In just four short weeks, I’ll be among 40,000 people taking to London’s streets in a bid to join the 1%.
Not that 1%, obviously. No, the far more egalitarian one hundredth of the population who have run a marathon. In this case, the London Marathon. The capital’s iconic (and gruelling) challenge has come around again, its autumn date a symptom of the savage Covid hangover still clearing across the globe.
But while more than a million people worldwide complete a marathon every year, many more attempt the 26.2mile challenge – only to be thwarted by their own body (and possibly mind) saying ‘no more, this is a terrible idea’.
I was – twice – in the first two months of training, with a recurring calf strain.
However, all is rarely lost. Injuries are often part-and-parcel of the traditional 16- or 18-week training plan many follow, and don’t necessarily mean you need to hang up your number or postpone a year.
So if there’s a marathon on your horizon but a pain in your hamstring (or foot, or ankle, or calf, or shin, or knee), read on for expert advice that will keep you on the road to running glory both literally and figuratively.
What are the most common causes of injury?
You may be aiming for a killer time, but the quickest way to injury is doing too much, too fast.
‘80% of running disorders are from overuse injuries,’ says Emma Condon, advanced physiotherapist at MSK Physio. ‘This results from a mismatch between the resilience of the connective and supporting tissue and the running load.
‘Overloading injuries of the lower limb are the most common, such as inflammation of the Achilles tendon, shin splints, iliotibial band syndrome – also known as runner’s knee – anterior knee pain and ankle sprains.’
Marathon runner Ian Wilkerson, co-presenter of the Long Run podcast, sees the same issues occurring away from the physio’s table.
‘Gaining a place in a marathon is a massive thing, but it’s a long slog and that’s not just the race,’ he tells Metro.co.uk.
‘So often, people fly out of the traps in a burst of enthusiasm and push too hard, too soon.
‘Then they run too fast, which means they don’t have enough in the tank to get through what is a gruelling programme and their body eventually says “enough is enough”.
‘I’m no elite athlete but I’ll reach weekly totals of around 50 miles during a plan and your body simply won’t cope if you don’t take it easy. Of five runs a week, I would only really push myself in one of them.
‘Taking on too much, too soon, at too strong a pace is a recipe for disaster.’
How can you prevent running injuries?
‘Prevention is always better than cure,’ says Emma.
‘Poorly perfused tissues [those with less blood supply] such as ligaments, tendons and cartilage are particularly at risk because they adapt more slowly than muscles to increased use.
‘You need to build up your distance slowly to allow them to positively adapt to increased load – that’s why Couch to 5K is such a good tool.’
However, there’s so much more to preventing injury than what goes on during the running itself – something I paid pretty much zero attention to in the early days.
‘Cardio exercises are very useful for strengthening the heart and lungs, but to prevent overuse injuries, strength exercises are best as it makes the tissues more robust when dealing with loading,’ says Emma.
‘The physiological effects of strength training are very different from cardiovascular training. When muscles and joints are put under load by lifting weights you get increased muscle size. With a few strengthening sessions you get an increased firing from the brain to activate the muscles, you get increased nerve units that activate the muscle locally – leading to general improved function of the muscles generally – increased strength in the tendons, ligaments, collagen, bones and cartilage, and bone growth.’
In other words, hit the gym (or invest in some weights if you don’t have a membership).
‘Most people will need weights, not just body weight, for a workout to be classed as resistance training,’ adds Emma. ‘But building up the resilience of your muscles will allow you to do those longer runs.’
You’ve suffered an injury – what now?
In week three, during the same run to work I’d been doing for literally months, my entire left leg went into spasm. Presuming it was just a cramp I tried to walk it off, but to no avail, and it morphed into a calf strain that kept me off the roads for ten days.
A bit of rest should surely put it right again though?
Wrong. A few weeks later on a holiday in Galway the same thing happened again. Had I done any rehab or exercise other than running in between? No.
‘The best advice for if you’ve suffered an injury always has to be to seek medical opinion,’ says Ian. ‘It’s not cheap to see a physio or osteopath, but at least you know where you are.
‘The worst thing you can do is just carry on and ignore it.’
He’s not wrong, and after a trip to the physio and a week of focused exercises in the gym, I was back on track.
And the good news is, depending on the severity of the injury, running might not be off the cards altogether, says Emma.
‘There’s no one recipe when it comes to addressing running-related pain.
‘Run as much as possible if your pain is around 4 or 5 on the pain scale [where 0 equals no pain and 10 the worst imaginable] while also doing your rehab. But if it goes above a 5, stop and focus just on your recovery.
