Everything You Need to Know Before You Run a Marathon to Prevent Severe Injury

With the Los Angeles Marathon around the corner, both amateur and professional runners are planning for their biggest moment of the year.

The Los Angeles Marathon is a 26.219-mile run that was inspired by the success of the 1984 Summer Olympic Games. Keck Medicine of USC and the Los Angeles Marathon partnered up to host a Facebook chat on how to prevent injuries during a marathon. Our very own Eric Tan, MD, assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC and a foot and ankle specialist at Keck Medicine of USC, was invited to answer runners’ questions.

You can find the answers to these questions here: Facebook chat

Dr. Tan, a foot and ankle expert at USC Orthopaedic Surgery, also answered seven of the most common questions that runners have, especially when they want to prevent an injury.

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1. What are some key things people can do to prevent running injuries?

Preventing running injuries involves more than just stretching before and after your run. It involves everything from what you are eating to what you are doing on the days that you are not running. Here are a few key things that can help reduce the risk of running injuries:

– Maintain and improve your flexibility with daily stretching
– Warm up before and cool down after all runs
– Cross-train to help build strength and endurance
– Periodize your training program for a gradual progression of intensity and mileage
– Include days of rest into your schedule to allow your body to recover
– Keep hydrated and eat a healthy, well-balanced diet

2. How much stretching should someone do prior to a run? And what muscles should they target?

Improving and maintaining your flexibility to minimize running injuries is something that innately makes sense. However, it should be noted that in the best available scientific studies, stretching has not been associated with a statistically significant decrease in the risk of lower extremity injuries. This doesn’t mean that stretching is useless, but rather it is not the only factor in injury prevention.

Prior to and after a run, stretching is recommended for about 10-15 minutes and should include all joints and extremities. This should include your hip flexors, hip adductors, hip abductors, hamstrings, iliotibial (IT) band, quadriceps, and calf muscles. In elite runners, there is usually increased flexibility in the hips and shoulders, so these areas a good place to focus as well. In addition, if there are distinctly sore or tight muscles, these should be targeted to help with rehabilitation, as well as the prevention of recurrent injuries to these muscles.

3. Would you recommend more dynamic warm up exercises as opposed to static stretches prior to a run?

A good warm up regimen consists of a combination of stretches as well as dynamic exercises. Static stretches help to improve range of motion of the muscles, but running and sports also requires dynamic flexibility. Dynamic stretches are movements that mimic the way your muscles and connective tissues actually stretch during running. Performing dynamic stretches on a regular basis helps minimize the internal resistance from the muscles and joints. A combination of static and dynamic warm up exercises will help provide a gradual progression from resting to active levels by loosening and lubricating the muscles.

4. What should I look for in a good running shoe?

Running shoes are a very personal choice. Whichever shoe brand you prefer, there are some specific things that you should look for in a running shoe. What one runner finds is their ‘go-to’ brand may be very uncomfortable to the next runner. A good shoe is one that adequately supports your foot and gait. Trying on various brands and styles of shoes will ensure that you find the one that makes your foot feel the most comfortable. In addition, while most shoes will also be lightweight, they should have some stiffness to the sole to help absorb some of the impact from your foot striking the ground. An insole may also help provide additional comfort and support for the foot. Shoes should generally be replaced approximately every 500 miles to ensure continued structural integrity of the shoe and support to your foot and ankle.

5. What should I do to safely recover after a long run?

  • Hydrate for the first 10-15 minutes after finishing. Beverages with electrolytes are recommended.
  • Stretch for 10-15 minutes, focusing on the major muscle groups (hips, quads, hamstrings, calves) as well as any specific muscle groups that are tight or sore.
  • Replenish carbohydrates and protein with a small meal (like a protein bar) to help rebuild muscles and refuel the body.
  • An ice or cold water bath for 10-15 minutes will help to constrict the blood vessels in the legs which decreases metabolic activity and reduces swelling and tissue breakdown. This will help to ease inflammation and reduce muscle soreness.
  • Be sure to incorporate a well-balanced meal as well as time for rest and sleep.
  • Days before and after a long run should include either an easier run, cross-training, strength conditioning or even total rest. An appropriate training regimen is integral to preventing injuries.

6. What are the most common running injuries and how can I prevent them?

  • Plantar fasciitis & Achilles tendinitis – this is pain in the heel that is typically the result of a sudden increase in activity. Gradually increasing your activity, stretching, as well as wearing the right shoes will help to reduce the risk of this injury.
  • Stress fractures – these are tiny cracks in the bone caused by repeated impact. It is usually associated with a sudden increase in activity or mileage. Acute pain in the foot should not be ignored — a stress fracture might require a break in training or, in some cases, even surgery. Proper footwear, nutrition (including plenty of calcium and vitamin D), and cross-training can help to reduce the risk of stress fracture.
  • Ankle sprains – these occur when the ankle rolls, either inward or outward, resulting in ankle pain and instability. Usually, this involves a curb, pothole, or uneven surfaces. Depending on the severity of the injury, rest is recommended until the pain and swelling subside. A brace and physical therapy may be needed in more severe cases. Supportive footwear and knowledge of potential terrain difficulties may help to reduce the risk.
  • Shin splints – stabbing sensations to your shins that occur as a result of the muscles and tendons covering the tibia becoming inflamed. Ice, elevation and anti-inflammatories may help to reduce the pain. A few things that may help to prevent shin splints include placing insoles in your shoes, in addition to running on softer ground and avoiding hills if possible. Gradually increasing the difficulty of your training program may also be helpful to reduce the risk of this injury.
  • Muscle strain/tear – this most commonly involves the calf and hamstrings in runners. A few causes involve overuse and inflexibility. A proper warm up and cool down, as well as proper running technique can help prevent a pull of the muscle.
  • Blisters – these can pop up anywhere along the foot and toes, usually in places where the foot rubs against the shoe. The best way to prevent this is to make sure your shoes fit well and that you wear a good pair of socks. If a blister does appear, moleskin is a good way to protect it from getting worse.

7. Are there certain foods or supplements that can help prevent injuries?

A balanced, healthy diet is important to establishing a foundation for you to build your strength and endurance. Be mindful that you need to eat enough calories and nutrients to support your activity level.
With regards to injury prevention, there are a few supplements that can be helpful.

  • Iron – it is important for the formation of red blood cells, which is essential for endurance. Iron deficiency may result in persistent fatigue, which can make a runner more prone to injury.
  • Vitamin D & Calcium – these are important for bone health. Appropriate intake of vitamin D and calcium is important to maintain the strength of the bones, which will reduce the risk of stress fractures.
  • Fish Oil/Omega 3s – these have natural anti-inflammatory properties that may be helpful in improving strength and physical performance. Both may also help to reduce muscle soreness and damage.

Dr. Eric Tan specializes in both common and complex problems of the foot and ankleTo schedule an appointment with USC Orthopaedic Surgery, call (800) USC-CARE (800-872-2273)  or visit https://ortho.keckmedicine.org/request-an-appointment/.

by Leonard Kim and Mary Dacuma