26.2 Tips from the Race Medical Director
26.2 TIPS TO HELP STAY INJURY FREE WHILE TRAINING (AND RECOVERING) FROM A MARATHON
By Dr. Perry Julien, DPM, CO-Medical Director of the ING Georgia Marathon & Half Marathon
The marathon distance was once only in the domain of experienced long distance runners. Now, thousands of runners complete this coveted distance in marathons all over the world. Although now a “common running distance”, 26.2 miles still needs to be respected. These tips were designed to help keep you on the road as you train to reach this goal.
1. START WITH A REALISTIC TRAINING SCHEDULE. There are several great marathon training programs in Atlanta. If you are a first (or 50th) time marathoner these groups will help establish a proper training program for you based on your goals and current fitness level. These groups will also provide you with running partners to train with.
2. CONSIDER CUTTING BACK ON OTHER COMPETITIVE SPORTS AND FITNESS ACTIVITIES AS YOU INCREASE YOUR MILEAGE AND GET CLOSER TO MARATHON DAY. Playing 3 sets of tennis after an 18 mile run can lead to overuse injuries due to the muscular fatigue that occurs after a long run.
3. DECREASE LOWER EXTREMITY WEIGHT TRAINING A COUPLE OF MONTHS BEFORE YOUR MARATHON. Your legs require muscles that are not fatigued to help absorb the impact that running place on them.
4. INCORPORATE SOME CROSS TRAINING INTO YOUR MARATHON PROGRAM. Low impact activities such as cycling, swimming, and hiking can help maintain your aerobic base and increase your strength while placing less impact on your body.
5. MAKE SURE YOU HAVE THE APPROPRIATE RUNNING SHOES FOR YOUR FOOT TYPE AND RUNNING STYLE. An experienced athletic shoe fitter or sports medicine podiatrist can help ensure you are running with the proper shoes.
6. PROPER SHOE FIT IS EXTREMELY IMPORTANT. When purchasing new running shoes try them on later in the day or after a run as your foot tends to swell slightly. Use your own running socks to try shoes on with to make certain the sock doesn’t affect the fit. Allow at least 3/8 inch between your longest toe and the end of the shoe. Use the size only as a reference point. Even shoes within the same company may vary in size from model to model.
7. REPLACE YOUR SHOES EVERY 300 TO 500 MILES (ABOUT 4 MONTHS). Fifteen percent of overuse running injuries can often be attributed to one’s footwear. Replacing worn out shoes is one way to help avoid injury.
8. KEEP YOUR TOENAILS HEALTHY. Bruised toenails are an occupational hazard that comes from distance running. You can help prevent black toenails by ensuring proper shoe fit (most black toenails are caused by shoes that are to small), and making sure you trim your nails before long runs and especially before your marathon.
9. USE ACRYLIC BLEND SOCKS. These provide excellent wicking and can help prevent blisters.
10. TRY YOUR BEST TO PREVENT BLISTERS. If you have a tendency to form blisters try different types of socks or a small amount of Vaseline or blister lubricant over any hot spots. Anticipate these hot spots by running a few long runs in the shoes and socks you plan to use during your marathon.
11. SO WHAT DO YOU DO IF YOU GET A BLISTER? The proper way to treat a blister is to drain the fluid from underneath. To do this first cleanse the skin with some form of antiseptic. Next, using a sterile pin make one or two small holes in the skin overlying the blister. Gently push out the fluid, cleanse the skin once again, and apply a protective dressing. Don’t peel off the skin as this acts as a barrier against infection. If the area becomes red or more painful after a few days contact your physician.
12. CHOOSE YOUR RACE DAY RUNNING SHOES AND SOCKS A COUPLE OF WEEKS BEFORE YOUR RACE. Make sure you take them out for a test run to make sure there are no rough seams or fit problems that could cause a problem 20 miles into your race.
13. ALLOW TIME TO WARM UP AND COOL DOWN DURING YOUR TRAINING RUNS.
14. DEVELOP AND MAINTAIN GOOD STRETCHING HABITS. Tight calf muscles can directly or indirectly contribute to various overuse injuries such as Achilles tendonitis, plantar fasciitis, and shin pain. Stretching should be done on a gradual, consistent basis, placing emphasis on the muscle be stretched rather than the tendon.
15. ICE IS NICE. Purchase a bag of frozen peas or corn. These work well as an ice pack for early treatment of injuries or muscle/tendon soreness. When icing an injured area the ice should be applied no more than 15 or 20 minutes but can be repeated several times a day. A bag of peas can mold to most body parts and is reusable. (just don’t eat the peas after they’ve been defrosted a few times)
16. RECOGNIZE THE EARLY SYMPTOMS OF PLANTAR FASCIITIS. Pain on the bottom of the heel that occurs when getting up after sitting or lying down is often caused by plantar fasciitis, which is probably the most common overuse running injury. The pain often feels like a stone bruise and in its’ early stages will often go away after a few steps. Self-treatment includes applying ice, using some form of arch support, and stretching your calf muscles.
