Marathoners: Prevent injuries

Over the past couple of months, a
similar scenario has transpired in my clinic a number of times. An athlete
comes in for an assessment and, during the history taking, I discover the
athlete is training for a marathon or triathlon. 

Usually, the athlete has come into
the clinic because some sort of ache or pain has progressed to the point where
it is affecting their performance or actually stopping them from training. 

Of course, my next question is,
“How long has this been going on?”  To my
surprise and dismay, when dealing with endurance athletes (athletes who run
long distances or do triathlons), the answer to this question is often greater
than three months and sometimes over a year! 

When I ask why it has taken so long
to address the pain, often the answer is, “Well…  I just thought it would go away on its

Often these athletes come into the
clinic four to six weeks before their big event. Either the peak of their
training regime has devastated their poor overused part, or they are starting
to get worried about their weakest link and how it will react to race day

The problem is, often these types
of injuries require rest in order to heal. That usually is not in the plan for
an individual who is in the last month before a marathon.

As a therapist, this is a tough
position to be in; these athletes have put in months of training every day,
eating right, getting adequate rest, participating in 5am training sessions and
staying in on the weekends. Now I have to tell them that they either have to
rest, cross train or accept that they are going to run with a potential
race-destroying injury. 

Why did this happen and how can
these athletes prevent this from occurring in the future? 

Watch for warning signs

Most of these athletes have had
some sort of warning sign for a significant period of time. Even though these
individuals were still able to participate in their select training, they were
all having pain, stiffness or tightness long before the actual injury forced
them to take a break from training. 

The lesson to be learned here is
that it is important to listen to all the little messages your body is giving
you. If you have pain, stiffness and tightness in your hamstring, for example,
and you continue to train without addressing the issue, you will eventually
strain the muscle. If you have sore shins just at the beginning of your training
runs, if you continue to train and do not address it, it will become constant
and even start to affect you when you are not training.

This does not mean you have to seek
medical attention every time you have an ache or pain. If this were the case,
all endurance athletes would constantly be seeking care.

However, if you have a muscle that
is sore and tight, you should be paying special attention to that muscle. You
should be doing proper warm-ups, stretching adequately and icing after
activity. Give yourself one to two weeks to address the issue on your own and
if you do not see any progress, then seek the advice of a professional
physiotherapist or chiropractor. 

Don’t wait until the last minute

Care certainly should not be left
until the month of your major event because, at that point, options become

Some other factors involved in the
prevention of overuse injuries in the endurance athlete include:

The 500 mile rule – Running shoes are
only good for 500 miles (800km). After that they are garbage. Personally, I write
the date on my runners the first day I wear them. I know it takes me about
three months to run 500 miles, so this helps me keep track of when to throw
them in the bin.

Cross training is integral – If you are
generally feeling achy in one specific joint or in many load bearing joints,
get off your feet. Converting a workout to a water running workout or a spin
bike workout means you can get the cardiovascular benefits without getting the
impact on your joints.

Running surface – Running on concrete
sidewalks and pavement is not easy on muscles and joints. Unfortunately, in
Cayman, as there are not really many leisure trails. However, you do have other
options to get off the hard pavement. Examples include, the golf course trails,
the beach, treadmill running and soccer fields.

The 10 per cent rule – Never increase
your weekly mileage or your long run mileage by greater than 10 per cent per
week. For example, if you are training 50 miles a week and your long run is 10
miles, the most you should do the next week is 55 miles for the week and an 11
mile long run.

Recovery runs – If you do a hard
training session with race pace intervals or tempo running, the next day must
be a recovery run (easy running, shorter distances). Doing back-to-back ‘hard
days’ is inviting injury. This becomes trickier with multi-event athletes, but
the main message is, if you do too many hard days in a row, you are asking for

Rest and nutrition – It is important for
all aspects of life. If you are having muscular or joint soreness the body
needs energy and nutrients to heal. If you rehabbing from an injury getting
over eight hours sleep per night and getting enough protein in your diet will
give you the best chance at recovery.

Keep your mobility – Muscle and joint
mobility is an important factor in a healthy athlete. Regular stretching (or
warm muscles) is an important part of staying injury free. Yoga or chiropractic
is a great way to stay as mobile as possible.

Address your aches and pains early
– Address your achy parts immediately (independently and diligently try
stretching after warm up and icing after work out). Seek guidance from a sports
medicine doctor, physiotherapist or chiropractor if your overuse aches and
pains last longer than one to two weeks, especially if they are progressively
getting worse.

I am a competitive runner and I
have not had to take more than three weeks off running in the past five years.
This is because I take care of aches and pains before they become

So, with the Cayman Islands Marathon
and the Cayman Islands Triathlon fast approaching, keep this message in mind.
When it comes to your body, be proactive not reactive!

Krissy Dooling is a physiotherapist based in the Cayman Islands.


Packed crowds of runner make their way down Natio Parkway, Sunday 1 October, 2006 in the first few miles of the 26.3 mile race.
Photo: The Oregonian

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