Medical Advice

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Medical Advice

Read the following marathon medical advice carefully before you embark on your next 26.2-mile challenge, says Medical Director Professor Sanjay Sharma

Since 1981, more than one million runners have successfully completed the London Marathon and many more will cross the Finish Line safely in years to come. 

Provided you follow these common-sense guidelines, you too will be a picture of health as you cross the Finish Line of the 2019 Virgin Money London Marathon on Sunday 28 April.

Leading UK road races like the Virgin Money London Marathon and the Great North Run have come together to create the runners’ medical resource – a unified stance on medical issues relating to running and triathlon events. 

As you know, taking part in these events is beneficial to your health if you are aware of the correct ways to train, drink and eat. Participants need to take responsibility for their own health by equipping themselves with the right information. 

The following simple advice on how to look after your body will help you to have a safe and healthy race. Make it your priority to be informed.

Medical problems

Discuss any medical problems with your GP. This advice supplements anything he or she says. See your GP if you have a problem that makes it a risk to run a marathon. You will find further useful and comprehensive advice below. If you would like more detailed information on medical issues related to the marathon and distance running in general, visit virginmoneylondonmarathon.com

Fit to compete

Running is good for the heart, and while more than one million runners have successfully completed the London Marathon, there have been several fatalities from serious heart disease in runners apparently unaware that they had a problem. Their condition could have been detected if they had had medical advice and the relevant heart tests. A ‘fitness test’ is not sufficient to detect these problems.

If you have a family history of heart disease or sudden death, or have a high risk from high cholesterol or high blood pressure, but particularly if you have symptoms of heart disease – such as chest pain or discomfort on exertion, sudden shortness of breath or rapid palpitations – see your GP who can arrange for you to have a proper cardiac assessment. 

Such an assessment may not be instantly available, but continuing to run with these symptoms may shorten your running career catastrophically!

Training

Muscular aches and pains occur most commonly after an increase in training. Training should be increased gradually so that you do not suffer prolonged exhaustion. Separate days of heavy mileage with one or two days of lighter training, or rest days, so that your body can refuel your muscles with muscle glycogen. 

To reduce injury risk, vary your training runs, the running surface (parkland or hills), the pace and distance, and do not always use the same pair of shoes. Always run facing oncoming traffic and be visible – at night wear bright or reflective clothing.

Stress fractures commonly occur in endurance running and generally affect the shin bones, but may also affect the hip bone. Such fractures are more common in women. If you are a runner and have noticed a gradual increase in hip or groin pain with running training, or during a race, you are advised to stop and seek medical attention. Early diagnosis and management will prevent a potentially more serious injury from occurring.   

Illness and training

If you have flu, a feverish cold or a tummy bug, do not train until you have fully recovered – then start gently and build up gradually. Do not attempt to catch up on lost mileage after illness or injury – this may cause further damage. If you have flu it can take as much as a month to recover. If you cannot run 15 miles comfortably one month before a marathon, you will not manage it in safety or enjoy it – please do not run if this is the case.

Drinking

Fluid lost in sweat must be replaced otherwise your body becomes dehydrated (short of water) and less efficient. Alcoholic drinks, tea and coffee are dehydrating. Take plenty of non-alcoholic drinks, especially when training in hot weather. Drink enough to keep your urine a pale straw colour. 

Drink plenty of liquids after training, especially long runs, and practise drinking during longer training runs. Try Lucozade Sport (which will be handed out during the 2019 Virgin Money London Marathon) in training to see if you like it. It tastes quite different after 20 miles, and drinking on the run needs practice. 

Drink plenty of fluids, but preferably no alcohol, in the two days leading up to a race. Do not drink excessively just before a race, during a race or gulp water after a race as you may develop hyponatraemia (see ‘Drinking Safely’, below).

Drinking on the day

Start every race well hydrated, and if you are not already bursting, drink half a pint (250ml) of water or sports drink in the half hour before the start. Do not be greedy and take extra bottles of drinking water to pour over yourself, as you may be depriving slower runners of much-needed drinks. If it is hot on the day of the 2019 Virgin Money London Marathon, additional water will be provided and showers will be set up on the course to help runners to cool down. 

Drinking safely

Drinking too little on the run can lead to problems, as you need to replace some of the fluid you lose as sweat. Drinking too much can be very dangerous and lead to hyponatraemia (water intoxication), fits and even death.

Drink when you feel the need and do not gulp large volumes of fluids before, during or after the race. Your needs vary with your build, your speed and above all the weather.

Faster runners (under 3:30 for a marathon) on a warm day may need as much as a litre of fluid per hour (two pints). Slower runners should need to drink less, particularly on a cool day, and should not drink more than 500ml of fluid per hour.

At the Virgin Money London Marathon there will be frequent Buxton Natural Mineral Water stations so you do not need to drink at every one – just swallow a mouthful of water occasionally. If you’ve trained successfully with Lucozade Sport, have that as well.

