Ground and pound

This past weekend was the Marine Corps marathon which draws approximately 25000 folks. The MCM is great because it is an accessible race which tends to draw many first timers to take their chances at the marathon distance.
In the clinic , we tend to see a surge in clientele leading up to raceday. Most of the runners coming in to the clinic are at the end of a long cycle of training. Many of the rookies have dealt with building a base, then starting marathon specific training. This combination can take upwards of 6 months. More experienced runners will still put in 3-4 months of specific training. Bottomline is that anyone showing up to the start of a marathon has some miles on 'em! The surge we see in the clinic represents the rather cruel side of marathoning. Simply stated, the miles add up. We see the folks who have broken down along the way. Consider that a long run, which is the cornerstone of any marathon program, can have a runner pounding the ground 12-15thousand times. We see that a tiny imbalance leads to something much larger when it is stressed so many times. This is where we start to see things like IT band syndrome, and anterior knee pain creep up on people. Both of these common conditions are often from mechanical strain dues to abnormal movement patterns in a runner's legs. The movement deviation is typically subtle, say 5-10 degrees off course. However, even 5 % of drift of the leg towards midline of the body can lead to 80% increased strain on the lateral part of the patella. Understanding this makes is easy to see why common running injuries can be so common. There is the ground, there is the pound, and then there is repetition. This cycle, my friends, is what leads to injury and pain. If the painful flareup happens at the start of a cycle, usually it is a runner starting too aggressively and the body can't catch up to the stress. If the injury happens at the end of a cycle, usually the cumulative stress has broken down the body's stress tolerance and this leads to injury. A great example is a stress fracture. This injury is effectively the stress of training causing breakdown of the bone which exceeds the body's ability to remodel the bone. As I said, the marathon is cruel. So much goes into getting ready, and the training is fraught with pitfalls. Overtrain and you are guaranteed to be injured. Undertrain and you are certain to underperform. Guess it is time to start training like Goldie Locks! Just right! From a PT's perspective, this is all about specific and purposeful running. It is also about doing active recovery cross training, targeted strengthening and stretching, plus recovery. If a runner rounds out their schedule to cover these targets, the ground and pound can be minimized.