As we approach the start of the 2012 Los Angeles Marathon on March 18th. We want to take a moment to wish each and every participant a safe and healthy marathon experience.
Enjoy the moment that is marathon racing and do your best. Rest assured as the race approaches that your training will serve you well on race day. Know, that with each marathon it is estimated that each runner will take between 25,000 and 30,000 steps (1). It is always better and safer to take more than not enough we recommend to strive for 180 foot contacts per minute. With each step ground reaction forces up through the runners kinetic chain from the ankle to the hips and lower back increase by several times the individuals body weight. (2) With this being stated, it is a given that many of the participants in the marathon this Sunday will experience some type of pain or discomfort or may even experience an injury following the race. This is especially true of those who are completing there first marathon. Just know that unfortunately, this may be “par for the course” so to speak as each individual race concludes. Common injuries following, and often leading up to, a marathon include: anterior knee pain, Illio-Tibial Band ITB syndrome, Achilles Tendonopathy, Plantar Fasciitis, and Pain in the Lumbo-Pelvic Complex of the low back. Not to mention the usual muscle aches and pains you will encounter and the increase in blisters, especially when it is wet (given the upcoming forecast). Apply more Vaseline/skin lube in the toes, heel, arm pits, or where there is repeated friction.
With anterior knee pain, the extensor mechanism (quadriceps tendon and inferior patellar tendon) are commonly injured due to its function in absorbing eccentric force which is basically the shock absorption portion of gait or when your foot lands on each stride. As much as 42% of ground reaction forces are absorbed here. The knee also spends an increased amount of time in a flexed position which also increases stressors placed on the knee. (1) While running allows the knee to flex slightly but comfortably to absorb force but not too flexed.
Injury to the Illio-Tibial Band is thought to be caused by increase friction to the distal aspect of the tendon as it inserts onto the lateral aspect of the patella (knee cap) and deep fascial attachments to the lateral aspect of the knee joint. With the knee spending an increased amount of time in the flexed position there is the greater potential of there being valgus (lateral or outward forces on the knee) through the knee and therefore producing friction leaving the ITB more susceptible to injury (3) Try to minimize the side-side movement of the pelvis as you run.
Achilles tendon injures occur due to increased peak force at the mid-stance aspect of running rather than at heel strike which was once believed to be the cause of injury. Therefore with the repetitive contraction of the gastroc-soleus (calf) complex rather than the shock absorbing created during running may lead to potential injury at the Achilles tendon. (1) Make sure you stretch it out well each day and before the race with the knee bent and straight. A foot flat contact will also mitigate the forces required on the calf but will increase the load to the hamstring so be aware of that too.
The plantar fascia acts to absorb and store elastic potential energy. Peak stress on the plantar fascia occurs in mid-stance phase of foot contact to the ground and pronation moments at the foot increase stressors to the medial or inside aspect of the foot predisposing the tissue to repetitive stress injury. Make sure you rotate your shoes and don’t use a brand new or old pair for the race.
The Lumbo-Pelvic Junction or low back injury may result from the disposition of the runners torso as one runs longer distances. With the increase in distance correct running form and technique succumbs to fatigue causing a greater flexion (or forward bending at the waist)moment at the torso therefore increasing stressors and increased muscle activity on the low back. If you lean forward in gait be sure that it comes from the ankle and not the hip or waist.
With each of these potential injuries there is a cause and effect relationship. Increased running distances produce increased demands on contractile and non-contractile structures of the lower extremities. Areas of muscular weakness and improper biomechanical function are exposed and repetitive stress injuries may develop. If you need to increase the number or time of walk breaks then do it to reduce the effects of fatigue. Remember to run your race which is the pace you trained at. Many people are very excited at the start and blast out of the gait reaching mile 5 and feeling exhausted because they went too fast.
Effective post race management should include the R.I.C.E principle of rest, ice, compression, and elevation of the injured body part as possible. If injures persist following your race a consultation with a physical therapist is advisable to identify the biomechanical cause of your symptoms and effectively treat your injury so that you may heal get stronger become educated and start to think of you next race. Remember we will be at the Double Tree after the race to help manage any of these possible problems.
From all of us at Paulseth and Associates Physical Therapy have a wonderful race day!!