After the Finish do not drink large amounts of water. It can be quite normal to not pass urine for several hours after a marathon. You can only rehydrate (replace lost fluids) gradually over the next 24 to 48 hours. Try to eat some salty food as well as spacing out your drinks. This way you will not get hyponatraemia and will still replace the water, salt and glycogen lost during the marathon.

Eating

Large doses of supplementary vitamins and minerals (such as iron) are not essential and produce no benefit if you are on a healthy, balanced diet, but additional vitamin C in small doses is reasonable when fresh fruit and vegetables are in short supply. 

Training (with adequate rest) helps you to sustain a high level of muscle glycogen as long as you eat enough carbohydrate. If you can, eat within two hours of your long runs. This helps to rapidly replace the muscle glycogen and speeds recovery. 

Do not change your normal diet drastically in the last week before a marathon, but eat less protein (meat) and eat more carbohydrate (pasta, bread, potatoes, cereals, rice and sweet things), especially for the last three days when you should also be markedly reducing your training (tapering). 

This loads the muscles with glycogen and delays or prevents you ‘hitting the wall’. Unless you reduce your protein intake, you will not eat enough carbohydrate. (Not all runners are helped by first depleting carbohydrate with a long run and low-carb diet and then loading, as this can make your muscles feel very heavy.) 

Feeling unwell?

Do not run if you feel unwell or have just been unwell, even if you are raising money for charity. Most medical emergencies occur in people who have been unwell but do not wish to miss the event. If you feel feverish, have been vomiting, have had severe diarrhoea or any chest pains, or otherwise feel unwell, it is unfair to you, your family and your charity to risk serious illness and become a medical emergency. You are unlikely to do yourself justice. There will be many other races.

On the day 

Wear appropriate clothes for the weather when you’re racing. On a cold, wet day you can become very cold if you reduce your running pace or walk. A hat and gloves will prevent heat loss and are easily carried. 

If it is hot, wear loose mesh clothing, start slowly and, if possible, run in the shade. Please don’t wear multiple layers and don’t try to attempt a personal best. Use shoes you know from experience will not give you blisters.

At the Finish

Once you have completed a race, do not stand about getting cold. Keep walking, especially if you feel dizzy, and drink to replace lost liquid. Get your kit and change into warm, dry clothing. Foil blankets will not stop you from becoming cold. Keep on drinking slowly and have something to eat. Some runners feel faint more than half an hour after finishing a race, often because they have taken insufficient fluid and/or not eaten anything. Again, do not drink excessively. 

None Professor Sanjay Sharma 

BSc (Hons), MD, FRCP (UK), FESC, is Professor of Cardiology at St George’s, University of London and the Medical Director of the Virgin Money London Marathon, The Vitality Big Half, the Vitality London 10,000 and Prudential RideLondon. Follow Professor Sharma on Twitter @SSharmacardio

Think Before You Drink

Adequate preparation for a marathon requires appropriate nutrition, hydration and rest. Athletes often consume isotonic, carbohydrate and protein drinks, as well as energy gels and bars purchased in sports and health-food shops in preparation for the event, which is considered safe practice.

However, over the last two decades there have been an increasing number of commercially available compounds that claim to enhance performance. Some have been found to contain substances banned in other countries and other products (such as steroids) that are banned for use among competitive athletes. Such products are usually purchased via the internet and should not be used by anybody training for a sports event like the Marathon.

Runners using performance-enhancing compounds that have not been licensed and regulated properly may experience serious side effects and increase their risk of developing heart disturbances that culminate in sudden death. There have been well-publicised cases of runners inadvertently using compounds in an attempt to help them fight fatigue during endurance events, and this caused detrimental effects on their health, resulting in their death. 

In one recent case, toxicology identified traces of DMAA, which is an amphetamine-like substance. Although banned in sport, the product was legally available at the time and advertised as a powerful performance enhancing agent, and the warnings associated with the potential harmful ingredients were not highlighted on the product. Runners should avoid consuming unregulated substances bought over the internet. Certain painkillers termed non-steroidal anti-inflammatory drugs (NSAIDS) such as brufen or naproxen can cause problems with the kidneys in states of dehydration, and should be avoided within 48 hours of running the marathon. Muscular pain during this period should be treated with paracetamol. 

The 2007 London Marathon was the second hottest in its 39-year history and was sadly noteworthy for the death of 22-year-old David Rogers from hyponatraemia. There were 12 other cases of hyponatraemia the year before, six of whom required emergency treatment in hospital. 

Again, it is likely that all of these runners drank more than necessary for the hot conditions, despite the official advice given by the London Marathon on safe drinking during the race. The 1996 London Marathon was run on a similarly hot day and, while there were complaints about the water running out, we had no significant cases of hyponatraemia. 

In 2003 there were plenty of drinks available for what was another warm marathon day but on this occasion we had 15 hospital cases of hyponatraemia. Many runners are drinking too much! The Virgin Money London Marathon has many Drinks Stations to ease congestion and allow access for the 41,000 expected runners, but supplies far more drinks than are needed. This ensures there is enough for everyone, including the slower runners at the back.  

You do NOT need to drink at every water or Drinks Station. THINK before you DRINK.