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Marathon training

Close to the Finish Line: How to Prevent Late-Stage Marathon Training Injuries

Marathon training is a unique adventure in its own right. While running is good for the body, running marathons isn’t. The term “hitting the wall” in marathon running is not supposed to be literal, but it feels like it. Hitting the wall means that your body has decided to shut down due to a lack of stored glycogen (sugar or energy sources in the liver and muscles).

Such activity can’t possibly be good for you so let’s not beat around the bush. Training for a marathon takes a significant toll on the body. Still, many of us, myself included, decide to push on anyway, in the hope of achieving one of life’s great achievements. Preparing for the predictable aches and pains of marathon training will go a long way toward ensuring you have as enjoyable an experience as possible.

Now that we’re in the late stages of marathon training season, the practitioners at Capitol Rehab of Arlington see a lot of marathon training-related injuries. We know that doing all this training and then coming up short would be one of the most disappointing letdowns an athlete can experience, so while we help athletes heal from injuries, our primary objective is to advise and educate athletes on ways to prevent injuries.

First, let’s look at the most common marathon-related injuries:

  1. Shin Splints: Information regarding shin splints has come a long way, even in the just the last few years. Shin splints are identified as pain along the front of the shin. The pain can be along the inside or the outside of the shin bone. The pain is caused by scar tissue formation, due to overuse along the bone.
  2. Plantar Fasciitis: Commonly associated with pain under the foot, usually close to the heel, although the pain can be anywhere under the foot, patients with plantar fasciitis frequently report that the pain is worse in the morning and gets milder as the day goes on. Runners may notice that the pain can be relieved with proper foot wear, but eventually note that the footwear stops being helpful.
  3. Runner’s Knee: The medical name for Runner’s Knee is Chondromalacia Patella or Patellar Tendinitis, but the term Chondromalacia Patella, is misleading.  It literally means “softening of the patella,” but that isn’t the case, especially in runners. Runner’s knee is the result of an imbalance between the hamstrings being overactive and the quadriceps being inactive.  The force of an overactive hamstring results in the patellar tendon being stretched, causing pain in the front and around the sides of the knee.  If this problem persists, it can result in bigger problems like stress to the meniscus and cartilage.
  4. Hip Pain. The hip joint can go largely overlooked. The ball and socket hip joint is the second most mobile joint in the human body after the shoulder. Because of its excessive movement, it can move slightly out of place, creating groin pain and/or pain along the inside of the thigh. Runners report the pain as being sharp and worsening when their foot strikes the ground.
  5. Lower Back Pain. The excessive running of marathon training requires a more stable and more functional athlete.  Strength and endurance requirements go up dramatically and so does the commitment to developing a stable core and lower spine.  The lower back is made up of a series of very small, durable joints which can shift out of place during excessive training.  Assessing proper joint movement, and maintaining lumbar stability is essential.

Tips For the Successful Marathon Runner

Athletes can — and should — take plenty of proactive measures to help themselves prevent injury. Successful marathoners, like elite runners, implement a team approach. That means they partner with a massage therapist, a chiropractor, a good running shoe company, and an Active Release Technique (ART) provider to ensure that all the elements are covered.

Consider these providers as consultants to be incorporated periodically through the training cycle.  Doing so will prevent injuries, and helps runners to avoid a prolonged period of recovery from injuries that disrupts the training schedule.

Here are some ways to prevent injuries:

  1. Get Fitted For Running Shoes by a Professional Running Company. We primarily use Pacers Running, which has stores in Washington, D.C., and Northern Virginia as well as in Princeton, N.J. We refer many of our runners to Pacers to get properly fitted with good equipment.
  2. Develop a Core Training Program. Strengthening the core will significantly reduce the frequency of lower back and hip injuries.  Additionally, strengthening the core, takes unnecessary stress off the “running muscles” of the thighs and lower legs. There are plenty of good classes and several videos on line. Pilates and yoga are also great options if time and budget allow. Runners need to master three or four essential movements in these exercise areas.  Feel free to call our office at 703-527-5492 if you’d like to receive four free videos that we recommend to all of our runners.
  3. Foam Roll. Every marathoner should own a foam roller.  The foam roller can save the legs from the negative effects of long training hours.  Additionally, foam rolling of key points like the muscles around the hips and knees will help to prevent injuries such as runner’s knee, shin splints, and lower back pain. We advise runners to use the foam roller 360 degrees around the legs.  Roll out the hamstrings, quadriceps, IT band, and calf muscles to break up scar tissue, reduce lactic acid buildup, and improve circulation.
  4. Find a Golf Ball. Use a golf ball under the sole of the feet, for a few minutes a day while sitting at your desk or watching TV. It will provide tremendous relief for plantar fasciitis, tired feet, and shin splints. Runners report that this feels sore and painful at first, but over time, golf ball rolling will improve the movement of the joints in the feet (a common cause of foot plantar fasciitis) and break up muscles soreness associated with prolonged running and training.
  5. Get in the Ice. Nobody wants to hear this, but using an ice bath will significantly reduce the inflammatory phase the body goes through when running longer distances.  Six to eight minutes should be sufficient, and athletes should try not to go much more than 10 minutes in the ice bath. Here’s a tutorial on how to do an ice bath for the best effect.
  6. Find a Massage Therapist. We recommend that marathon runners see a massage therapist one-two times a month during training and then schedule a final massage seven-10 days prior to the race, but NOT in the last 48 hours. Have the massage therapist do a deep tissue or sports massage of the legs, calves, feet, and spine. Massage therapy will help with all running injuries, especially plantar fasciitis, shin splints, and runner’s knee.
  7. Consider Orthotics. For many, improper footwear can literally add a spring to the runner’s step.  Many shoes don’t provide the support they should, and every runner’s foot is different.  An off-the-shelf orthotic is helpful for some, but for most, a custom orthotic that properly supports the foot throughout the runner’s gait, can limit the occurrence of plantar fasciitis, shin splints, knee injuries, and lower back pain.
  8. Utilize a Good Chiropractor Trained in Active Release Technique (ART). There is a reason why every NFL team and The Ironman Triathlon have ART providers on their sidelines and at their events. A chiropractor will help maintain fluid joint movement in the lower back, hips, knees, and feet.  An ART provider can treat the scar tissue formation that builds up in the feet, legs and lower body.  Scar tissue is more painful than normal tissue, it is less flexible than normal tissue and it is more likely to reinjure.  Proper assessment and treatment of the scar tissue will reduce the flare-ups of plantar fasciitis, shin splints, runner’s knee, hip flexor, tendinitis, and lower back pain. In particular, shin splints are very effectively treated using ART, and finding an ART specialist will provide tremendous relief.

If a teamwork approach works for the high-level athlete, the recreational athlete should consider doing the same. If you’re going to invest the time and effort into training for a marathon, make sure to invest in the techniques and practices that will help you to cross the finish line.

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