The Health Effects of Marathons and Ultras on our Bodies

There are a lot of training plans for marathon and ultramarathon training. These plans work because they are devised by experienced trainers and runners who know what a person has to do to complete a long distance race. The plans, though, have one weakness: they don't take into account reduction of our health through possible damage to our bodies caused by the running of long distances.

Scientists are beginning to investigate the effects of long distance running on our bodies. Scientific tests are being performed to investigate particular aspects of this issue, and other aspects of this issue are ignored in those tests. This means that an individual scientific test doesn't give the full story about the issue. It is, therefore, necessary that all scientific tests be studied to give one a better understanding of what is actually happening.

This page was created to give my thoughts about and our health. Keep in mind that I'm not a scientist or a doctor, and my thoughts may be naive. Also, I'm sure that tests have been conducted that aren't described in this page, and I will appreciate having links to such tests emailed to me.

 

Amount of Training Prior to a Marathon

The Boston Globe, in an article dated April 17, 2006, reported on the effect of training prior to a marathon on the cardiactic health of the runners. The conclusion of the tests was expressed by Dr. Malissa Wood, a cardiologist and codirector of the Massachusetts General Hospital Women's Cardiovascular Health Center. Dr. Wood is a runner and has completed four marathons.

Among marathon runners, the biggest cardiac risk seems to arise in people who train the least. People who worked up to a marathon by running at least 45 miles a week for at least three to four months ''were golden. They didn't get into any trouble at all," said Wood. ''If they trained less than 35 miles a week, they were in big trouble."

The article summarized the effect of marathon running on our bodies.

As for marathoners, Wood and her Mass. General colleagues have found that running 26.2 miles can lead to clear signs of cardiac stress. They have found that cardiac troponin, a chemical that shows up in blood tests only when heart muscle is damaged, rises in 60 percent of runners, and in some, it rises so high that ''if you had just looked at these scores, these people would have been admitted to the hospital for heart attacks," Wood said.

They've found that another chemical, BNP, or brain natriuretic peptide, another red flag for cardiac dysfunction, goes up after a marathon in 60 percent of runners. Platelets also become activated and more likely to form the clots that can trigger heart attacks, according to a just-published paper by Siegel and Alexander Kratz, director of the hematology lab at Mass. General. And, as shown on echocardiograms, the heart's ability to relax after each beat remains impaired for at least several weeks in most marathoners.

Age of the Marathoners

In an article dated August 31, 2010, ScienceDaily reported on tests conducted on older marathoners (average age of 50) who were not elite runners.

Immediately after finishing the marathon, there were some significant changes of the parameters of diastolic and right heart function. However, even though these changes were statistically significant, they were all within the normal levels and therefore do not seem to be clinically relevant. All parameters had returned to normal two weeks later, and the most likely cause of the changes were tachycardia and dehydration during the race. Also, for some runners, there was an increase in certain myocardial biomarkers but no correlation could be drawn between this increase and any myocardial dysfunction. It is believed that the temporary increase was probably caused by functional changes of the cardiomyocytes while running and not by myocardial damage.

The article concluded by stating

As a result of this study, it would appear that elderly amateur runners can continue to compete in marathon races without increasing their risk of sustained heart damage.

Heart Damage May Be Temporary

The study referred to above about the age of runners was a study of runners completing the 2006 and 2007 Berlin marathons. As indicated in the quote given above, the symptoms of heart damage were gone two weeks later.

The October 25, 2010 issue of ScienceDaily reported on MRI tests of runners completing marathons. The MRI tests allowed doctors to look at individual segments of the hearts. The tests showed that damage does occur to hearts. Runners who wern't properly trained for their marathons had more damage to their hearts, but the damage was temporary.

His research found that the magnitude of abnormal heart segments was more widespread and significant in a group of less fit runners. During the marathon, they had signs the heart might be at greater risk of damage than that of runners who had better training or at least had better exercise capacity.

His research found that the magnitude of abnormal heart segments was more widespread and significant in a group of less fit runners. During the marathon, they had signs the heart might be at greater risk of damage than that of runners who had better training or at least had better exercise capacity.
"Without proper training, marathon running can damage your heart. Fortunately the exercise-induced injury is reversible over time," said Dr. Larose. "But it could take up to three months to completely recover."

Canadian researchers found that marathons may cause damage to our hearts, but that damage is likely temporary and reversible. However, we need to do long-distance LSD enough that we become "fit" runners.

Investigators who studied a group of recreational marathon runners have established that strenuous exercise such as running a marathon can damage the heart muscle. Although they found the effect is temporary and reversible, they warn that these effects are more widespread in less fit distance runners and that recreational distance runners should prepare properly before marathons. Their findings are published in the October [2013] issue of the Canadian Journal of Cardiology.

Another Look at Marathons and Ultramarathons

The New York Times reported that British researchers have learned that half of the older elite athletes who were tested and who trained hard have scarring within their heart tissue. The tests were performed with a new type of MRI.

The results, published online a few weeks ago in The Journal of Applied Physiology, were rather disquieting. None of the younger athletes or the older nonathletes had fibrosis in their hearts. But half of the older lifelong athletes showed some heart muscle scarring. The affected men were, in each case, those who’d trained the longest and hardest. Spending more years exercising strenuously or completing more marathon or ultramarathon races was, in this study, associated with a greater likelihood of heart damage.

The Times article also reported on tests made on laboratory rats that showed that prolonged running by the rats did cause scarring of their hearts.

The rats had begun their regimens with perfectly normal hearts. At the end of the training period, heart scans showed that most of the rodents had developed diffuse scarring and some structural changes, similar to the changes seen in the human endurance athletes. A control group of unexercised rats had developed no such remodeling of their hearts. The researchers also could manually induce arrhythmias, or disruptions of the heart’s natural electrical rhythm, much more readily in the running rats than in the unexercised animals. Interestingly, when the animals stopped running, their hearts returned to normal within eight weeks. Most of the fibrosis and other apparent damage disappeared.

