Injury Before Marathon

by Joe, answer by Marius

How does one deal with nagging injugies the last month before the marathon ?

"Hello, I have four weeks to go until race day for the marathon. My training has been going ok but about a month ago my hamstring started acting up. After my long run this past Sunday it has become much worse. At this point what do I do with regards to the rest of my training? Do I stop running and see if I can heal it enough to run the race? Or do I run through it and run the race with the pain? If I do stop my training program do you think running the race in a month will still be ok? I should also mention that I have already had two twenty mile long runs but have a third left this coming weekend that is in my schedule. Thanks, Joe "

Answer : Hi Joe, this is how you can solve this. I do think you'll be ok for the race, especially since you've already got those twenty milers in there !

1. Get treatment on it. Light massage is the best. Do not stretch it at all. Though stretching feels better at the time (and even the next day) it only aggrevates the hamstrings in the long run.

2. Take three days completely off training. Once you start again, do 2 easy runs of 30 minutes only before starting off any kind of interval training again. Do this session at a controlled effort only.

3. Cut down on all the really long runs now before the marathon (max 1:30 to 2 hrs) , but keep the interval training going (but "run controlled" !)

This together should get to ready well in time for the marathon. Also consider some Magnesium supplements and Omega 3 to reduce muscular tension and take some of the small inflammation away there.

Good luck !

Kind regards,

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Knee pain and marathon training

by Marco
(Leiden, The Netherlands)

What to do if you experience knee pain and you are marathon training ?

"Hi Marius,

Yesterday I run my first half marathon, I'm quite satisfied by my time 2.03.06 (I aimed to do in less of 2 hours, but last 6 weeks I didn't train as I'd have liked....).

Anyway, today my left knee (the right one less) is quite painful on the extranal side (in particular when going down from the stairs).

I think it could be the "famous" runner's knee (quite disapponted indeed), but I've experienced this issue ONLY and ALWAYS after the long runs (>2hr) and a running friend (middle distance runner) told me that it can be caused also by the small/limited knee movement/extention during the run and he's suggested me to try to run faster with big legs movements for 2-5 minutes.

Since I'm very constant on the pace (let's say incredibly constant, fluctuation of max +-0.2km/h during the whole half marathon), I was wondering if my constance can be a "problem".

Shall I alternate faster period and slower period during the run? Or being constant is a good point?



Answer: The question to you is simple and it works on the combination knee pain and marathon training most of the time :

1. Get cross friction massage on the quad muscules - the outside part. Do this yourself (see the video in the 100 day plan of the massage of v.lateralis) and get a physio to do it in addition to what you do yourself.

2. Tension on the outside usually cause an inflamed bursae on the outside of the knee. In addition to point 1, you have to get rid of that acute/sub-acute inflammation. The best way is to have your doctor do a cortizone injection to the bursae. It is a closed sac so injecting it in there has no effect/injury to the tendons/soft tissue around. It is 100 % safe.

3. Place in some training sessions of type 45 sec run, 15 sec rest in a progressive manner (like you see examples of in the 100 day plan) This will help you vary the muscular stress abit. On the easy runs, alternate running and walking instead of speeding up more. This is a much better approach for variation.

I wish you all the best with your training,

Kind regards,

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Marathon injury prevention

by Scot

How to deal with nagging hip pain right before a race ?

"Marius, What was a less than nagging hip flexor strain has flared to an official nagging injury in recent weeks after the longer and faster workouts, to now showing up during the runs even after warm time. With just 2 weeks before th Chicago Marathon, what path should I take to keep further damage to minimum,maintain fitness, and maximize healing.(without panic!)"

Answer: Hi Scott - to make the answer general.

If you experience injury trouble that close to a race I recommend :

1) anti-inflammatorie tablets, ideally doctor subscribed (stronger) up until 4-5 days before the race (no closer!) After that, stop due to its effect on muscular tension.

2) Warm (not ice) baths every day, even twice daily for that same period as you take the tablets. 10-15 minutes at a time as warm as you can handle.

3) Avoid speed work, and cut down about 30 % on the runs. BUT keep the same system, except for maybe one period of 2-3 days without running (no more)

This is the absolute best approach to this and in many cases it is enough to get your body going again. IF you feel pain on race day, you may take some pain relief tablets again on race day only, but ideally not anti-inflammatories - only type paracetamol (pure pain relief)

All the best for your race and hopefully the injury has just helped your shape peak even sharper due to the extra rest,


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Tibialis Anterior tendonitis

by Alan
(St Kilda, Australia)

Tibialis anterior tendonitis before marathon :

"Hi Marius,

with 4 or so weeks to Berlin, i have developed tendonitis in my tibialis antrior on my right leg - OUCH!

I have had some physio on it, who has also recommended resting with a course of oral anti-inlammatories (Voltaren 25mg).

I am not 100% nervous, as i have built up a good base but i have stopped running for the last week replacing swimming to give it as good a chance to fix itself.

I am now in week 9 and have several hard sessions to do - but I am worried about doing more harm if I do these. I was due for a long run of 2.30hr + 30walk yesterday and 3 hours next weekend - I ice & have a compression bandage on my shin, but was worndering if you had any other advice.

I saw your idea of plastic wrap and anti-inflam gel over night which I will try tonight.

Have you any other suggestions? and should I be changing my goal?



Answer: Hi Alan, this is a very common running injury - I've had it myself.

Now, this is the deal. Continue with the physio on it. In addition step up the dose of Voltaren somewhat, in many cases 50 mg x 2 is recommended (talk to your doctor about this) You also want to use Voltaren/anti-inflammatory gel and apply it at night - plus wrap it in so that you can sleep with it on top of the affected area.

VERY IMPORTANT : do not run the race with lots of Voltaren in your body - it can affect racing performance. As you get close to rhe race, stop taking these and just stick to the night wrap.

Also, after a few days of total rest, you want to get gradual going again. It will hurt in the beginning, the first 2-3 sessions then it will get better. Start with walking, then jogging, then intervalls (use 4-5 days to build up to this)

You have a good chance of getting through this, you may want to consider changing the goal time but take that decision much close to the race !

best wishes,

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