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The Running Doc’s 10 Commandments Of Marathon Running

There’s nothing common about common sense.

There’s nothing common about common sense.

Written by: Lewis G. Maharam, MD

There’s nothing common about common sense. If there were, endurance athletes wouldn’t have to be reminded of the most basic precautions to keep from hurting themselves.

But they do need to be reminded, especially when so many potential marathoners pour all the training and racing of their yearlong preparation into one big, final blowout of a race. The morning after, I can count on a stream of telephone calls from patients who either can’t figure out what went wrong or just need to admit to some blunder. Smart people, apparently, make mistakes all the time.

In fact, every physician who has ever covered a marathon, including me, has seen far too many of these people hunched disconsolately in our medical tents after a slipup they thought they were too savvy to make. As a result, the International Marathon Medical Directors Association (IMMDA) began keeping a list of what goes wrong most often. Yes, at one point I’d have said some of the resulting 10 Commandments were too elementary for athletes who’d been around the block a few times. But that was before I saw who was filling up the medical tents. The commandments are for marathoners in particular, but they apply to any endurance sport where you’re about to lay it on a tougher line than you have in a while.

1. Make sure you’re physically fit for the activity you’re undertaking. That means more than doing the training mileage.  You’re about to take a car that usually goes for groceries and drive it to Florida, and you don’t want sudden mechanical surprises from previously hidden problems. Runners, for example, should be aware of pronated feet, high-arched ankles, bowed legs, or leg-length discrepancies. Physical characteristics like these are more likely to cause injuries in endurance events than during training. So if you’re going where you’ve never gone before, either in distance or in pace, consider a good exam by a sports medicine physician before you toe the line. That is not to say you must get these things corrected if you are in no pain (if it’s not broke, don’t fix it!). It is to be aware of them so that if you do get some pain, you know there is something biomechanical being magnified by each step as you increase your mileage.

2. Train properly. Too obvious for words? Maybe, if you’ve been following a training plan designed for you. But if you’re coming to the line with a workout log peppered with the “workouts of champions,” you may be closer to my waiting room than you are to the winner’s circle. Select and follow a training plan that is appropriate for your skill level, experience, and the race distance.

3. Follow guidelines for proper nutrition. Most athletes already know that carbohydrates and fats are the body’s main race fuels, but what about protein for muscles? Don’t worry. In a balanced diet you’re getting plenty, and any extra doesn’t become muscle anyway; it becomes fat. Worse yet, a body with excess protein has to use extra water to eliminate nitrogen by-products, and in a long race there’s no such thing as extra water. And as for that plate full of pasta before the event, if you don’t normally eat pasta in heaping piles, don’t start now. For more details and recommendations regarding eating before and around your endurance event, follow my guidelines in Part I.

4. Maintain adequate hydration. Everyday marathoners aren’t the only skeptics about the virtues of water stops. I see professional runners skipping them, figuring, “Hey, I’m making  such good time, so why slow down?” But they are slowing down anyway—from dehydration. Learn to drink when you are thirsty and you will do fine.

Sports drinks work best, but this is no time to experiment. If you haven’t tried them in training, don’t start now. As unlikely as it seems, those friendly carbohydrates your muscles crave can instead irritate a surprised stomach and cause cramps, especially if the carbohydrates are from something you are not used to. Again, for further guidelines and suggestions, see Part I.

5. Warm up on race day, and stretch every day. Stretching is especially important for marathoners. Global flexibility makes for more enjoyable runs and walks. Never stretch a “cold” muscle; always warm up before stretching. Make sure you stretch every day.

On race day do a 10- to 15-minute warm-up. Light jogging, jumping jacks, anything that makes you warm. Do not stretch before the event.

And once you’re across the finish line, don’t just quit in happy exhaustion. Your tight muscles are now riddled with little microtears, and if you don’t stretch again, they’re going to heal at a shorter length. The whole muscle will end up smaller, and the next time you work it hard, you will pull something. So lightly stretch the same way you do in training, no more and no less. Remember, nothing new on race day!

6. Dress according to the weather. Simple? Not always, especially for a late fall event. You may need to layer on some throwaway clothes so that you’re warm until the start; once you’re cool enough after the race begins, you can toss these clothes aside. Because cotton socks hold your sweat, try one of the more specialized running socks you can get at a local running store. The wicking away of moisture from the skin that the synthetic fabrics in these socks can achieve may prevent those nasty blisters you’ll otherwise have at the end!

7. Use proper, comfortable running shoes. The people I’ve treated for bloody feet, black toenails, and blisters invariably had new shoes. Believe me, no matter what you read, shoes must be broken in. Even the same model you’ve always worn can have mild imperfections or something in one shoe that’s not in the other. Nothing’s always on the money.

If you’re buying a new pair, do it in the afternoon or evening when your feet are swollen, and do it weeks before running in them so that you can walk around and test them out. Then break them in during the weeks before the event so that you are not toeing the start line in brand-new shoes.

8. Watch the condition of the surface. Race directors try to give you a safe ride, but there will always be enough holes, oil slicks, or misplaced hazard markers to keep my ankle-mending business going. Try not to become part of it.

9. Go at your own pace. Even race winners know this. The championship swimmers I treat tell me that if they’re swimming to beat whoever’s in the next lane instead of themselves, they rarely do their best. And they usually pull something or get hurt trying to overextend what their body is ready to do.

10. Listen to your body. If you feel sick, you probably are. Stop. But what about a pain? Here’s my rule: If it changes your mechanics—your normal running or walking form—stop. But if you can slow down and hold on to your form, you can probably finish the race safely.

This article was adapted from the book Running Doc’s Guide to Healthy Running with permission of VeloPress. From head to toenails, Running Doc’s book explains healthy running practices and guides runners to the right diagnosis and treatment for over 100 running injuries and related health problems. Running Doc’s Guide to Healthy Running is now available in bookstores, running shops, and online. Download a free sample and preview the contents at


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