READY? SET? GO!MEDICAL ADVICE AND TIPS IN PREPARATION FOR THE CHICAGO MARATHON OCT 12, 2014

BY TERRY NICOLA, MD, MSDirector Sports Medicine and Rehabilitation at UI Health Assistant Professor, Clinical Rehabilitation Medicinein the Department of Orthopaedics at UIC

Allow your body time to condition fully to any long distance training program. Muscle development will

respond quickly over a period of months. Development of the more ‘structural’ body tissues, such as bone, ligament, and tendon will occur more slowly over a period of a year or more. You may have rapidly gained the strength and speed to run a marathon. Still respect any pain signals that develop and trim back the intensity and mileage of your program to avoid injury to these ‘structural’ elements.

Please visit an MD or DO physician in internalor family medicine for a full medical examination and

clearance to train for long distance running, even if you are an experienced runner. This is a critical factor in the prevention of severe consequences in long distance racing.

The only way to avoid overtraining is to err on the side of caution. A few training sessions in which you

feel sluggish or just slower should lead you to trim back your training program. The early warning signals of fatigue, sleep disturbance, slower running are more important as warning signals than any marathon training plan. Listen to your body first.

Ice is the first line treatment for any ache or pain. It is the safest and strongest anti-inflammation treatment

you have available. Apply to any painful or stiff joint 15 minutes, at least twice a day. AVOID ice directly to the outside of your knee if your foot or lower leg becomes numb (loss of feeling). A vital nerve passes by your knee to the foot.

Avoid the use of any anti-inflammatory medicinesbefore or during a race. There is no benefit to this

self-treatment and you may risk serious injury to your stomach and kidneys.

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The correct intake of water is very important intraining programs. It requires a balance of a) enough

fluid consumption to avoid collapse or possibly heat stroke and b) avoidance of ‘hyponatremia’ from excessive fluid intake, a water dilution that occurs to your blood sodium. The latter is a dangerous condition in runs longer than 4 hours also associated with brain swelling, collapse and occasionally death. Use a scale and weigh yourself imme-diately before and after runs (naked weight). If you have gained weight trim back your fluid consumption. If you have lost more than 1lb of weight you can increase your fluid consumption.

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Salt your foods ASSUMING that you have beenmedically cleared to do this. You will lose enough

salt on training days of an hour or longer to justify up to a teaspoon of salt added to your diet. DO NOT take salt tab-lets for possible upset to your digestive system. You may even add ¼ teaspoon of salt to a pint of water to drink before long training runs.

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Always go out and buy the next pair of shoes for almost any pain. Shoes wear out quickly, often faster

than the expected 400 miles of wear. The shoe may be de-fective or simply does not break in well. The best result will be relief; the worst is that you have two nice pairs of shoes to use after you figure out the problem.

Walking is an important training tool for runnersof all abilities. You should become comfortable with

frequent 1-minute (or longer) walks throughout your long runs to avoid injury from excessive strain to those muscles and other ‘structural elements’.

Cross-training on a stationary bicycle (or movingbicycle understanding the risks involved) is the

greatest method to continue your training when youare tired or trying to avoid those early pain signalwarnings. Ride the bicycle for slightly longer (10%)than you would have run on any given day.

Wear shoes that are clearly big enough to allow room for your growing foot due to:

1. Age2. Foot muscle development3. Swelling that occurs over long runs.

Try using soft inserts like Spenco, Sorbothane, Sofsol, or Lynco to replace the inserts that come with the

shoes for more cushion. Buy the inserts oversized and slightly trim back the front to fit the shoe a little more snug and wide.

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Use calf stretches (down) and raises (up) preferably barefoot to condition those critical muscles within

your feet. They are important and will help to also avoid pain higher up in the calf.

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To help avoid plantar fasciitis and other foot and calf problems you should:

1. 1. Massage the bottom of your feet in the long and transverse arches with your thumb or with a golf ball (gradually) avoiding painful weight on the golf ball.

2. 2. Soak your feet in a water footbath with the gradual addition of ice as tolerated for 10-15 minutes.

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Daily footwear should include comfortable squaretoe shoes that absolutely do not squish the toes.

Try adding a soft 2/3 (not full length) insert from thepharmacy foot section to gain more cushion and comfort.

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Avoid cramping of your front calf and foot tendons when lacing. Avoid lacing the top hole of the shoe to

avoid pinching of the tendons. However, lace snug to avoid slip by pulling on the laces nearest your toes then work up toward the ankle and consider adding another 1/8 of padding to the shoe’s tongue to prevent lace pinching.

Run ‘tall’ with a forward kicking stride to avoidexcessive stress to overly flexed knees, hips, pelvis,

and back.

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‘Run the line’ by running with one foot in front of the other foot such as running the line on a

neighborhood track. You want to avoid excessive left and right weight shifting and stress to structures likethe side supporting iliotibial band (ITB).

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Your hips and oblique abdominal muscles can be conditioned by ‘marching in place’ for 30 seconds

daily. Gradually progress the height and speed you can march or run in place while standing ‘tall’. AVOID PAIN and use your common sense to cut back if you are progressing too quickly.

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Use your internal sense of effort to guide how fast you should run. I recommend learning to use the

Borg 6 to 20 scale. 6 = sitting, 20 = maximum effort run. Try to train in the 12-15 range to avoid pushing your body when tired, especially on warm and sunny days.

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Consumption of complex or simple sugars (carbohydrates) should be controlled to specific

time periods on a long run or race day.

1. You should consume a few hundred calories up to Two hours before your run. Closer than that to the run and you may experience an insulin generated drop in blood sugar at the start of the run and related loss of energy.

2. Wait till you have run for at least one hour to consume more carbohydrates since research has shown that eating during your run any sooner will be of no benefit to your blood sugar level or your performance.

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Avoid any opportunity for sunburn. You shoulduse SPF 30 sun block on your longer runs. Avoid

sunbathing other than routine outdoor sun exposure. You need your unburned skin to lose excessive heat and sweat. Also avoid sitting out in the sun for long periods of time on the morning of warm weather races to deter heat exhaustion and heat stroke.

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