Fevers, severe pains, stress fractures, and chest pains are pre-race warnings for marathon runners

Dr. Maharam: I am planning to run my sixth marathon in a few weeks. 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 out of a marathon:

Read more: http://www.nydailynews.com/sports/more_sports/2011/10/17/2011-10-17_fevers_severe_pains_stress_fractures_and_chest_pains_are_major_warning_signs_for.html#ixzz1b9qNGVaF

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Stretching is the key for runners looking to avoid Achilles injuries

The Running Doc is now a columnist on nydailynews.com, and will be answering some more of your burning running questions there too!

Here is the latest question Dr. Maharam received:

Hi doc. Just began seeing your column in the News, great to see running getting some space. Anyway, I’m a runner, have run 6 marathons in the last 6 years. Got faster every time till last year when my calf/Achilles acted up during training. Just very tight, pain in my heel, too. Massages, physical therapy, active release, stretching programs, heat, ice, etc. have offered little relief, and it’s been over a year now. I’m still running a bit, but I’m missing my first fall marathon in 6 years and that’s the worst part. Any insight?

Eddie D. New York, NY.

Thanks, Eddie. This time of year I see tons of Achilles tendonitis, so this question is really timely. Any sport that keeps you on your feet and uses a pushing-off motion can produce Achilles trouble. Orthotics are usually prescribed, but stretching is always your first defense.

The Achilles tendon, which is formed from your calf muscles, can be pushed beyond its limits and become inflamed. That’s the tendonitis to which most athletes ascribe pain – and perhaps some swelling – above the upper heel. But every time the tendon gets inflamed, and certainly every time the pain comes from more serious micro-tears in the overused tissue which can easily be mistaken for tendonitis, the Achilles grows just a little weaker.

What brings the condition on, other than simple overuse? The Achilles is vulnerable to misuse. Designed to do its job of guiding the heel in a vertical plane, it’s intolerant of the inward rolling of the ankle when it rolls outward.

But a calf muscle routinely loosened by conscientious stretching every day and after a workout cuts the tendon some slack, particularly in stiffer athletes, reducing the tendon’s role as a shock absorber for which it’s not very well suited anyway. So on those impatient days when stretching seems too much of a bother, it pays to remind yourself that a neglected and partially torn tendon needs to rest and heal in a cast for 6 to 8 weeks unless you like courting a rupture.

Read more: http://www.nydailynews.com/sports/more_sports/2011/10/12/2011-10-12_stretching_is_the_key_for_runners_looking_to_avoid_achilles_injuries.html#ixzz1agTO5XcG

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Can I PLEASE have a massage when I finish?

 

“I have noticed that more and more races are not having massage therapists at the finish. Why is this? I always like that massage after a race!” – Billy W., East Hampton, NY

Great question, Billy. I get this question at each marathon expo and I think it is time that everyone knows the answer.

Yes, marathon medical directors and race organizers who understand running physiology have limited massage in finish areas. Of course it feels good to be touched, but medical science has taught us that it is not the best thing for runners at this time.

Here is why:

When you run a race, your body uses its energy stores and makes lactic acid as a by-product. If you have a massage within the first two hours of finishing a race, you move that acid around, causing more cellular damage and more soreness and inflammation the next day. After two hours, the body naturally buffers this acid (returning it to a neutral pH); then it is advisable to get a massage to move by-products out of your muscles. Obviously, race organizers don’t want participants hanging out for two hours waiting for a massage. You would be better served to make an appointment with a local massage therapist after returning home or to your hotel.

So what can you do to lessen post-event muscle soreness? Try these tips for less soreness the next day:

•Ice and ice bath when you return home.

•Cool showers for a day or two. Warm water or heat will cause more inflammation.

•Stay away from ICY HOT and BIOFREEZE and the like. They work by a chemical that again makes inflammation “hotter.”

•Try to get a massage anywhere from two to six hours after finishing. That is the best time to get the buffered by-products out.

•After you are eating and urinating normally, taking a NSAID (non-steroidal anti-inflammatory) may be of assistance.

If you do all this, you will feel way better the next day than if you got a massage right after you finish.

Enjoy the ride.

Lewis G. Maharam, MD, FACSM

Got a question about running health, injuries, or similar topics? Email your question to Doc at askrunningdoc@runningdoc.com!

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Which injuries can I run through?

“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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

Got a question about running health, injuries, or similar topics? Email your question to Doc at askrunningdoc@runningdoc.com!

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