginning — or Restarting — Running the Right Way
Most people who struggle with running or sustain early injuries do so not because their bodies cannot handle the activity, but because they progress too quickly. Modern life does not condition most of us for repetitive impact loading, and the body requires time to adapt its tendons, bones, and connective tissue even when cardiovascular fitness is already present. Your first weeks of running should feel easier than you expect. The goal is to build tolerance, not prove toughness.
Start with low weekly mileage and build gradually. Walk-run intervals are a smart and evidence-supported strategy, not a sign of weakness. Avoid chasing speed in the early weeks, and treat pain and soreness as information rather than a challenge to push through. The single most common cause of running injuries is increasing mileage, pace, or intensity too quickly — a pattern that leads predictably to overuse injuries including shin splints, plantar fasciitis, Achilles tendinopathy, anterior knee pain, and stress reactions in bone. A practical and well-supported guideline is to increase total weekly mileage by no more than 5 to 10 percent per week, with scheduled down weeks built into the training cycle.
EQUIPMENT
Your Feet Are Your Foundation
Footwear matters more than most runners appreciate, and the choices have never been more varied or more confusing. For the majority of runners, supportive footwear remains the appropriate starting point. The most important criterion is comfort — if a shoe does not feel right during the first mile, it is not the right shoe regardless of what the label says. Proper fit means adequate room in the toe box, a secure heel without slipping, and supportive midfoot contact without compression. Beyond fit, matching the shoe to the purpose matters: daily trainers for most runs, lightweight options for speed work once a base is established, cushioned shoes for longer distances and joint comfort, and trail-specific shoes for off-road terrain. Running shoes generally require replacement every 300 to 500 miles depending on body weight, running mechanics, and terrain — a variable most runners underestimate.
BUILDING DURABILITY
A Body That Loves to Run
Running places repetitive stress on muscles, tendons, ligaments, and bones. When introduced gradually, the body adapts exceptionally well to that stress — becoming stronger, more efficient, and more resilient over time. When introduced aggressively, it breaks down in predictable ways. The factors that determine which outcome you get are not complicated: gradual mileage progression, adequate rest and recovery between sessions, supplementary strength training to protect the joints and manage load, mobility work where individual limitations exist, quality sleep, and consistent nutrition and hydration. None of these are secrets. The challenge is executing them consistently rather than relying on motivation that tends to spike in January and erode by March.
FOR REFERRING CLINICIANS
Running-related injuries represent a significant and often undertreated source of musculoskeletal morbidity, particularly in the active adult population. Patients presenting with shin splints, plantar fasciitis, Achilles tendinopathy, patellofemoral pain, iliotibial band syndrome, or early stress reactions frequently benefit from a sports medicine evaluation that addresses both the injury and the underlying training error driving it. I offer comprehensive musculoskeletal assessment including diagnostic ultrasound, gait and biomechanical evaluation, and a full range of image-guided interventional options when appropriate — alongside evidence-based return-to-running programming. I welcome direct physician-to-physician consultation.
PERSPECTIVE
A Note on Consistency Over Intensity
We live in a culture that rewards extremes — extreme diets, extreme training programs, extreme transformation timelines. None of that is how healthy, durable fitness actually works. The athletes and active adults I see who sustain their fitness into their fifties, sixties, and beyond are not the ones who trained the hardest in their thirties. They are the ones who trained consistently, recovered intelligently, and respected the signals their bodies sent them before those signals became injuries. Running is one of the great democratizing forms of exercise — it requires no gym, no equipment beyond a decent pair of shoes, and no coach to begin. What it does require is patience and discipline applied over time. You do not need to be extreme this year. You need to be consistent. The body rewards that approach more reliably than any other.
DISCLOSURE & REFERENCES
This article is for educational purposes and reflects clinical experience and interpretation of published literature. It is not a substitute for individualized medical evaluation. Key references: Scharhag-Rosenberger et al. (running adaptation and mitochondrial biogenesis); Nielsen et al. 2014 (10% rule and injury prevention, BJSM); van Gent et al. 2007 (running injury incidence and risk factors, BJSM); Malisoux et al. 2015 (footwear and injury risk, AJSM).
ABOUT THE AUTHOR
Dr. Mahajer is a double board-certified physiatrist and sports medicine physician, fellowship-trained in Interventional Spine & Sports Medicine at the Icahn School of Medicine at Mount Sinai. He is an Assistant Professor of Neuroscience at FIU Herbert Wertheim College of Medicine. He is the Immediate Past President of the American Osteopathic College of Physical Medicine and Rehabilitation (AOCPMR), holds medical licenses in Florida, New York, and California, and has been recognized as a Top Physiatrist and Top Doctor in both Florida and New York.
