by Dr. Anthony Gallo
With the plethora of
people trying marathons for the first time and many running incredibly fast
times, it really begs the question, “How can we perform intense training while
limiting injury.” Such a quandary is laudable to say the least and I will do my
best to provide an overview.
First we need to explore
the idea of “injury.” With training in general, and with marathon training
especially, we must be constantly aware of this potential. While “injury” can
mean a great deal of things, we will focus on those injuries that are primary,
physical in nature, and limited to the lower extremity. Examples run the gamut
from sesamoid bone fractures of the foot, to Achilles tendon avulsions, and
certainly include muscle strains and ligament sprains. Some are certainly more
serious than others but all can curtail our training.
In general terms, lower
extremity injuries fit into two categories: one is overuse and the other is
accidental. I will deal with the latter first as it is the one that is least
preventable. Accidental includes trauma from a rolled ankle, bumped knee,
etc… These injuries happen regardless
of preparation. While preventable in theory, they will likely occur due to
simple chance. It is for this reason that it’s likely we all will experience an
injury at some point (sorry).
Photo cap: Anthony Gallo qualified at 5000m for the 2008 US Olympic Trials by running
13:44 and has qualified for the 2012 US Olympic Trials Marathon by running
1:04:35 at the 2009 Virginia Beach Half Marathon.
The more common and
preventable overuse injuries are due to stress. The force of running requires
great resiliency from our joints, bones, tendons, and muscles. With time, we
are able to adapt to running and strengthen these facets of motion, thus
limiting injury, but it does take time. An example here is someone who is well
trained and adapted to running, and in preparation for a marathon is quoted as,
“running 150 miles a week.” I caution the reader to take such blanket
statements with a grain of salt as this likely exceeds most runner’s threshold
of resiliency and would create the dangerous stress you want to avoid.
Prevention and limitation
of injuries can be accomplished by following some basic principles. I would say
that the most important tenant to follow would be to avoid changes in training
that are rapid and (by definition) “severe.” The best examples relate to the
mileage and quality sessions that you run. Also, while it’s fun to run with
others, sometimes your training partners are more fit than you are. If you try
to run their workout paces, or even their casual paces, it’s likely too
strenuous for your body. I would remind the reader that there is a great
satisfaction in self-accomplishment; training at your own desirable pace can
really help achieve this and limit the chance of injury. I feel compelled to
mention footwear; objectively analyze your shoes, “Do you need a new pair?”
Injuries can be
propagated by injuries. The medical literature also indicates that starting
back to running before an injury has healed puts you at a greater risk for new
injury by compounding what hasn’t healed yet. When running with an injury your
mechanics change and new stress is placed where it hasn’t been felt before.
Thus the knee pain you’re experiencing leads you to change your foot strike
which leads to new ankle pain (a simple example).
While many of us are
“concrete and asphalt bound” in our daily training, I would encourage the
athlete reading this to make time for alternate running surfaces, both outside
as well as inside. Treadmill
running is a great adjunct to outside training since it provides a flat training
surface, some cushion and is relatively safe (unless you are listening to a
cassette tape player, reading a magazine and watching TV, and yes, I have seen
the aftermath of this failed attempt at multitasking).
Cross training is a great
way to maintain cardiovascular fitness. There is a plethora of gadgets out
there that simulate running while minimizing impact. Supplementing these
contraptions for a formal run will help maintain cardiovascular fitness while
keeping lower extremity impact-related injuries at bay.
Whether it is injury that
dictates it, or if it is an elective decision to waylay injury, time off from
running can be as beneficial to your long-term running progress and enjoyment
as any workout, race, or casual run. Never fear a day of rest or cross
Let’s say you experience
pain in the knee, hip, ankle, a sore calf, limp, etc. Please, seek formal
medical advice and begin a treatment plan immediately. Remember, there are
races every weekend and of every distance. You may have to adapt your racing
schedule around an injury. This is of little consequence when considering the
potential complications of chronic injury, or of new injuries that arise while
compensating for a current injury. If this happens to you, please use it as a
learning tool and consider adding cross training (once healed) to maintain
cardiovascular fitness during normal training cycles; you may never experience
a lower extremity injury again!
If you are seeking the
best training advice, scientific in foundation and proven in practice, it can
be found in Daniels’ Running Formula. Dr. Daniels has gone to excessive lengths
to formulate the greatest approach to running and he provides phenomenal
insight into training. Following his basic principles regarding mileage and training
paces (to just touch the surface of what he discusses) will help you to train
smarter and remain injury free. His training minimizes the potential of injury
and allows the athlete to maximize potential.
After completing your
marathon it is best to rest the body. This is a great opportunity to travel the
countryside for a week or two in the town you traveled to compete in! I
recommend no less than one week without running (post marathon); your body will
thank you. Do make sure that any ailments you have acquired are dealt with
appropriately, that you don’t start running if you acquired an injury (before
it can fully heal) and finally, when you do start back, you would do best to
allow your body to reacclimatize to training and this usually means less
intensity in general, at least initially.
Anthony Gallo is
currently training at 7000 feet in Flagstaff, AZ where he recently worked at
the Coconino Health Dept. as a Medical Director. He’ll start his Radiology
residence at the Medical College of Virginia in July of this year.
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