Dear Running Doc:
I am planning to run my sixth marathon this winter. I have heard of many different injuries and conditions, which some doctors tell their patients they can run through and others tell them not to run. Can you tell me absolutely, for once and for all, what injuries or conditions I should not run with? Thanks.
Edward. L. Miami Beach, Fla.
Edward, I hear this same question event after event sitting at the Marathon Medical desks.
“I hurt blah blah and my doctor told me I shouldn’t run. Can I run?” I usually ask the runner, halfway kidding, “If I told you not to run, would you?” The answer is always: “Yes”!
There are really only four reasons I know to keep a runner from continuing to run a marathon. This of course assumes you are healthy, been cleared cardiac-wise and medically by your doctor and have trained adequately to run the distance.
1. You have a fever of 101 degrees or higher. Fevers are the body’s way of killing an infection. When you run a marathon, your body heat rises naturally due to your increased metabolism. If you start high, your body’s way of cooling you down starts off “out-of-whack” and can lead to a heat illness, coma or death. Your body’s proteins (which make up the structures of your vital organs) breakdown at high temperatures. If you need Tylenol (acetaminophen) to keep your fever below 101, you really should lay off running until you are naturally cooler.
2. You have so much pain that your running form changes. Runners are the smartest athletes. They don’t need a coach to tell them when their natural running form changes. They do need a sports doc to tell them, however, to stop running if they have so much pain that their form is changing due to that pain. Compensating for that pain will cause an injury somewhere else. Again, it is just not worth the time you may spend recovering. If it is before the marathon, just don’t run this one. If it happens during the race, first try backing down on stride length and speed; if you can go with good/normal form slower, finish the race. Chances are you won’t do more damage that way. If you can’t maintain form even slower, stop and ask a doc at a medical station to check you out. It’s FREE ADVICE on race day: take advantage! In either case, be checked by your sports doc at your earliest convenience to rid yourself of this problem for good.
3. You are experiencing new medical symptoms (like chest pain) since your last physical. Running may be like a stress test daily for you. If you are ignoring chest pain or a new medical symptom like increased thirst, dry mouth, shortness of breath or increased urination, please get a real check up by your internist. You may have developed a medical condition that requires attention, may not prohibit you from running if cared for properly, but left unchecked could do you harm while running a long distance.
4. You have a fracture or stress fracture in a weight bearing bone. I’ve seen runners stop at med stations with a broken tibia (shinbone) sticking out of their skin asking for some tape so they can finish the race! Runners will do anything to continue running! Running on a stress fracture can lead to it fracturing all the way through and a devastating open fracture (sticking through your skin) on race day. This will result in surgery, a long healing period, a possible non-union (non healing) and further complications as well as the psychological trauma of being off running for months! It is just not worth the risk. If you have a stress fracture, listen to your sports physician, take the time off from weight bearing exercise (you can run in the pool!) and be ready for the next race. And if you are in a walking cast, I know you want to compete, but have your doctor make it waterproof and get your exercise via water running and don’t mess up the healing process by walking the race on it.
So, if you don’t have one of the above four, chances are you are safe to run. Have a great safe race.
Enjoy the ride!
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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
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