The first marathon runner, Pheidippides, may have died of exhaustion but more than 860,000 people still registered to take part in the London Marathon last year.
When Pheidippides reportedly ran from Marathon to Athens to announce victory over the Persians in 490 BC, he had no idea that he had started a major trend. But perhaps we should pay more attention to his sad death, as this is an endurance event even though more and more people are willing to take up the challenge.
I experienced this myself in 2018, running the hottest London Marathon to date in temperatures of 24C. Race day was exhilarating, even though I had only trained for 21 miles and was relying on adrenaline for the last five miles. I finished it in a decent amount of time and raised money for a good cause, but the impact told a different story: the prolonged pain and fatigue took a toll on my 47-year-old body that took a long time to recover. When I get back to running, I choose shorter, more manageable distances like a 5k park run on softer terrain. However, for many others, completing a marathon is just the beginning, fueling efforts to take on greater endurance challenges. Be careful though, the achievements, sense of accomplishment and medals full of medals can be fatal.
The most common injury pitfalls
According to a recent survey of 7,600 runners, 84% of first-time marathon runners experienced a running injury during training. A separate study – which tracked more than 1,000 marathon runners – found that the prevalence of overuse injuries nearly tripled as training progressed, and peaked in the final quarter of training. Dominic Rae, Chief Sports Medicine and Performance Specialist at Ten Percent Club, said the final weeks were when the most avoidable damage occurred.
“The runners had been working for months and they were so close they ignored the signals,” Dominic said. “An interruption becomes an injury. A missed window of nutrition becomes a ‘wall’ at mile 18. The runners who get injured at this stage are often those who have trained the hardest.”
Another common mistake new runners make is underestimating the cumulative load of marathon training relative to the event itself. “Many beginner runners focus too much on completing long distance runs, but neglect to plan adequate training and recovery,” warns Dominic. A common problem is increasing mileage too quickly, which significantly increases the risk of injury, usually tendon injury due to overuse.
All sports have risks, of course, but road running is associated with quite a heavy load on the joints (especially running on pavement). “From a musculoskeletal perspective, repetitive high-impact loads without adequate strength or adequate recovery can lead to chronic tendon problems, joint changes, or even stress fractures,” adds Dominic. This is often the result of asking the body to do more than it can tolerate and adapt to.
Health problems you didn’t expect
Joint pain, tendon strains, and muscle tears are the types of injuries you may experience from running long distances on hard surfaces. But there are other risks that are more hidden and unexpected.
“The hormonal and metabolic consequences need to be considered, especially in chronically under-fueled and under-recovered individuals,” added Dominic. “Relative Energy Deficiency in Sport (RED-S) is increasingly recognized to occur in endurance athletes and can impact bone health and immune function, which will impact overall performance.”
Although heart-pumping, circulation-boosting exercise like running generally improves heart health, endurance distances like marathons and ultramarathons (usually 50k/31 miles or more) may carry a low and temporary risk of sudden cardiac death, some studies show. However, this is most likely to occur if there is a pre-existing condition or undiagnosed coronary artery disease. “Cardiac examinations, such as an EKG or echocardiogram, may also be necessary for high-level training,” advises Dominic. “Especially for those who have a family history of heart problems.” Experts warn that runners should be on the lookout for a gradual decline in performance or increased effort at the same pace – which are signs of fatigue. “Changes in resting heart rate, heart rate variability, or sleep may also signal chronic fatigue or systemic stress,” adds Dominic. “It’s important to keep an eye on these things.”
Using empty or inappropriate fuel can also cause long-term health problems, according to Professor James Fleming, Associate Head of Nutrition at St Mary’s University London. “Without adequate periodization and planning, the body will have difficulty adapting, and you may be more susceptible to injury. This is also about supporting the body by encouraging training and recovery. Think about what we eat after training as well as before, as the body will only get better after being given good nutrition and adequate rest (including the quality and quantity of sleep) and recovery.”
How to avoid risks
It is possible to reap the benefits of marathon running and prevent some of the potential long-term side effects of resistance training with the right amount of pre-planning and post-run recovery movement. “One area where novice marathon runners make mistakes is not giving themselves enough time to train,” emphasizes Lewis Moses, head coach at RunThrough (runthrough.co.uk). “Starting training earlier than January if you are running a marathon in April, getting ahead of the game and building a foundation over long distances is much better and reduces the risk of injury as you gradually increase the distance on your legs and your body adapts comfortably.”
So, as long as you do moderate amounts of activity and with proper conditioning and recovery, running can improve bone health, according to some studies. Lewis says many runners make the mistake of ignoring strength training for fear of gaining weight. Dominic agreed to this. “Targeted loading on key areas, such as the calf muscles, quadriceps, and posterior chain, using exercises such as squats, lunges, bridges, and hip hinges will build lower body strength in muscles and bones.”
Simple nutritional choices can also help protect and strengthen your bones if you continue to run long distances. “Nutrients such as calcium and vitamin D are key to bone health,” emphasizes Karine Patel, sports dietitian at Dietitian Fit. But they don’t work alone. “Vitamin K, magnesium, and protein all play a role in keeping bones strong and resilient. I always encourage people to focus on balanced whole foods. Green vegetables like broccoli and kale, dairy products, whole grains, nuts, and oily fish are all great choices. For those following a plant-based diet, fortified foods also help fill nutritional gaps.”
Stay strong, eat well and monitor your heart, and you’ll make great strides toward reaping the rewards of running without finishing like Pheidippides did.
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