Not only runners are affected by long distances. Long-distance skiers have similar effects.

Dr Andersen said the study was important because, although there have been other studies looking at the effects of endurance exercise on various cardiovascular problems such as ischemic heart disease and stroke, there have been only a few, smaller studies of its effect on heart rhythm disturbances, and they have tended to look at people who are less physically active, or compared very sedentary people with those who were very active.

Most runners aren't in the elite group that was the subject of the research, and the concluding paragraphs of the Times article may serve as a guide for us.

So for now, the best response to the emerging science of excessive exercise is to just keep exercising, but with a low-level buzz of caution. If your heart occasionally races, which could indicate arrhythmia, or otherwise draws attention to itself, Dr. Nattel said, consult a doctor.

But if you exercise regularly and currently have no symptoms, “I think it’s safe to say that you should keep it up,” Dr. Thompson said.

A Word of Caution

I found the following paper on the web that discusses the effect of endurance exercise on the heart. The paper is titled, The endurance athletes heart: acute stress and chronic adaptation. The paper, itself, is too complex for me to understand, but the Conclusion was written in terms that I could understand.

It is, however, entirely likely that for the vast majority of endurance athletes, the stress of acute exercise will lead to healthy, physiological adaptation in the heart. For a very small minority, though, there is emerging evidence that endurance exercise may be part of a patho-physiological cascade that clinicians must be aware of and respond appropriately too.

Since none of us know if we're in the "vast majority" or the "very small minority" of endurance athletes, it would be wise for persons considering running a marathon to have a good health examination before they begin marathon training. If they're already in marathon training, it might be wise for them to push their marathon plans out a few months and do significantly more long distance runs before the race, and to provide time for a good health examination prior to the race.

Ultra-Endurance Running

ScienceDaily, in an article dated August 31, 2010 reported on the cardiac effects of running 50 and 100 miles in difficult conditions, including hills, thunderstorms, and strong rain. The athletes had trained for that distance, and all athletes had been running marathons and ultras for over two years. The athletes had no known heart problems. The article described the results of the testing.

The ECGs at the start of the race displayed the typical features of an athletic heart, with the slow heart rate and electrical changes commonly seen in athletes. At the finish, there were significant electrical changes in over 50 percent of the ECGs, and in some there were bizarre electrical changes not commonly seen in normal ECGs, either at rest or during exercise. However, the changes in cardiac Troponin I did not correlate with specific electrical changes on the ECGs. Further data, to be presented at EUROECHO later this year, will show that baseline heart function was normal, but there was a 6 percent drop in heart function at the finish, which may also be relevant. Whether these changes reflect undiagnosed cardiac conditions was undetermined.

The following statement by Professor John Somauroo of the Countess of Chester Hospital concludes the article.

"This study suggests that running continuously over 50 or 100 miles may not be good for the heart. 96 percent of the finishers developed a significant increase in cardiac Troponin I, which can be an indicator of heart muscle damage -- and 12 percent showed signs suggestive of significant cardiac damage. They also developed significant electrical changes on their ECGs and, in some cases, quite bizarre changes. However, there was no proven correlation between the changes in cardiac Troponin I and the ECG changes."

Read the full article in the link given below for more details about adverse effects of extreme workouts.

"Physical exercise, though not a drug, possesses many traits of a powerful pharmacologic agent. A routine of daily physical activity can be highly effective for prevention and treatment of many diseases, including coronary heart disease, hypertension, heart failure, and obesity," says lead author James H. O'Keefe, MD, of Saint Luke's Hospital of Kansas City, MO. "However, as with any pharmacologic agent, a safe upper dose limit potentially exists, beyond which the adverse effects of physical exercise, such as musculoskeletal trauma and cardiovascular stress, may outweigh its benefits."

The Duration of a Race

Fifteen runners completing an ultra event that lasted from 5 to 7 days were tested for cardiac fatigue, and none was found.

If cardiac muscle were to respond in the same way as skeletal muscle, the expectation would be for lower contraction velocities after exercise. However, the results of the study show that this was not the case. It is worth noting that these results are not consistent with other studies of endurance events such as marathons or triathlons. The researchers believe that this may be because average intensity was relatively low despite competitors exercising for extended durations that averaged 150 hours. Therefore, a possible conclusion may be that it is exercise intensity rather than exercise duration that is the primary source for cardiac fatigue.

Some Marathoners Die

Even though most marathoners recover from the heart-damage of their marathons, a few runners have died during the race or shortly thereafter. There is speculation that those runners may not have been able to handle the stress of the damage.

A new study finds that marathon runners experience temporary heart damage during their 26.2 mile (42.2 kilometer) races. The damage is reversible, but it may be one reason that seemingly healthy people sometimes die during long races.

However, researchers at Harvard University discovered that deaths in runners usually occurred in persons who had previous, underlying damage to their hearts.

Other Effects Besides the Heart

In addition to studying effects of distance running on the heart, scientists are looking at possible effects on other organs. A report was recently issued about possible buildup of liquid in the lungs of marathon runners. Keep in mind that only 26 runners at one marathon were tested.

Lead author, Dr Gerald Zavorsky from the Marywood University, USA, said: "Marathon running is linked to an increased risk of pulmonary edema, and it seems that women are at higher risk than men regardless of marathon finishing time. While pulmonary edema can be a negative consequence of marathon running, regular exercise can also keep you fit and healthy. We do not yet know the impact of this finding on long-term health of runners."

One effect on our health of distance running that has received little attention is the effect on our bladders. 

"The added stress on the body that comes with running a marathon can cause urinary stress incontinence problems during the race or down the road," said Melinda Abernethy, MD, fellow, Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Chicago Stritch School of Medicine. "People who already suffer from incontinence also are at risk for bladder-control issues while running."