‘But key is coming to see us before it becomes a big problem.’
In the weeks following my injury, worried not about the pain but of failing to make it around the 26.2miles, I was particularly cautious not to overdo it at any time (apart from some energetic dancing at a wedding). Again however, being uber-cautious isn’t necessarily the best option.
‘There’s some research around fear avoidance,’ says Emma, ‘in that negative beliefs around injuries can impede recovery, and those who take a passive response to rehab have a worse prognosis.
‘A little bit of pain is okay and worrying less about it improves your prognosis – the psychological effects can’t be overestimated.’
Other factors including how well you’re sleeping and eating, or high stress levels, can also affect the level of pain seen in the same injury between different people.
‘Remember you don’t have to hit every single run, says Emma. ‘If you’re not feeling it one day or you haven’t slept well and you’re pushing yourself to keep up with the programme, you’re probably more likely to get an injury.’
Those missed miles may prey on the mind, but have less effect on the body than you think, and almost every marathon runner will tell you don’t try to catch up.
‘That will only make things worse,’ says Ian. ‘Plans look lovely on a spreadsheet but you will have to jiggle things around.’
But if the physio gives you a plan, stick to it.
‘Just after the Edinburgh marathon my calf went pop as I was trying to escape an aggressive goose on a towpath,’ says Ian. ‘I went to the physio who diagnosed me with a weak glute muscle, so after two weeks of exercises, I was ready to go again.
‘If a physio prescribes exercises, make sure you do them. It’s for your own benefit.’
Preach.
Top tips
- Take it slowly in your training, even if you’re behind schedule – doing too much, too fast will only lead to problems down the line.
- Don’t think marathon training is just about the miles. You need to build up full body strength to prepare your joints and muscles for the challenge ahead – and to keep good running form when you start to fatigue, another common cause of injury.
- One of the great things about running is it doesn’t require much financial outlay – but if you’re running a marathon, you will need good trainers. This doesn’t necessarily mean Kipchoge’s sub-two-hour marathon carbon fibre-plated Atomkit Alphaflys, but it does mean it’s worth getting your gait analysed (many shops will do this for free) and investing in the right shoe for you.
- The weekly long run is your friend – even if it doesn’t always feel like it! Aim to work up to three hours or 3.15 around four weeks out from raceday.
- Enjoy it! Training may temporarily take over your life, but it’ll be worth it on the day (and for the carb-loading beforehand).
When should you pull the plug?
‘If someone with medical expertise advises you that you shouldn’t do a race, it’s in your best interests not to do it, however frustrating it may seem,’ says Ian. ‘But the beauty with most races is that you can defer your place until the following year – these things happen and people understand.
‘This will apply to any charity you’re running for too, so don’t turn up to the start line if you’re struggling just because you don’t want to let anyone down.
‘If you’ve had a setback and the original date is just going to come too soon for you, don’t panic because your training may not go to waste – you may be able to pick another race a month or two after.’
Advice for first-timers
‘Remember, setbacks are totally normal and to be expected when training for such a gruelling challenge,’ says Emma. ‘But anything is achievable with the right attitude. If you can look after your mental health, sleep, and not get worried about some setbacks this will help you a lot in achieving your goal.
‘The more races you run and the more training you do, even if you don’t finish your first marathon and have to stop, you will still have achieved more in trying than not trying.’
Achievement is definitely the watch word when it comes to marathons.
‘Don’t get too wound up about what time you are going to do it in,’ says Ian. ‘It’s a long way and a massive achievement to get over the finish line, and if you go into it determined to enjoy the day then you will.
‘You shouldn’t fear the distance, but you should respect it. And, if you’ve completed your 16 or 18-week training plan, then you’ve done the hard bit.
‘Lots of people say they want to run a marathon, but only one per cent of people actually do – revel in the fact you’re going to be one of them. Wave to the crowd, high-five the kids, take in the surroundings and celebrate what you’ve done.
‘And then sign up for another one.’
I’m running the London Marathon in support of Age UK – to donate, head to my JustGiving page.
Emma Condon is an advanced physiotherapist at MSK Phsyio. Read her blog here
Ian Wilkerson is co-presenter of the Long Run podcast, produced in association with the Fordy Runs running community, an inspirational group of everyday runners which has 10,000 members on Facebook
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source https://metro.co.uk/2022/09/04/expert-advice-on-dealing-with-injury-during-marathon-training-17289484/
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