So You Are Training for a Marathon or a Half Andrew Getzin, MD Clinical Director Cayuga Medical Center Sports Medicine and Athletic Performance www.cayugamed.org/sportsmedicine
Introduction Why Run? Training Fluids Warning signs Common injuries
Cardiovascular fitness Weight Reduction Camaraderie Mental Health Helps regulate bowel patterns Increase energy Improves sleep Increases libido Why Run?
Reduction In All Cause Mortality Myers, et al. Exercise Capacity and Mortality Among Men Referred for Exercise Testing. N Engl J Med 2002;346:793-801
Reduction In Cardiovascular Harvard Alumni Study 16,936 male alumni, 35-74 years 1 st heart attack inversely related to energy expenditure Ex-varsity athlete maintained lower risk only if they maintained level of exercise Mortality Paffenbarger, et al. Physical Activity as an Index of Heart Attack Risk in College Alumni. Am J Epidem 1978;108(3):161-175
HIV Obesity Reduction In Diseases And Hypertension Cancer Diabetes mellitus Dyslipidemia Disease Burden Osteoporosis Severson, et al. A Prospective Analysis of Physical Activity and Cancer. Am J Epidem 1989;130(3):522-529
Running Myths Stretching decreases injury Running causes arthritis You are too old to run
Why Run a Half or Full Marathon? Good to have a goal Life list Inspiring Charity Do you really need to run a marathon?
Training = exercise + rest/recovery/nutrition
100 80 % chance of setback 60 40 20 0 Training Stress
Stress Adaptation Maladaptation Individual Stress Limit Time
How Should You Feel? At times, lousy Running is difficult If you are feeling lousy before every run you are overtraining
Training Programs A great starting point You need to listen to your body Be flexible Be realistic in your goals Increase by 10%/week
10% / Week? Novice runners training for 4 mile race 8 week training program vs. 13 week graded program increasing by 10%/week 20% injury in both groups Programs very similar, intensity not controlled Buist,et al, No effect on graded training program on injury prevention. AJSM 2008;36:33-39
The Danger of an Inadequate Water Intake in Marathon Running Wyndham, 1969, SA Medical Journal Sugar s marathon x2 in 1968 20 volunteers Increased rectal temperature post race up to 105.1 and 105.6, associated with 4.3% and 4.8% water deficit Increase rectal temperatures when 3% water deficit
The ideal regimen of water drinking is to take about 300ml every 20 minutes or so. This should start right at the beginning of the race.
When you are training alone be sure to either carry fluids, stash them along your route or plan to run routes that will take you by places where you can stop at regular intervals for a drink. At group training sessions all runners must stop and drink at every water stop! It is essential that you drink plenty of fluids to stay well hydrated. Thirst is a sign that you re already dehydrated. Drink before you get thirsty!
Exercise-Associated Hyponatremia (EAH) EAH is the occurrence of hyponatremia during or up to 24 hours after prolonged physical activity and is defined by a serum or plasma sodium concentration below the normal reference range of the laboratory performing the test. For most laboratories, this is a [Na+] < 135 mmol/l
Boston Marathon 2002 Death of female runner from hyponatremia 488 blood samples from finishers 13% with hyponatremia 3 with critical values, 114, 118, 119 Strongest correlation with weight gain Almond, et al, Hyponatremia among Runners in the Boston Marathon, NEJM 2005,352,1550-1556
EAH is primarily a dilutional hyponatremia caused by an increase in total body water relative to the amount of total exchangeable Na+
What Is the Correct Amount Of Fluid? Dehydration increases the risk for hyperthermia Overhydration can cause EAH It is OK to drink as thirst dictates Approximately 400-800ml (1 large water bottle) per hour Less fluid for slower, smaller athletes exercising in mild environment Be conditioned to environment. Practice drinking in your training. LISTEN TO YOUR BODY!!! Noakes, IMDDA-AIMS Advisory statement on guidelines for fluid replacement during marathon running
NYC ½ marathon 3/21/10 Race day temperature 50 degrees Wind 5-8 miles per hour Wore shorts, baseball hat, sleeveless shirt Mild sweat throughout the race 1:25 Grabbed 2 Gatorade endurox while running and had 2 sits from each
Injury Epidemiology 40-60% of runners have 1 significant injury per year >40 miles per week correlates with an increase risk for injury 25% of runners are injured at any given time
What are Injury Warning Signs Pain that does not go away in a day Pain that is progressive Swelling I usually see people 4-8 weeks after they have increased their training
Stages of Injury Stage 1- pain after activity Stage 2- pain during activity that goes away with activity Stage 3- pain throughout activity Stage 4- pain that limits activity
Injury Prevention Keep a log Listen to your body If have a small injurydon t let it become a big one by pushing through Cross train Appropriate footwear No speed work when training for first marathon
Runner s Knee (Patellofemoral Syndrome) Anterior knee pain Pain with sitting for long periods of time Pain with stairs Popping or cracking of knee
Runner s Knee Treatment Ice NSAIDSs- Naprosyn, ibuprofen Physical therapy- working on proximal stability Cross train Brace? Tape?
Iliotibial Band Syndrome (ITB) Pain along lateral aspect of leg Can occur from hip to knee Closely related to runner s knee Exacerbated by downhill running, track running and camber of the road
ITB Treatment Ice Physical Therapyproximal strengthening, IT band flexibility NSAIDs IT band strap Injection?
Medial Tibial Stress Syndrome (MTSS)(Shin Splints) Pain along the posterior medial border of the tibia Periostitis with inflammation from pulling at muscle attachment Needs to be differentiated from stress fracture and compartment syndrome
MTSS Treatment Ice Physical therapy Nsaids Cross train Aircast?
Stress Fractures Microfracture in bone that results from repetitive physical loading below the single cycle failure threshold
Microdamage Accumulation
Wolff s Law If there exist gradual and repetitive increase in stress applied to bone, the bone will modify its molecular structure and adapt with hypertrophy
Stress Fracture Cont. Insidious onset Night pain Localized tenderness Swelling +hop test
Stress Fracture Treatment Pain free Ice Cross train Physical therapy?
Can I Run Through an Injury? What is the injury? When is the race? What are your goals for the race? What are your long term goals?
Summary It is great to run If racing, have a plan Listen to your bodythirst and injuries Don t let a small problem become a big one
Thank You