Ask the Physical Therapist: Running a Marathon and Customized Workouts

The following is a transcript of a question-and-answer session, conducted over the FSH Society’s Facebook page, with Julie Hershberg, PT, DPT, NCS. Hershberg is a physical therapist who is a Board Certified Neurologic Specialist.  She practices at [re+active] physical therapy & wellness and is an instructor in Doctor of Physical Therapy program at USC.

I am a 48-year-old man who is asymptomatic. I am still fairly active. Prior to my genetic diagnosis of being positive for FSHD in 2011, I ran two NYC marathons in 2008 and 2009. I am thinking about running another one next year or the year after at a slower pace than I did six years ago. I ran a sub 4:15 in those, and this one would probably be somewhere between 5 and 5.5 hours.

Do you foresee any issues or have any concerns if I take up this endeavor? If not, what precautions could or should I take prior to and during the training for the race?

Awesome! I think this is an excellent goal! My advice is to proceed with awareness and just an ounce more of caution with your training in general. I would say the same thing to anyone who has not run for a while. Something in particular to think about is that while you may not be aware of any symptoms right now, there may be very subtle areas of weakness or tightness that can predispose you to injury (this is true of the general population). This video, put out by the American Physical Therapy Association, is an excellent resource for things to consider when returning to running:…/VideoLibrary/detail.aspx.

I highly recommend a running analysis by a PT (including high-speed camera 2D video analysis) to help identify areas of strength and areas that can be optimized.

There also is a free e-book from the APTA on tips for healthy running:

Some great nuggets of information from that e-book that I think you may want to consider: “Recovery time isn’t a break from training; it is part of it. Runners, particularly those at the Master’s (40+) level, can consider taking recovery time every third week instead of every fourth week during a marathon training program. Consider using cross training, such as the elliptical or bike, to substitute for recovery runs to give your legs a break. This allows you to rest your legs while remaining on track for a successful race.”

I would like to know what type of exercise I can do at the gym. My trainer gave me a good program, but i would like to have your opinion so that I’ll be able to ask my trainer to do a specific program for me.One thing that is very important for me is to continue training at least twice a week. Plus, I’m doing 30 to 40 minutes of bicycling twice a week.

It sounds like you have an awesome routine and commitment to your health and wellness—I applaud you for that! I work with people and their trainers all the time to customize their routines. I am not able to prescribe a specific routine for you andyour trainer without knowing you, but I would recommend that you work with a PT who can create an individualized routine for you to carry out with your trainer. When I do this, I create videos and take pictures of clients doing the exercises so they can share this with the trainer—I highly recommend that for you if that is possible. Also, I highly recommend that the trainer pay close attention to your movement as you do the exercises—always quality before quantity. Finally, I recommend a very thorough assessment and training routine that includes key areas such as scapular and shoulder strength, abdominals (deep abdominals and back muscles—not just crunches or sit-ups), hip strength (especially gluts), and knee and lower leg strength. In general, I am a proponent of functional strengthening done in upright positions (doing as much as you can while standing or sitting) and in many planes (not just straight up and down but rotation and diagonals).


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