17. AVOID DEVELOPING ACHILLE’S TENDONITIS. The Achilles’ tendon is the strongest tendon in the lower leg, but has a poor blood supply making it slow to heal. Stretching the calf muscle will help both prevent and treat Achilles problems, but avoid trying to stretch the tendon itself as that will tend to keep the tendon irritated.
18. TRY TO STAY CLEAR OF THE DREADED ITBS (ILIOTIBIAL BAND SYNDROME). ITBS is caused by irritation to a fibrous band that attaches to the outside of the knee. It is often caused by worn out shoes or over-striding, especially when running downhill. This injury can often be prevented by slowing down slightly or shortening your running stride when running downhill during your training runs.
19. RECOGNIZE THE SYMPTOMS OF STRESS FRACTURES. Stress fractures are essentially overuse injuries occurring to the bone. Unfortunately bone injuries can take 6 weeks to 6 months to heal and this injury could keep you from starting your marathon. Stress fractures often occur in the lower portion of the leg and the metatarsal bones on the top of the foot. The pain is usually well localized and increases with activity. There may also be slight swelling and bruising. Increasing your running mileage gradually and maintaining good nutrition can help minimize the chance of developing a stress fracture. If you think you have this injury see a sports medicine physician as soon as possible.
20. GET TO KNOW A MASSAGE THERAPIST. Sports massage therapy has many benefits, not only in treating certain soft tissue injuries, but also in helping to prevent overuse problems that may develop in your training. Check with your running group, local running club, or your sports medicine physician for recommendations.
21. STAY HYDRATED. Adequate water intake (at least 6 glasses per day) is essential not only to avoid dehydration and heat illness, but also for muscle flexibility. Your muscles contain a large percentage of water, and low water volume can lead to muscle tightness and inflexibility, which in turn could lead to injury. Make sure however that you don’t over-hydrate and deplete your electrolytes. Balancing your water intake with electrolyte replacement drinks such as PowerAde or Gatorade can help prevent this.
22. USE ANTI-INFLAMMATORIES CAREFULLY. The use of ibuprofen and other anti-inflammatory medication can help reduce the pain associated with minor overuse injuries. However, if you need to take high doses of these medications to get through a run you should try to determine and treat the cause of the pain instead of masking it. Always take these drugs on a full stomach and with plenty of water to help prevent side effects.
23. LISTEN TO YOUR BODY. If you have had an exceptionally hard day at work or have been on your feet excessively you should consider reducing your evening running mileage that day. Most marathon training programs have a certain amount of latitude built in. Use a rest day if you need it.
24. IT IS BETTER TO BE SLIGHTLY UNDER-TRAINED THAN INJURED AT THE STARTING LINE. You will not lose a tremendous amount of fitness if you have to take some time off to allow an injury to heal or for other reasons (travel, work, son or daughter’s soccer games). If you are trying to heal an injury quickly, avoiding the impact stress of running will help accelerate the recovery process. Try pool running or cycling to keep fit without the pounding.
25. WHEN SHOULD YOU SEE A PHYSICIAN? Any time you have an injury that is not improving after 7-10 days despite your best efforts; an injury that is geeing worse; or one that reoccurs, you should see a ports medicine physician familiar with running injuries.
26. TAKE IT EASY FOR A COUPLE OF WEEKS AFTER YOUR RACE. Although you may have the urge to go out and run a P.R. the week after your marathon, remember your body needs recovery time after a strenuous event such as running 26.2 miles. Keep your fitness with low impact exercise such as walking, pool running, and cycling.
.2. BE CAREFUL HOW QUICKLY YOU SAY “NEVER AGAIN”. The marathon distance is a tremendous accomplishment whether you run a 2:08 or a 6:08. Many runners that initially claim “this is my first and last”, end up retracting their promise after a few days of recovery and begin planning and training for their next 26.2 mile adventure.
Perry H. Julien, D.P.M. is a podiatrist specializing in sports medicine at The Atlanta Foot and Center in Sandy Springs, Georgia. Dr. Julien has run 20 marathons and is the co-medical director of the ING Atlanta Marathon and Half-Marathon. He is past president of the American Academy of Podiatric Sports Medicine and the author of Sure Footing – A Sports Podiatrist’s Perspective on Running and Exercise Related Injuries.