Dr. Abernethy admits that more research needs to be conducted on bladder-control, but she says "that runners should monitor their fluid intake and go to the bathroom at least every few hours during a marathon".

The Big Picture

As I read these articles, I'm beginning to see what seems to me to be the "big picture" of the effect of long distance running on our bodies, particularly on our hearts. Here is a summary of my understanding of this.

• Run at least 45 miles per week for several weeks prior to a marathon.
  
• Be aware that irregularities in your heart may occur right after a marathon, but those irregularities will likely return to normal within two or three weeks after the race. However, some runners may not recover from the damage.
  
• Older runners can run marathons without permanent damage (assuming, of course, they have properly trained for the marathon distance, and have been cleared by their doctor to run marathons).
• Use caution in deciding to run ultras. The effect of ultras on your heart is more severe than the effect of marathons.
• Use caution in the intensity of your training. Heart damage may occur in older runners who have run marathons and ultras for many years and have trained hard for those races.

Using Strength Training to Avoid Injuries

The following post is by guest author Brett Warren, a biochemical research scientist based in Boston. He puts his expertise to work on a daily basis by developing sports supplements for Force Factor.

All athletes -- not just runners -- have a favorite form of exercise. But focusing on just one type of motion tends to cause some muscle groups to become stronger (and tighter) at the expense of other muscle groups -- leading to injuries. Cross training, by lifting weights for added strength or doing yoga to increase flexibility, can not only add variety to a workout routine, but also make workouts safer by preventing overuse injuries.

Some runners argue that the weight they add by bulking up with more muscle will slow them down when they are running, but nothing could be farther from the truth. In fact, increasing muscle strength will add power to each step, more than making up for the additional muscle weight that you will be carrying around. You will run more efficiently and with better form as a result of strength training. In fact, a University of Alabama study showed that marathon runners who included ten weeks of strength training in their pre-marathon regimens shaved 20-24 minutes off their total time, improving their speeds by eight to ten percent. Moreover, strength training gives you a cross-training activity to use on the days when you are taking time off from running so that your muscles can recover. You are cycling running days off into your training schedule, right? It's important to do so, because when you run or engage in any kind of exercise, your muscles develop microtears that need about 24 hours to recover. While they are recovering, though, you don't need to be on bed rest -- you can be training in other ways.

 

Muscle Groups

Here are just a few muscle groups, commonly overlooked by runners, that can benefit from strength training:

• Core muscles. The core muscles in your abdomen and back support the stomach, back, hips, and pelvis. Strengthening these muscles improves the alignment of your pelvis when you are running -- in other words, strong core muscles can improve your running form, giving you better economy of movement and making you a faster runner. If your pelvis is not aligned properly during a run -- if you are running inefficiently and with poor body mechanics and poor posture -- you are more likely to injure your hamstrings, develop low back pain, or have Achilles problems. Sit-ups and other crunch variations can help you to improve your core strength, but ONLY if you do them with good form, making sure to pull your navel in toward your spine as you sit up, without holding your breath. You can also strengthen your core muscles with Pilates or even with certain yoga poses (such as bridge, boat, or plank). Tai chi can improve your pelvic alignment. Push-ups are an excellent core exercise. You can also improve core strength by working with a stability ball, balance ball, medicine ball, or balance board.
   
• Glutes. During running, the gluteal muscles hold the pelvis steady, keeping the pelvis, torso, and legs in good alignment. When glutes are weak, runners are prone to developing shin splints, runner's knee, Achilles tendonitis, and injuries to the iliotibial-band. To work your glutes, you can start with traditional squats, but you might want to also branch out to lunges, quadruped hip extensions, step ups, four-way hip extensions, and a one-legged squat. If you're into yoga, try chair, warrior one or two, floating stick (which is also good for your core), half-moon, or crescent pose.
   
• Leg muscles. Do runners really overlook their leg muscles? No, but we tend to assume the legs are already covered by a running routine. However, strength training can build those muscles more, adding power to each stride and helping to preserve a range of leg motion beyond the motion that is used to take each step during a run. Fortunately, many glute exercises, such as squats and lunges, will also work your leg muscles.

 

Protect Yourself with Strength Training

As you train, have good form, balancing opposing muscle groups, and using a schedule that keeps your training regular but also allows for periods of rest and recovery. If possible, get advice from a personal trainer so that you can customize your strength building regime, and the amount of weight you use, to your particular goals. Moreover, a personal trainer can explain how to use the machines in your local gym to add weight to your strength training regimen, which gives you a way to make your training even harder as your body gets used to working with its own weight (as it does when you do squats, Pilates, yoga, and the like). You can add weights without using machines, though, by holding dumbbells in your hands while you do certain exercises -- but get some advice from a trainer to be sure that your form and body mechanics are right on target. No need to injure yourself with the injury prevention plan!

Protect yourself from injuries with strength training, and keep in mind that building muscle has another benefit as well -- as you increase the percentage of muscle in your body, you also increase the calories that you burn. It's a win-win situation -- just like running. Otherwise, you're likely to become what Tom Holland at Active.com calls an "accidental triathlete" -- someone who starts swimming and biking after being sidelined by a running injury.

Monitoring Your Wakeup Heart Rate

Whether we run for competition or for enjoyment (or both), we want to improve as runners or walkers. However, our hopes for improvement are often dashed on the rocks of injury. Some injuries may only set us back a few days of rest. Other injuries may set us back for weeks or months of no running while our bodies heal themselves. We need to recognize that our bodies are wonderful machines but they have limits. We need to recognize that our running or walking puts stress on our bodies, and if our bodies can't handle the stress, injury will likely occur. To solve this problem, we need to understand the signs that our bodies are nearing the "break-down" points where they will be overcome by stress.

