6 ways marathons can be harmful to your body

Philippides is credited in Greek literature for running the first marathon, bringing news of a battlefield victory, then promptly dying. This story highlights the difficulty in running a marathon; it is an act of endurance. Only about half of people in the US have run a marathon, translating to about 500,000 completed races a year. Obviously, something this strenuous can take a toll on the body, and there are risks of injury. This article will focus on typical orthopedic issues that affect runners while training and completing their marathon.

Stress fractures

They’re are a common injury in runners. While most fractures occurs because of a hyperphysiologic stress placed on the bone (falls, tackling, car accidents, etc), stress fractures are from a lower amount of load continuously placed on the bone for long periods of time. This injury is very typical of runners who are either running their first marathon, or have taken a long break from running before resuming running. The best treatment is obviously prevention. Go slow with training for a marathon, and this slow advancement of running will build bone strength, decreasing the likelihood of stress fracture.

{mosads}If a runner has had repeated leg stress fractures, this could be a sign of biomechanical issues with their running gait, and a video gait analysis could be helpful. Something as simple as practicing “running on egg shells”, trying to teach a gait that has less pounding on the legs, can work. Also, if a runner tends to strike on their heels, getting well supported shoes can be helpful, as opposed to minimalist running shoes, which work best in runners who tend to run on their toes. If runners have increased pain with running, if they are limping, or if they start having pain when they are not running, they should be evaluated by a medical professional. 

A true stress fracture may not show up on X-rays, and may require advanced imaging, such as an MRI or bone scan, to evaluate. Running through a stress fracture can make the fracture worse, and stopping running and alleviating the increased stress can help a stress fracture to heal. Sometimes, bone stimulators are used; these are external devices which can speed healing, especially in a bone that has not healed despite adequate treatment.

Plantar fasciitis 

This is irritation of the tendon-like cord that runs from the foot to the heel. Many times, runners have tight Achilles’ tendons and hamstring tendons, and this can put increased stress on the plantar fascia. Typically, patients with plantar fasciitis will feel pain directly at the heel (where it touches the ground). Pain is typically worse first thing in the morning, and limping in the morning is common.

Treatment focuses on stretching the Achilles’ and hamstring, which can be helpful. Heel cups can not only cushion the plantar fascia, but also unload the Achilles’ tendon. Dorsiflexion night splints allow increased time to stretch the Achilles’ tendon, and is sometimes useful. Cortisone injections can sometimes be employed as well. Stress fractures of the heel bone can happen, and if therapy and conservative treatment are not helping, X-rays should be obtained.

Patellar tendinitis

It is irritation of the patellar tendon, which attaches the kneecap to the shin bone (tibia). Again, tight hamstring tendons force a runner to overpower the hamstring with the quadriceps, increasing strain on the patellar tendon, causing pain. Runners will typically feel pain in the front of their knee, and have pain running on uneven surfaces. Physical therapy (focusing on hamstring flexibility and quadriceps strengthening) can be very helpful in this setting, along with counterforce bracing, to take the pressure off the insertion. In settings where conservative treatment fails, sometimes interventions such as a platelet-rich plasma (PRP) injection or even surgically removing the damaged part of the tendon is necessary, but this is rare. 

Chondromalacia patella 

It’s Latin for “softening of the cartilage” of the kneecap (patella). There are three parts to the knee, the medial (inside), lateral (outside), and patellofemoral compartment. Chondromalacia patella is damage to the patellofemoral joint, typically from overuse. Symptoms are accentuated by sitting for long periods of time and going up/down stairs. Treatment is typically conservative. Tight hamstrings put increased stress on the patellofemoral joint, and therapy can be very helpful. Knee sleeves can also unload the knee cap, allowing more function. If the chondromalacia progresses, this can lead to patellofemoral arthritis, which may require injection treatment as well.

IT Band Friction Syndrome

This inflammation/degeneration happens where the IT band inserts at the knee. Unlike patellar tendonitis, the pain here is lateral. The IT band is palpable; if you take your finger and press on the hard bone at the outside of your hip, you can feel a tough band of tissue coursing down the thigh, to where it inserts. Try to avoid this by remembering to stretch the IT band. Also, core strengthening exercises, such as Pilates, can be helpful to prevent IT Band Friction Syndrome. If it does occur, runners will typically have pain on the outside of the knee, and they may even feel a sensation of painful snapping in that area with running. Doing specific IT band stretching can really help. Dry needling, which is a physical therapy modality, can also be useful.

Hip Labral Tears 

Running puts a lot of stress on the hip joint, and many times runners may have a deformity in the shape of the hip joint, predisposing the hip to cartilage tears from impingement (Hip FAI). The onset of pain is usually gradual, and the pain is in the groin and front of the hip most often. Patients can feel a catching sensation in this area, and typically there is pain going from sitting to standing. Besides keeping your core strength optimized, there is really no prevention to this condition.

Physical therapy is a good option for initial treatment, but if this doesn’t help, seeing a Hip Arthroscopy surgeon who has a lot of experience treating this condition is the next step. Sometimes, a Hip Arthroscopy surgeon may try a cortisone injection inside the hip joint, which can help a patient get better with physical therapy. Nowadays, treating labral tears and the FAI through minimally invasive surgery can be curative.  

I’ve talked a lot about potential injuries from running marathons, and some tips to try to avoid injuries and how to treat them if they occur. I want to end by saying that as a Sports Medicine surgeon, I applaud runners. The cardiovascular benefits of exercise for the most part far outweigh risk of injury. My job as a Sports Medicine surgeon is to get people back to doing what they love to do. 

Derek Ochiai is board certified by the American Board of Orthopaedic Surgeons and specializes in injuries to the upper and lower extremities including: hip, knee, and shoulder arthroscopy.

The views expressed by contributors are their own and not the views of The Hill.