“I am planning to run my sixth marathon this winter. I’ve heard of many different injuries and conditions, which some doctors tell their patients they can run through while others tell them not to run. Can you tell me, once and for all, what injuries or conditions I should not run with?” – E.L., Miami Beach, FL
I hear this question year after year, sitting at the Medical Desk at marathon expos: “I hurt blah blah and my doctor told me I shouldn’t run. Can I run?” I usually ask the runner, halfway kidding, “If I told you not to run, would you?” Invariably, the answer is, “Yes!”
Assuming that you are healthy, have been cleared by your doctor, and have trained adequately, there are really only four reasons to keep a runner from running a marathon:
- You have a fever of 101 degrees F or higher. Fevers are the body’s way of killing an infection. When you run a marathon, your body heat rises naturally due to your increased metabolism. If you start high, your body’s way of cooling you down starts off “out-of-whack” and can lead to a heat illness, coma, or death. Your body’s proteins, which make up the structures of your vital organs, break down at high temperatures. If you need Tylenol (acetaminophen) to keep your fever below 101, you really should lay off running until you are naturally cooler.
- You have so much pain that it affects your running form. Runners are the smartest athletes. They don’t need a coach to tell them when their natural running form changes. They do need a sports doc to tell them, however, to stop running if they have so much pain that their form is changing due to that pain. Compensating for that pain will cause an injury somewhere else. Again, it is just not worth the time you may spend recovering. If it is before the marathon, just don’t run this one. If it happens during the race, first try backing down on stride length and speed; if you can go with good/normal form slower, finish the race. Chances are you won’t do more damage that way. If you can’t maintain form even at a slower pace, stop and ask a doc at a medical station to check you out. It’s FREE ADVICE on race day: take advantage! In either case, visit your sports doc at your earliest convenience to rid yourself of this problem for good.
- You are experiencing new medical symptoms (like chest pain) since your last physical. Running may be like a stress test daily for you. If you are ignoring chest pain or a new medical symptom like increased thirst, dry mouth, shortness of breath, or increased urination, please get a real check-up by your internist. You may have developed a medical condition that requires attention. Cared for properly, it may not keep you from running; left unchecked, it could do you harm while running a long distance.
- You have a fracture or stress fracture in a weight-bearing bone. Runners will do anything to continue running. I’ve seen runners stop at med stations with a broken tibia (shinbone) sticking out of their skin asking for some tape so they can finish the race! Running on a stress fracture can lead to its fracturing all the way through and a devastating open fracture (sticking through your skin) on race day. This will result in surgery, a long healing period, a possible non-union (non-healing), and further complications as well as the psychological trauma of being off running for months. It is just not worth the risk. If you have a stress fracture, listen to your sports physician, take the time off weight-bearing exercise (you can run in the pool) and be ready for the next race. And if you are in a walking cast, I know you want to compete, but have your doctor make it waterproof and get your exercise via water running and don’t mess up the healing process by walking the race on it.
So, if you don’t have one of the above four, chances are you are safe to run. Have a great, safe race.
Enjoy the ride.
Lewis Maharam, M.D.
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