Marathon Baker's Dozen: 13 Things You Need to Know About the Conditions of Long-distance Runners


The Boston Marathon is a pretty big deal here in town. Indeed, the event is scheduled on Patriot's Day, when many citizens of the Commonwealth have the day off and use the opportunity to get out their lawn chairs and park themselves somewhere along the route to enjoy the spectacle. We live near the top of "heartbreak hill" and have often watched the race from a vantage point along "Comm Ave."

This year, as is frequently the case, Kenyans have taken first place in both the men’s (Geoffrey Mutai) and women’s (Caroline Kilel) divisions. Mutai broke a world record by 58 seconds with a total race time of 2:03:02 seconds. Americans Desiree Davila and Ryan Hall made pretty good shows, coming in at second and fourth places, respectively, in their divisions.

We don't all treat elite athletes in our practices, but their performances in events like the Boston Marathon often inspire non-pros to engage in the sport. So we thought it might be an ideal time to review common medical conditions in marathon runners that can be minor to life-threatening. We'll list the common, non-life-threatening injuries first; these are mostly musculoskeletal in nature and due to the fact that it takes between 30,000 and 50,000 steps to run a marathon, and every time a foot hits the ground, a stress three to four times body weight is absorbed by the ankles, knees, hips, and lower back.

Then we'll list systemic physiological effects that can get runners into trouble.

  1. Muscle stiffness and soreness
  2. Pulled, torn, sprained or strained muscles
  3. Tendinitis
  4. Shin splints
  5. Heel spurs
  6. Blisters -- from ill fitting shoes, or exacerbated by feet getting wet in puddles or rain
  7. Chafing -- from constant friction from running shorts and shirts -- may be preventable by using petroleum jelly or other lubricating products on friction points.
  8. Diarrhea, nausea, vomiting, mood swings
  9. Heat stroke and hyperthermia: Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body’s temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided. For marathon runners, heat stroke may occur even in mild weather.
  10. Hypothermia: The risk for hypothermia is greater in cold, windy, or wet weather, but other factors may also be involved. Dampness of clothing due to sweating and or running slower in the second half of a race (generating less heat to maintain body temperature) may also cause problems. Experts recommend that you dress in layers with an outer layer that protects from wind and water, which should  be removed as the temperature rises. Replace or remove wet layers.
  11. Hyponatremia:This occurs when runners drink too much water while racing. The body loses sodium with sweating, and drinking too much water can dilute the sodium in the bloodstream. In the most extreme cases this can lead to brain swelling and other  life-threatening complications.  Current recommendations are that marathoners drink 13.5 to 27 fluid ounces/hour (400 to 800 milliliters).
  12. Dehydration: Dehydration is the most common problem in marathon runners and increases the risk of heat related illnesses.  Dehydration can affect physical and mental performance, increase cardiovascular strain and decrease heat tolerance.
  13. Sudden cardiac death is extremely rare among highly-trained athletes; one study estimated the risk at only 0.002%.