Lindsey Ebbs Podiatry - Insights

What you wouldn’t expect to see at the end of a Marathon

(from Podiatrists who were at the finish line)

Suzanne and I were part of the medical team located in the tents at the finish line of the London Marathon this year and whilst neither of us are runners we do appreciate how important it is for the runners to complete this event.

A Podiatrists job in simple terms is to keep people moving, it is what we do on a daily basis in clinic so applying our professional knowledge to help those at the finishing line at the marathon was a real treat for us.

We were so impressed with the amazing organisation that is the London marathon, it ran like a well organised machine with 1000’s of committed volunteers making sure the experience was a positive one for runners, family and spectators alike.

Running 26.2 miles is an incredible achievement for the body, preparation and conditioning is key here to compete and complete an event like this.

However, we were surprised at the range of problems runners presented with at the finish line, most of them could have been easily prevented, which is why we felt a blog to help prevent these issues would be beneficial to any potential runners for the next season of marathon events.

Injuries

We personally came across three runners that had Achilles rupture/tears on the day, all three could hardly walk and had to be helped into the triage tent. Chatting to all of them, they admitted they were having treatment for niggling Achilles issues prior to the run. We cannot comment on these runners as we are not privy to the full medical history details prior to the event but for us -common sense has to prevail here?

Achilles injuries are tricky customers and are very prone to injury, the treatment and rehabilitation of a ruptured Achilles is a long and complicated one. So, from our point of view, if an Achilles is playing up before a major event, full ultrasound diagnostics is in order beforehand so a fully informed decision can be made whether it is advisable to carry on and start the event. There is always next year!

March(stress) fractures are also common when running long distances, these are a common fracture for the armed forces, marching on hard surfaces for long periods of time are a causative factor. Marathons easily fall into this category, usually they present in runners that are not prepared for the distance involved, a lack of conditioning if you like.

It is recommended that when training that there is no more than a 10% increase in distance per week covered in training so the body can become conditioned to the distanced involved. Any niggles that present in the body- the training schedule should halt and reverse to a distance and intensity that the body is comfortable with.

Tim Gabbett is the world renown expert in the acute: chronic work load management in the prevention of injuries and training plans for all sports. Here is a link to his website. The acute: chronic workload calculators are available on line and can be personalised to your running schedule ensuring your training plan is a success. https://gabbettperformance.com.au/.

Disappointment

Why were we so surprised? finishing in itself would be such an achievement for us! However, we soon realised that from a competitive point of view, the runners who compete in marathons on a regular basis and are in it for personal best times and a placement.

This was particularly noticeable in the second cohort of runners, just finishing behind the elite runners, members of amateur running clubs and very serious about their running. Marathon training will have taken up a lot of their free time as they probably work full time too. These guys were surprisingly hard on themselves, clearly disappointed, wishing they had achieved better times.

The elite runners were also exhausted and their emotion was cloaked, they were prepared on every level and it seemed just a job for them.

The joy for us was watching those competitors who had never ran a marathon before, becoming tearful at the finish line, clearly an incredible emotional achievement for them to finish.

Most runners seemed to have a story, either they were recovering from a cancer related illness and had it as a goal whilst receiving treatment. Or those who were running to raise money for their chosen personal charities or raising awareness around medical conditions that require further research.

The dressed up runners were impressive and entertaining, how some of those runners ran one mile let alone 26 was incredible, they were great to see and very uplifting for spectators and runners alike.

Most competitors were excited and delighted at their personal achievement which was lovely to see but for those who were disappointed, we hope it was a short-lived emotion for them?

Disorientation and exhaustion

Were common sights at the finish line and can be caused for many reasons;

Drinking too much water along the run, can affect the bodies level of electrolytes and over a long period of time this can create disorientation during the run and is very noticeable at the finish line. Runner's can struggle to coordinate themselves and can be a bit fuzzy in their decision making until their electrolyte levels return to normal.

Popping a sachet of dioralyte into a bottle of water or consuming a sports drink that contains electrolytes already will help resolve that issue- it usually takes half an hour to correct. The hotter the weather and the more water is consumed; this will exacerbate the problem.

Observing the elite runners, it was quite apparent that they had expended every bit of energy they had at the end of the marathon and they were helped or carried away from the course by members of their team. It was quite interesting and reassuring that even that section of runners were not able to do much for themselves at the end of a race. I feel it’s important that all competitors realise this as the elite runners seem to look almost `superhuman` when viewed on the TV.

Pre-race diet and post- run food are so important, the body is reliant on the correct nutrition for weeks prior to a race as this helps the body to be able sustain the amount of energy needed to complete the event. Lack of nutritional preparation beforehand is noticeable for those who struggle to put one foot in front of the other when finished. Lack of energy can be just as detrimental as an electrolyte imbalance in causing disorientation and exhaustion.

James Collins is a Nutritionist to elite sports and has books and blogs that can help with food preparation for marathons. http://jamescollinsnutrition.com/

Shaking, shivering and teeth chattering

Is the bodies temperature system trying to adapt to the change in circumstances that the body has just endured? The brain is clever and works out the skin and body temperature need to be kept at an average 37C. During activity it rises and the blood vessels in the skin open up to allow for the increase in the blood flow enabling the body to sweat, which in turn allows the body to cool down.

Once completing the marathon, the brain sends messages to the blood vessels to constrict, which then decreases the blood supply, the body’s temperature then returns to its normal resting level.

Sweat remaining on the skin then cools the body down but the body temperature can drop too low possibly causing hypothermia. Regardless of the weather, shivering is a prompt from the brain to warm the body up- a thermostatic kick start if you like! Shivering, shaking and teeth chattering are all part of this really clever temperature preserving system, however trying to function enough to do fiddling bits like opening a bag or un fastening laces are almost an impossible task when the body is in this state. Even if the weather is warm this can happen but if it is cold, windy or wet the body’s temperature will drop rapidly and the shivering/shaking will start almost at the finish line.

How can you prevent this?

Take a clean dry change of clothes with you, including socks, shoes and change into them as quickly as you can. There is a temptation is to hang around and do a` post mortem` on your run with running friends and family, delay that conversation to after a change of clothes.

A lot of marathons have a foil blanket in the post- race goody bag, open and wear it as soon as possible, regardless of how you may feel, preventing a drop-in body temperature is the priority here. The foil blankets can be a bit fiddly to open, we know this as we were asked quite a lot -to open them for the runners as they couldn’t open them due to their shaking hands!!

A warm drink not only warms your hands but warms you from the inside too, ask family and friends to meet you with a cuppa of something warm.

We hope to be selected for next year’s London Marathon finishing team as it appears it is just as addictive for the volunteers as it is for the runners!


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