 

Heart Rate

Fortunately, our bodies give indications about their health, and if we monitor those signals, we can know within a reasonable assurance how well our bodies are functioning. One of those signals is how fast our hearts are pumping blood, or our heart rate. Our hearts pump blood to all parts of our bodies. One of the prime things carried in the blood is oxygen. If our bodies need more oxygen, our hearts beat faster. If they need less oxygen, our hearts slow down. Heart rates are unique with each person, but typical values are around 70 beats per minute. Athletes usually have lower heart beats or rates. Older persons may have faster heart rates. By measuring our heart rates each day, we can get an idea of how hard our hearts are working.

My Procedure for Measuring Wakeup Heart Rate

Here is the procedure I use to measure my WHR. I wake up and walk into the bathroom and shut the door and turn on the light. If I stay in bed to measure my WHR, the light may wake up my wife. My walking into the bathroom causes my heart rate to increase, so I sit quietly for a minute or so to let my heart rate begin to come down. Then I put my fingers (don't use your thumb) on a pressure point and count the heart beats for one minute. I use the pressure point where the top of my ear connects to my head. Usually, my heart rate is still decreasing, so I repeat the measurements for as many times as needed until my heart rate reaches a more or less steady value. For example, the other day my first reading of my heart rate was 59. Subsequent readings gave 59, 58, 57, 56, 55, 56, 56, 55. My WHR began at 59 and decreased to 55 and 56, where it repeated those values. I thus took 55 as my value for my WHR. I felt pretty good during my stretches and situps, and I went running.

My Actual Heart Rates

I've measured my wakeup heart (WHR) rate for most of my running career, and I have a good understanding of how my heart behaves as my body receives stress. Below is a graph I made of my heart rate over a 14-month period. The graph has two plots. The blue plot is of the actual values of my WHR, and the red plot is a 7-day average of the WHR that smooths out the plot of the actual values but still shows the overall movements of the WHR.

First, notice that the actual values vary from day to day, indicating that my body needs more or less oxygen on a day-by-day basis. These variations could be caused by colds, insufficient sleep, hard physical activities such as running, mowing lawns, etc. Also notice that sometimes the actual values are above the red line and other times the actual values are below the red line. This comparison of the two lines shows how my heart was currently functioning relative to the past 7 days. At times my heart was more tired and at times less tired than it was during the past week.

The spike in the actual values shows how the heart behaves from the stress of an auto accident and three weeks of my being in an induced coma caused by drugs. High stress and a saturation of my body with drugs sent my heart into a very fast mode of operation, and my heart took an awfully long time to recover from the drugs.

Interpreting Wakeup Heart Rate

When I get up on a day that I will be running, I measure my WHR and decide if I will go running or go back to bed. The following table gives the conditions or algorithm that I use to make that decision.

Less than normal	Go running
Less than normal + 10%	Go running
Greater than normal + 20%	Abort the run for that day

Of course as my WHR approaches or leaves +10% or +20%, I have to make a judgment call. I use my energy level to help me make judgment calls. Do I feel energetic or do I feel tired? Do I have a cold? Am I still tired from a heavy workout the day before? My normal WHR is 50, and the two numbers that I look for when I measure my WHR are 55 and 60. If my WHR is higher that 60, my body is tired and my heart is working 20% more than it usually does, and I may abort my run to give my body extra rest.

As I mentioned above, I've measured my WHR for many years, and, at least for me, WHR is a good indication of my body being tired or not. However WHR is a static test: my body is at rest. When I do my situps, my body is in motion, and I've found that my energy level during those situps is an even better indication of the condition of my body because it is a dynamic test. Thus, I use both parameters, WHR and energy level during my situps, to help me make my decision about running that day.

Some runners will run regardless of how they feel, because their schedule calls for a run that day, or because they are afraid they will lose conditioning if they don't run. These runners are being foolish, because if they feel tired, their WHR is elevated, and their body is already not handling stress; if they do run, they are giving even more stress to their bodies. This means they are on a path to injury, although that injury may not come for weeks or months. That injury may not come at all if they recognize their bodies need rest, and they give their bodies additional rest.

Injuries From Running

Running creates stress and is thus destructive. Our bodies respond to the stress by strengthening themselves. However, this strengthening does not occur during the running; it occurs during rest after the running. Thus, to prevent injuries, we must have sufficient rest that our bodies can strengthen themselves and eliminate the stress. If we don't have sufficient rest, residues of stress remain and accumulate, and eventually this stress will cause injuries. Many running injuries can be avoided if we have sufficient rest, if we keep our training within the capabilities of our bodies to handle stress, and if we stretch to strengthen our muscles. For suggestions on preventing injuries, see my page Preventing Injury (see link in left-bar).

In this section, I am giving descriptions of common running injuries; the descriptions are paraphrases from The Runners Repair Manual, by Dr. Murray F. Weisenfeld, and from various web sites. Because that book is copyrighted and is still being sold, I will not give the stretch exercises and treatment that Weisenfeld recommends for the injuries. The book can be purchased for less than $11 at Amazon.

RICE

The RICE procedure can be used for several days after an injury to reduce swelling, to control pain, and to promote healing.

R - Rest
I - Ice
C - Compression
E - Elevation

Rest to allow your body to begin the healing process. Stop all activities that cause pain.

Ice for 15 or 20 minutes at a time during the first 24 - 48 hours after the injury; keep a cloth between the ice and your skin. Icing helps reduce swelling.

Compress the injured muscles with an elastic bandage. This helps reduce swelling.

Elevate the injury area to increase blood circulation. Raise the injured part above the heart. Increased blood circulation helps increase healing.

Meditation

Running injuries come from stress, and this site gives traditional ways of reducing the stress. In addition, there are alternative ways of reducing stress. One alternative is meditation. The National Institutes of Health has a center for alternative medicine, and the NIH page for that center gives a good introduction to mediation. In addition, the University of Wisconsin has reported that meditation changes the brain and helps persons to have more compassion and empathy towards others.

