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Running a Marathon this Year? Advice to Minimize Injury Risk

In Brief

  • Marathon running places a great deal of stress on the body. If you are new to the sport, schedule an appointment with a sports medicine physician first to make sure there are no existing health problems.
  • Proper hydration and nutrition are essential during the training phase as well as on race day. Choose carbohydrate-rich fluids, but make sure not to “over-drink.”
  • Visit the course, do a trial run, and know where the hydration stations will be located.
  • The day of the race, eat a carbohydrate-rich breakfast two hours before race time, dress for the weather, and do light warm-up activities 15 minutes prior to the beginning of the race.
  • Some of the most common injuries that you could sustain include shin splints, stress fractures, and tendinosis — which is inflammation followed by scarring and can happen to a variety of tendons throughout the body.
  • The physicians of Crozer-Keystone’s Healthplex Sports Medicine Institute offer medical services that can help marathoners of any skill level.

Most runners will tell you that there is an almost unexplainable joy that comes along with running outdoors. Whether it is taking in nature’s beauty or just the variety of the terrain, most people who enjoy running tend to be longtime enthusiasts.

It makes sense, then, that at some point in a runner’s life they will attempt to run a marathon. Some will do a half-marathon first, others will just go for the whole 26.2 (miles, that is).

Training for a marathon is long, hard work, and is something that should be started many months — or depending on your level of fitness, years — before race day arrives.

Training and Preparation Tips

Running a marathon places significant stress on the body. If you’re new to the sport, consider visiting a sports medicine physician first. He or she can evaluate you for any preexisting medical conditions that could prevent you from running your race — such as cardiac or respiratory problems. Your doctor can even evaluate your strength and flexibility to see if any adjustments should be made to prevent injury. 

Start with the basics. Proper hydration and nutrition are critical during the training phase as well as during your trek.

“Probably the best way to address hydration is to weigh yourself before and after each run, and keep a log of how much weight is lost,” says Steven Collina, M.D., medical director of the Crozer-Keystone Sports Medicine Fellowship Program and chief of the Division of Sports Medicine for CKHS. “You also want to keep track of how much fluid you take in during the training session. The difference between how much weight is lost and how much fluid you took in can then help you on the next training session. It is okay to lose about 1-2 percent of body weight, but there is a danger in over-hydrating.

“Particularly during long endurance events, such as a marathon, athletes sometimes over-drink because they are not feeling well or because they think they need to. This dilutes out the sodium in our bloodstream and cause hyponatremia,” he continues. “I like to think of this as ‘over-hydration.’ This can be a serious problem and even lead to death if it becomes extreme. Symptoms include weight gain during the event, tight watches or rings, inability to urinate, headache, dizziness and disorientation. It needs immediate medical attention.”

As far as nutrition, Collina says that “most athletes prefer carbohydrates in their fluids — such as a sports drink — but some do not like the sugary aftertaste, so they prefer to combine water with gels, nutrition bars or sports jellybeans. Whichever you prefer, always try it out before the race. Don’t try something new, even a new flavor, on race day. After your workout or race, fluids — including carbohydrate and protein — have been shown to be beneficial. Chocolate milk or a recovery sports drink with protein and carbohydrate is recommended.”

Your training itself will probably be the most challenging part — until race time, of course — but it is also one of the most rewarding.

David Webner, M.D., co-director of the Crozer-Keystone Sports Medicine Fellowship Program and a veteran of nine marathons, advises that runners pay strict attention to strengthening the “runner’s core.”

“Many common injuries can be prevented by proper training and strengthening of the runner’s core,” he says. “For example, a person who has never run before should not train for a marathon in four months, but rather slowly build their body up through a period of long walking and then running over a 1-2 year timeframe before they are safely ready to tackle such an arduous goal. In addition, someone who has done some light running on and off should not select a training program that requires 5-6 days a week of running if they had been only doing two days a week before this. In order to attain this volume of running, one needs to slowly build up to these levels over the course of months. In many cases, some people cannot tolerate running more than every other day.”

It is important for a novice marathoner, or even an experienced runner, to meet with a sports medicine physician prior to running a marathon. In addition to the factors mentioned above, the sports medicine physician should review the marathon training schedule and make sure the athlete is not at risk for overtraining or “breaking down” even before the marathon is ever run. In marathon training, more is definitely not always better.

For the race itself, do multiple trial runs in advance. Go see the course. Drive it or try to run a portion of it just to get a feel for the land. Know where the water and electrolyte stations will be set up, as it is essential to keep yourself well-hydrated during the race (but, again, do not over-drink). 

Know what the weather will be like on the day of the race, and wear layers of clothing so that you do not overheat. When you do your practice runs, make sure to wear the same clothing that you will wear the day of the marathon.

Make sure to eat a carbohydrate-rich breakfast about two to three hours prior to race time. A bagel, sports bar or banana are good options. Stretch a little, then warm up with a bit of light jogging about 15 minutes before the race starts.

While your goal may be to just finish the marathon, take care during the training period and event itself to prevent injury. Some of the most common injuries that you could sustain include shin splints, stress fractures, and tendinosis — which is inflammation followed by scarring and can happen to a variety of tendons throughout the body.

Some injuries, such as stress fractures, can be treated with rest — which means no running — to allow the bone to heal. Others require a visit to a sports medicine physician for evaluation and treatment. “I first do a comprehensive history, including an overview of the patient’s running program, running experience and previous injuries,” Webner says. “Then I do a focused examination of the area in question. Occasionally, imaging — usually X-rays or an MRI — is needed to confirm or classify the injury further. Treatment is aimed at getting the runner back to doing what they want to do — run — as quickly and as safely as possible.” Physical therapy is also indicated for certain conditions, such as tendon injuries.

Webner and Collina advise, evaluate and treat many long-distance runners at their practice, the Healthplex Sports Medicine Institute, located adjacent to Springfield Hospital. Some of the services that they can offer novice as well as veteran marathoners include management of overuse or stress fracture injuries, video gait analysis, custom foot orthotic evaluation and prescription, tenotomy, platelet-rich plasma therapy, and much more.

For more information about the Healthplex Sports Medicine Institute or to make an appointment, call (610) 328-8810.

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