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Proper Training Minimizes Marathon Related Injuries

New York (Dec 1, 2011)

If you were inspired by this year's New York City Marathon – and it's surely one of the most entertaining and uplifting events in a city filled with inspiration – and you're thinking about joining 45,000 plus fellow athletes at the starting line next November, it's not too soon to put together a training plan. A well-considered plan is key to preventing the variety of injuries that runners can develop, explained physiatrists Christopher J. Visco, M.D., and C. David Lin, M.D.

"Good preparation and adequate training for a marathon are far and away the best preventative measures against injury," Dr. Visco said. And good preparation includes a focus on parts of a training regimen that may not be obvious: proper nutrition and hydration, and temperature regulation. It's in these areas that the most common recovery problems for marathoners and other endurance athletes develop, according to Dr. Visco.

C. David Lin, M.D.
C. David Lin, M.D.

Inexperienced runners may believe they should carry a water bottle or two on their runs, and stop at every water station during a race, said Dr. Visco, because there's such a widespread emphasis on preventing dehydration. But when slower-paced athletes take frequent water breaks they may overload on fluids and develop hyponatremia, or low blood sodium. "This increasingly common complication of marathoners can lead to a number of significant problems starting with a change of consciousness, and possibly to seizures and death in the most severe cases," said Dr. Visco.

To avoid hyponatremia, runners should follow a simple strategy: "They should drink to satisfy their thirst and no more," Dr. Visco said. Sports drinks, which contain around 6% carbohydrate, are both good hydrators and prevent depletion of the liver's energy stores, "allowing you to run farther without fatigue," he said.

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Another common problem for runners is hyperthermia, which they're more likely to develop when it's above 65 degrees or very, very humid outside, Dr. Visco said. "Hyperthermia can take effect rather quickly, and once it does thermoregulation is more and more difficult. If you've only trained in cool-weather areas, it's much more difficult to deal with a warm November day." How much fluid runners need in warm weather is very individualized, he added. "That's where training comes into play. With experience you get used to how much fluid you need when you're really thirsty, and when you should replace fluids."

Because running is a high-impact activity, runners often develop repetitive stress injuries, said Dr. Lin. "These are common in people who over-train and don't listen to their bodies. When injured runners continue to train, the injury will get more inflamed and they'll have even more pain." An important preventive measure is a proper warm up and stretch before running, Dr. Lin said.

Christopher J. Visco, M.D.
Christopher J. Visco, M.D.

One of the repetitive stress-related injuries many runners develop is shin splints, "shin pain from the repeated pounding on the ground. It's related to periosteal reaction, a fancy word for inflammation of the covering around the bone," explained Dr. Lin. Shin splints can evolve from an improper running style, poor biomechanics, or hyperpronation – flat feet, he said. "Once you have some shin splint pain and keep on running through it, you'll eventually develop something more catastrophic like an outright fracture," so it's important to take a break and give the area time to heal, he added. Dr. Visco mentioned it's best to seek out a physiatrist if pain worsens or persists for several days.

Other common injuries are plantar fasciitis, inflammation of the big fibrous band at the bottom of the foot, and inflammation of the Achilles tendon and "we see a lot of runners who develop patellofemoral pain syndrome – knee pain – and sometimes iliotibial band syndrome, tightness in the big band on the side of the thigh that goes all the way down to the knee, which can also cause pain in the knees."

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Both Drs. Lin and Visco recommend a recovery approach for acute injuries with the acronym PRICE: P for protecting the injured areas from reinjury, R for relative rest during which you stop training for a few days to let things heal. I is for ice for the first few days after an acute injury. C is for compression, to prevent swelling. And E is for elevation to decrease swelling in the affected limb.

Depending on the injury physiatrists might recommend physical therapy, a brace, or orthotics. Occasionally, anti-inflammatory medications may be prescribed to assist with recovery. Runners may consider altering their training regimen to include recovery time.

Given the range of preventable injuries, would-be marathoners should plan ahead and ramp up gradually to the event, said Dr. Lin. "Some people want to just jump in and run the marathon without a lot of preparation, but you really need to dedicate at least four months to training."

Contributing faculty for this article:

Christopher J. Visco, M.D., is an Assistant Attending Physiatrist at NewYork-Presbyterian/Columbia University Medical Center and an Assistant Professor of Clinical Rehabilitation Medicine at Columbia University College of Physicians and Surgeons.

C. David Lin, M.D., is an Associate Attending Physiatrist at NewYork-Presbyterian/Weill Cornell Medical Center and an Associate Professor of Clinical Rehabilitation Medicine at Weill Cornell Medical College.

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