Anatomical terms

If you're like me and aren't familiar with anatomical terms, refer to Arnold's Glossary of Anatomy.


Common Running Injuries
The folks at smoothfitness.com have created a graphic that illustrates the common injuries that runners experience. Here is the introductory paragraph from that site, followed by the graphic.

Despite all its benefits, running isn’t without risk. Every year, 36 million people in the United States run, and 40% to 50% of them suffer at least one running injury. It’s not uncommon for a runner to trip and fall, sustaining cuts and scrapes, and sometimes even broken bones. And if you don’t wear the right shoes, you can get some pretty nasty blisters. But the more common running injuries are those that come from running itself.
Your body is like any piece of machinery. The more you use it, the more wear and tear it endures, and that wear sometimes manifests as injuries. The more often and the longer distance you run, the higher the probability you’ll suffer a running injury. You also become more susceptible to running injuries as you age. Even kids suffer running injuries at a rate of about 16,000 per year. In addition, it’s not just outdoor runners who get injured. Running on a treadmill requires just as much care and preparation to avoid running injuries.
This diagram shows some of the most common running injuries, how to treat them, and how to avoid them altogether. If you do suffer a running injury, there are alternative exercises you can do with other fitness accessories while you recover. The most important thing to remember is, if your running injury is serious, don’t hesitate to see a doctor. Better to have it treated immediately than have it become a chronic condition that impairs your running forever.

Click on the image to see a larger view.

 

Sports Injuries
Here are great pages that give in-depth reviews of sports injuries.

http://www.niams.nih.gov/Health_Info/Sports_Injuries/default.asp
http://www.startlocal.com.au/articles/educational_footinjury.html 
http://mytopfitness.com/index.php/2016/07/23/running-injuries/

----------

Preventing Injury While Running

Many persons become injured while running, jogging, or walking. These injuries could probably be prevented if the persons observed a few simple "rules" in their running. In this page I will refer to "running", but that word could refer to "jogging" or "walking" as well as "running".

Listen to your Body

A phrase that one hears quite often in conversations about running is "Listen to your Body". By that phrase, people mean that your body will signal you when it is receiving more stress than it can handle. And, it is, after all, stress that causes your body to break down and become injured. Your body uses soreness and pain as signs that you're doing too much in your running and that you need to give your body more rest. Think of it this way: pain is not a natural condition of your body. If you have abnormal soreness or pain in your body, something has happened to cause that soreness or pain. You may be running too fast or too far. You may have the wrong shoes, causing your body to experience abnormal stresses. You may not be getting enough rest. My page on Overtraining (see left-margin bar) has a nice list of symptoms that may occur when you're doing too much. Study that list, because you'll probably experience some of those symptoms from time to time. When you do experience the symptoms, try to understand what you're doing wrong, and then change your training such that your body isn't stressed out and the symptoms disappear.

Get Enough Rest

When you have a run that puts heavy stress on your body (a "heavy" run), cells in your body are damaged. Running is actually destructive to your body. Your body needs time to repair that damage, and it can't do the repair if you continue to subject your body to heavy stress. You must give your body timeto repair the damaged cells. In fact, your body needs at least 48 hours after a "heavy" run before you have another "heavy" run. That is, the day after the "heavy" run should be a day of light stress or a "light" run. This "light" day could be a day with a shorter and/or slower run, a day of light cross training, such as swimming or walking, or a day of rest with no physical activity other than normal activities. In the running literature, this kind of schedule is known as "heavy/light" running.

In addition to "heavy/light" running, you must get sufficient rest during your sleeping hours. Staying up late or partying or watching late-night TV are not conducive to good running. As my mother used to say, "Go to bed and get up with the chickens."

Smaller Increases in Distance and Speed

Pretend you enter a building and want to go to the 54th floor. Also pretend the building has no elevator. You have a choice. Do you want to walk up the stairs one step at a time, or do you want to take two or three steps at a time. If you decide to take more than one step at a time, you'll probably do OK for a few minutes, but you likely won't make it to the 54th floor without stopping to recover and then resorting to doing one step at a time. On the other hand, if you decide to do one step at a time from the beginning, you'll probably still have a struggle reaching the 54th floor, but you'll likely feel a lot better when you do reach that floor. Running is that way. You want to run a longer distance at a faster speed. You have a choice. You can make relatively big increases in distance and speed, or you can make small increases in distance and speed. In either case you'll be subjecting your body to increased stress because you're asking your body to do more. But, doing smaller increases will put less stress on your body, and your body will be better able to adjust to the new stress. The running literature refers to this as the "10% rule", whereby you keep increases in distance and speed to 10% or less. The number "10" isn't a magic number; it is just a typical number. Some runners can handle more than 10% and other runners must have less than 10%. My experience has been that this number varies day by day and week by week as your body-conditions change. But, the principle is the same for everyone: make relatively small changes in your distance and speed. Doing this means you'll probably need more time to reach your distance/speed goals, but you'll do so with significantly less risk of injury. And, if you do become injured, it may be a long time before you reach your goals

Stretch, Stretch, Stretch

During running, your muscles tighten and get shorter, and it is important to stretch them to loosen then and return their length to their normal size. It is also important to make muscles stronger by stretching. Some people stretch before running, others stretch after running, while others (including me) stretch at both times. Be careful, though, because stretching if done wrong or overdone can cause injury. Here are my comments about stretching and pictures of the stretches I do.

Use of the Correct Type of Shoes

Using wrong shoes is one of the main causes of injury. This presents a dilemma because most of us don't know how to choose the correct shoes for our feet. Do you have a high arch? A medium arch? A low arch or flat feet? Do you pronate and if so, how much? Do you supinate? What kind of roads or trails will you be running on? These are some of the questions that must be answered if you are to get the correct shoes for your feet. So, if you're like most runners, you need professional help.

Go to a specialized running store to buy your first pair of shoes. I'm not referring to the mall-type of shoe store, but to a store that specializes in running apparel. Go to a store that has trained personnel who will watch you walk and, hopefully, watch you jog on a tread mill. Many of these stores will video tape you on the mill so they can use the tape to show you what your feet are doing. After the person understands your feet, he or she can recommend the correct type of shoe. Once you've found a shoe that works for you, stick with it as long as it is available. When you run, your body is subjected to a force that is 2-3 times your body weight, and your feet, ankles, legs, knees, and thighs take the brunt of that force. Thus, your shoes should cushion the shock of running to protect your body from the full effect of that force.

Unfortunately, as you run miles and miles and miles, the materials in your shoes compress, and your shoes provide less protection to your body. This means that you'll eventually have to replace your shoes. Shoe manufacturers and runners typically expect a pair of shoes to provide good cushioning for about 500 miles before they need to be replaced. My shoe page (see left-margin bar) gives more details about choosing running shoes.

Have Good Nutrition

Food is the fuel used by your body. Like a car that runs out of gas and stops, if your body runs out of energy, your running will slow and maybe stop. As your food is digested, it is converted to energy that is stored in the cells, and to fat. When you run, the energy propels your body, and if the cells have insufficient energy, you body will attempt to burn fat to obtain energy. However, the burning of fat is a less efficient way of getting energy, and you are better off having sufficient energy in your cells. You do this by eating nutritious foods in sufficient quantities. Typically, a runners diet should consist of about 65% carbohydrates, especially complex carbs like whole grains, fruits, and vegetables, 20% protein, and 15% fat. Those numbers are approximations, and different authors will give different numbers. Here is an article that discusses nutrition.

Develop Total Body Strength

Running develops the muscles in the lower part of your body, but it doesn't do much for the upper part of your body. By lifting weights as a cross-training (see left-margin bar), you can develop the muscles in the upper part of your body. Be careful, though, because injury can happen if you try to lift too much weight. And, you don't want big, bulging muscles since you are a runner not a weight lifter. You want strong but slim muscles that will enhance your running. Click here (see left margin bar) for suggestions to develop total body strength.

Not Running in Areas & Times of Day That Could Be Dangerous

We've been talking about factors that are under your control, but there are other factors that are not under your control that could lead to injury. Specifically, I'm thinking of the time of day or night that you run and the areas where you run. When possible, choose times that have reduced traffic, especially traffic from drivers that have been drinking, and times in which you can see and be seen by the drivers. Choose areas that are relatively safe, and if you must run in areas that have a higher risk, try and do so with groups of runners. I have a friend who was going to nursing school at Columbia University in New York City. She had to walk to work at midnight. I asked her if there was much risk of her being attacked, and she said, "no", because she always walked with groups of people. She completed her schooling without being attacked, so I guess she was right.

Training Appropriately for your Body

Some runners feel insecure in planning their running, and they try to follow a training plan they got from a book, web site, or another runner. In many cases, that plan is not appropriate for their body, and they end up pushing themselves too hard and become injured. They need to listen to their body and back off in their training if they body signals them that the body can't handle that level of intensity in running. And, they need to learn to adapt their plan to fit their body.

Change of Attitude

Many runners have been sedentary, and they are excited about being able to run, and in many cases excited to be loosing significant weight. They want to run faster and farther, and they push themselves to exceed their previous accomplishments in running. They push themselves beyond the capabilities of their body, and they become injured. To avoid injury, they need to understand and accept the fact that their bodies have limits in the amount of physical activity they can participate in at any point in time, and they need to slow down their rate of physical activity to be compatible with the limits of their body.

Another attitude that concerns me is that runners run but don't walk. I hear beginning runners talk about wanting to increase their distance and speed so they can run for a whole mile with walking. It's as if walking was a stigma that they were trying to avoid. It's true that as a runner develops body-strength and endurance, the need for walking declines, but it is also true that short walking breaks mixed with stints of running will conserve energy and allow the runner to go farther. The breaks reduce the intensity of the run and give the muscles used in running a change-of-pace. So, I hope that runners will consider walking breaks a friend that they can embrace while they are developing the endurance and strength to go it alone.

Respect Your Genes

I've know runners who seem to always be suffering from injuries. As much as they can, they do the "right" things to avoid injury, but they are still injured. I have no scientific evidence for my opinion, but I think they must have a body that is genetically susceptible to being injured from the stress of running. On the other hand, I've known of runners who do dumb things and are not injured. I'm in this latter group. I've only had one injury in my decades of running even though I do dumb things. The latest dumb thing that I've done was my wearing stability shoes for 20 years when I should have been wearing neutral shoes (I supinate). Back in the 80s, while I was in marathon training, I did a really dumb thing -- I wore my shoes for about 1200 miles. When they started to feel like I was running on a board, I would replace them. I'll never know why I wasn't injured (I was running 45 miles per week), but I'm grateful I wasn't. I now replace my shoes every 500 miles.

If you find yourself being injured again and again even though you do the "right" things, consider the possibility that running may not be "right" for your body and that maybe you should consider other ways of being physically active, such as walking, cycling, or swimming.

Make Running a Positive Part of Your Life

Many runners become so enthused about running, that it is hard for them to keep a balance in their lives about their sport. It is important that we run, and it is important that we enjoy it, but, it is not good if we become so obsessed with running that we overdo our training or hurt our relationships with others. This means that we must adjust our schedules and our behavior so we get sufficient rest between runs and so our family and friends won't think that running is more important to us than their relationships with us. My page on addiction (see left-margin bar) discusses becoming positively addicted to running.

Summary of Avoiding Injuries

The following graphic summarizes the major steps to avoid injuries. Click the image for a larger view.

Foot Problems

Here is a nice review of common foot problems. Click the image for a readable view.

Created by Dr. Comfort.

Achilles Tendinitis

The Achilles tendon is a cord that connects the heel to the calf muscle. If either a short calf muscle or a heel that is too far away from the calf muscle pulls too much on the Achilles tendon, you'll feel a lot of pain. Dr. Murray Weisenfeld, in his book The Runner's Repair Manual, suggests using your thumb and forefinger to pinch along the Achilles tendon, starting at the heel and working up the back of your leg to the calf. If you feel swelling and/or pain, you have Achilles Tendinitis. 

Runners with Achilles Tendinitis need extra lift in the back of the shoe. Start with 1/4 inch heel lifts and work up to more thickness if necessary. Also, be sure your shoes are flexible at the ball of the foot.

Before and after you run, do a lot of wall pushups to stretch your calves. Do knee presses and foot on chair or table to stretch your hamstrings. Do squats to stretch your Achilles tendons. When you first get Achilles Tendinitis, take a few days off from running until the pain subsides.

Go to http://www.achillestendon.com/default.asp for detailed information about Achilles tendonitis.

Here is a video on treatment of Achilles Tendinitis. Click the video after it has finished to go to youtube for links to other videos about Achilles Tendinitis.

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

Bursitis From Running

Dr.Murray Weisenfeld in The Runner's Repair Manual, gives treatment for two kinds of bursitis.

 

Anterior Metatarsal

Anterior metatarsal is pain between the toes and the point where they connect to the foot (metatarsal head). The pain is not an injury to the toes. "You're coming down too hard on that area." You can feel the pain by feeling between the toes and the metatarsal head. The problem can be caused by shoes and by foot imbalance. Dr. Weisenfeld, explains in his book how padding can be added to your shoes, and he gives an exercise to strengthen your toes.

The cure is to put padding behind the heads of the metatarsals. This puts some cushioning around the hetatarsal heads, so you won't be slamming down on them so hard.

Where should you put the cushioning? Bend your toes back and press till you find the spots that hurt. Now tape the padding behind those spots. (Behind, meaning in the direction of the heel.)

Another way to take pressure off the metatarsal heads is to lower your heels. If you're a woman, stop wearing high heels until the pain clears up. (The Runner's Repair Manual, p. 106)

Weisenfeld made additional comments about padding that I haven't given due to the book being copyrighted.

 

Inferior Calcaneal

Bursitis and heel spurs "usually occur together, and the treatment for them is exactly the same." Weisenfeld devotes several pages to heel spurs, and if you're having pain on the bottom of your foot, you would be well advised to get his book and read his discussion, especially since he says that you probably can't solve the problem yourself and will likely need treatment from a podiatrist. He suggests you try his "home treatment" suggestions before going to a podiatrist.

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

Buttock Injuries From Running

There are a number of injuries that can cause pain in the buttock and upper leg. They are typically caused by overtraining or by running on slippery surfaces

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

Groin Pull From Running

Groin Pull is pain in the upper inner thigh or abductor muscle , and it comes from tensing the inner thigh muscle when you turn your toe in. Turning your toe in is normal in running, especially when you run after rain or snow. The inner thigh muscle tenses up to increase stability. People who have improper balance may tense this muscle. Shoes with flared heals make the problem worse.

Dr. Murray Weisenfeld, in his book The Runner's Repair Manual, gives several stretches that will help you avoid a groin pull. These are illustrated in my page of pictures of stretches. Do the toe press and the inner/outer thigh.

According to Weisenfeld, if the pain moves from the upper groin area to the lower groin area, you may have an ischeal fracture of the pelvis, and you should see an orthopedist. In addition to the suggestions given by Weisenfeld, go to the Sports Injury Bulletin Groin Injuries and Groin Pull and Strain web sites.

Heel Spurs From Running

Heel Spurs and Bursitis "usually occur together, and the treatment for them is exactly the same." You can tell if you have heel spurs by pressing on the front of the heel; press where the heel meets the arch, and press backward toward the back of the heel. If you feel pain, you have heel spurs. Heel spurs can be caused by running on hard surfaces, running on the balls of your feet during speed work and hills, and by excessive time spent in running.

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

ITB Injury From Running

A common injury that is due to overuse or "doing too much" is the Iliotbial Band Syndrome, commonly referred to as an ITB injury. The ITB is a thick muscle that extends from the hip to the outside of the knee. This muscle helps to stabilize the knee and to rotate the foot during heel/foot strike and toe-off. The ITB rubs against a bone that is just above the knee and can become inflamed.

IT Band injuries can have several causes, including the following.

• Increasing mileage too quickly

• Running too fast for the current body condition

• Running on roads with a curvature or crown such that the same leg is always on the outside of the road

• Insufficient stretching of the IT Band and hip-related muscles

• Excessive pronation and not wearing proper shoes

Treatment does not involve surgery. It does involve physical therapy, flexibility and strengthening stretches for the hip and knees, getting proper shoes or orthotics, rest from running, and a slow, gradual return to running.

CAUTION: Do not try to run through the pain of an ITB injury!! You may make the injury worse, and it could become chronic. Here is a great article on ITB injuries.

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

Plantar Fasciitis From Running

Plantar fasciitis causes pain on the bottom of the heel (the fascia is a flexible material extending from your heel bone to your metatarsal bones to which your toes are attached). The pain usually occurs after running but not during running, although some people have pain during running. It also occurs when you first get out of bed. This injury is aggravated by running on hard surfaces, by running on the balls of your feet during speed work or hills, and by excessive time in running. If you have plantar fasciitis, you'll feel pain on your heel, usually on the inside of the heel. To test for it, press on the middle of the heel (press with your thumb upwards towards the top of your foot). With heel spurs or bursitis, you'll feel pain when you press on the front of the heel, near the arch.

Persons with low arches are susceptible to plantar fasciitis due to insufficient shock absorption. Persons with high arches are susceptible due to a tight fascia.

Dr. Gabe Mirkin suggests stretching of your calf muscles and gives other suggestions as well.

The following article was written by Jason Schultz, a treatment specialist at HeelThatPain.com and is posted with his permission.

Heel Pain Stopping You?

Many things can slow down your active lifestyle, but heel pain can definitely bring it to a stop. The most common form of heel pain in active people is known as Plantar Fasciitis (pronounced PLAN-tar fashee-EYE-tiss). It occurs when the long, flat ligament on the bottom of the foot (Plantar Fascia) stretches irregularly and develops small tears that cause the ligament to become inflamed. The pain is described as being dull aching or sharp and can be reproduced by flexing the toes upwards (dorsiflexion) and tensing the fascia.

Although the fascia is invested with countless sturdy 'cables' of connective tissue called collagen fibers, it is certainly not immune to injury. In fact, about 5 to 10 per cent of all athletic injuries are inflammations of the fascia, an incidence rate that in the United States would produce about a million cases of plantar fasciitis per year, just among runners and joggers. Basketball players, tennis players, volleyballer’s, step-aerobics participants, and dancers are also prone to plantar problems, as are non-athletic people who spend a lot of time on their feet or suddenly become active after a long period of lethargy. A recent study found that over 50 per cent of people who suffer from plantar fasciitis are on their feet nearly all day.

Plantar Fasciitis usually develops gradually. Heel pain may only occur when taking the first steps after getting out of bed or when taking the first steps after sitting for a long period of time. If the plantar fascia ligament is not rested, the inflammation and heel pain will get worse. Other conditions or aggravating factors, such as the repetitive stress of walking, standing, running, or jumping, will contribute to the inflammation and pain. In some cases, the inflamed ligament may not heal because many people who have plantar fasciitis do not completely stop the aggravating activity.

In athletes, a number of factors are associated with development of plantar fasciitis. These factors can lead the athlete to change his or her gait (the way the feet strike the ground), which can cause symptoms and injury. Risk factors for athletes include:

• Biomechanical factors, such as decreased flexibility in the foot and ankle, imbalances in muscle strength (muscles in one leg or foot are weaker than the other), abnormal foot mechanics (when stepping down), and tightness in the Achilles tendon.

• The repetitive nature of sports activities and improper training.

• Rapidly increasing the number of miles run.

• Running on steep hills.

• Wearing shoes that are worn out.

• Wearing running shoes that do not have a cushioned sole or enough arch support

• Abruptly changing the intensity or duration of the running routine.

The traditional remedies for plantar fasciitis include stretching the calf, massaging, decreasing one's training, losing weight, purchasing better-fitting shoes (with a raised heel and arch support), icing the sore heel, and taking ibuprofen.

Another treatment option, also known as one of the easiest, is using heel seats in your shoes. Heel seats pick up and re-stretch the plantar fascia, redistribute the heels natural fat pad, provide structural reinforcement to the foot, and apply acupressure to relieve the pain while your feet heal.

In any case, when you feel pain, your body is trying to warn you that something is wrong. See a doctor or specialist at the first sign of pain. Treating problems early is key to a healthy lifestyle.

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

Runner's Knee From Running

Runner's knee is a common injury. It is pain on either side of the knee, and it can happen to runners, tennis players, basketball players, etc. Dr. Murray Weisenfeld, in his book The Runner's Repair Manual, says it can happen to beginning runners, but the symptoms frequently occur when you extend your mileage. The pain may not occur until after you've completed your run, or even the next day.

Weisenfeld says you may feel the pain during the following conditions.

• Running downhill

• Walking down stairs

• Walking around after you've been sitting a while

He suggests that you take your own "running history" to understand the possible conditions in your running that might have caused the injury.

• Running on banked surfaces

• dramatic increases in mileage

• A lot of hill work

• Wrong type of shoes

If you've got runner's knee, your foot is probably built in such a way that it makes a wrong movement every time it hits the ground...This makes your shin bone move wrong and your knee move wrong. Those wrong moves are what's causing the pain.

Weisenfeld devotes seven pages to runner's knee, including short-term and long-term first aid. My stretching-picture page (see left-margin bar) includes the knee stretches recommended by Weisenfeld for runners knee (toe press, inner, outer thigh).

Runner's Knee is only one type of knee problem. Here are some links about other knee problems.

• http://www.sportsinjurybulletin.com/archive/0168-knee-injuries.htm

• http://www.medicinenet.com/script/main/art.asp?articlekey=43529

The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.

Shin Splints From Running

Shin splints are an over-use injury and are often called "too much, too soon". Shin splints are pain in front of the lower leg and are caused from overworked anterior muscles or because the calf muscles are tight and are pulling the muscles in the front of the leg. Dr. Weisenfeld, in his book The Runner's Repair Manual, explains that the front muscles are weaker than the posterior muscles and are more sensitive to stress. He explains that the front muscles aren't exercised as much by running and extra exercises are needed to strengthen them.


Weisenfeld further explains that when we run on hard surfaces and/or have shoes with insufficient padding, the front muscles may tighten up with each step to brace against the jolt and to keep the shock from spreading throughout the leg, hip, and spine. The muscles are thus overworking with every step. In addition, the front muscles may tighten up to provide additional stability to the foot. Also, over striding may cause shin splints.


The following stretches are recommended by Weisenfeld for shin splints (he has pictures to illustrate them). The stretches are illustrated in my stretching pictures page (see left-margin bar).

• Foot press

• Inner and outer thighs

• Leg lift

• Wall pushups

• Furniture lift

• Leg lifts

Here is a nice article on shin splints. Here is another article.




The information on this site is for informational purposes only; it does not constitute medical or physical therapy advice. For medical advice, consult a physician. For physical therapy advice, consult a physical therapist.